Tracheal Stenosis
The trachea (windpipe) is the airway that leads from the larynx (voice box) to the bronchi, which are airways that lead to the lungs. Tracheal stenosis is a narrowing or constriction of the trachea.
Most cases of tracheal stenosis develop when the trachea is injured after prolonged intubation — when a breathing tube is inserted into the trachea to help maintain breathing during a medical procedure — or from a tracheostomy (surgical opening of the trachea).
Tracheal stenosis can also develop from a number of other causes, including:
- External injury to the throat
- Benign or malignant tumor pressing on the windpipe
- Certain autoimmune disorders, such as polychondritis, sarcoidosis, papillomatosis, amyloidosis, or Wegener's granulomatosis
- Infections (bacterial and fungal infections as well as tuberculosis).
Tracheal stenosis can also develop as a side effect of radiation therapy when administered to treat a tumor in the head or neck.
Symptoms
Tracheal stenosis can develop slowly. Early signs and symptoms may be mistaken for a variety of other disorders and may delay treatment.
Symptoms include:
- Coughing
- Cyanosis, a bluish color in the skin or the mucous membranes in the mouth or nose
- Difficult or labored breathing
- Difficult-to-treat asthma diagnosed in an adult
- Fatigue and general feeling of discomfort (malaise)
- Frequent inflammation of the lungs (pneumonitis) or recurrent respiratory infections
- Shortness of breath
- Stridor, a high-pitched musical sound that can be heard as the breath is drawn in and is caused by a blockage in the throat or voice box (larynx)
- Wheezing
If you exhibit any of the symptoms listed above, a number of tests may be used to diagnose tracheal stenosis, including:
- X-ray of the chest and windpipe
- CT scan of the neck and chest
- Laryngoscopy — an endoscopic examination of the larynx (voice box)
- Bronchoscopy — an endoscopic examination of the trachea and bronchi biopsy
Types of tracheal stenosis, by cause
There are several different types of tracheal stenosis. These can be divided into stenoses conditions that are present from birth (congenital), and acquired conditions, which have developed later in life.
Tracheal stenosis may occur as a result of:
- Treatments such as endotracheal intubation, tracheostomy, radiotherapy, or past surgery
- Congenital conditions
- External injury
- Cancer
- Autoimmune conditions such as sarcoidosis, polychodritis, or Wegener’s granulomatosis
Treatment
Tracheal stenosis can sometimes develop as a result of an underlying medical condition. In those situations, doctors will focus on the other issue before treating the stenosis. Surgery is an option for treating tracheal stenosis, depending on the exact location and extent of the stenosis.
Surgery
Common surgical options for tracheal stenosis include:
- Tracheal resection and reconstruction. During a tracheal resection, your surgeon removes the constricted section of your windpipe and rejoins the ends. This is usually a very successful treatment, with excellent long-term results.
- Tracheal laser surgery. In some cases, doctors can use lasers to remove the scar tissue that is causing the stenosis. Laser surgery offers good short-term effects and provides temporary relief, but it usually isn’t a long-term solution. In some situations, laser surgery can actually worsen the stenosis. For those reasons, your doctor will consider the underlying disorder before using laser surgery to treat tracheal stenosis.
- Tracheal dilation. Widening of the trachea — either with a balloon or tracheal dilators — provides temporary symptom relief and allows doctors to determine how much of the trachea the stenosis affects. During the surgery, doctors can also diagnose the cause of the stenosis if it is unknown.
- Tracheobronchial airway stent. A tracheal stent is a metal, silicone, or hybrid tube placed at the site of the stenosis to help keep the airway open. Stents are used as both short- and long-term treatments for stenosis.