Tracheal stenosis

Overview

The trachea (windpipe) is the airway between the larynx (voice box) and the lungs. Tracheal stenosis is the narrowing or constriction of the trachea, interfering with normal breathing. This chronic inflammation can have different causes, but the most common are prolonged intubation (use of a breathing tube) or tracheostomy. There are two forms of tracheal stenosis:

  • Congenital — present since birth
  • Acquired — caused by an injury or illness

Causes

Congenital tracheal stenosis is rare. More often it is caused by injury or illness, such as:

  • An external injury to the throat or chest
  • Viral or bacterial Infections, including tuberculosis
  • An autoimmune disorder (such as sarcoidosis, papillomatosis, Wegener's granulomatosis and amyloidosis)
  • Benign or malignant tumors pressing against the trachea and restricting air flow
  • Radiation therapy to the neck or chest

Diagnosis

The following tests may be used to diagnose tracheal stenosis:

  • Spirometry
  • Computed tomography (CT) imaging of the neck and chest
  • Fiberoptic bronchoscopy

Symptoms

The symptoms of tracheal stenosis are similar to those of other conditions, so it is important to see a physician, especially if you have had an injury to the throat. Typical symptoms of tracheal stenosis are:

  • Fatigue or malaise (feeling generally unwell)
  • Wheezing, coughing, shortness of breath, difficulty in breathing
  • A high-pitched squeal from your lungs when inhaling
  • Frequent pneumonia or upper respiratory infections
  • Asthma that isn’t responding to treatment
  • Chest congestion
  • Pauses in breathing during sleep (apnea)
  • Cyanosis of the skin or mucous membrane of the mouth or nose

Treatment

A multidisciplinary approach (using specialists with different skill sets) is most important for a good outcome. There are several treatment options, depending on the cause, location and severity of the stenosis. Interventional endoscopic procedures, for example, can provide immediate relief but are temporary solutions. Other treatments may offer a better long-term outcome. For tracheal obstruction, surgery should be the first choice.  Minimally invasive techniques are preferable whenever possible, though they still require general anesthesia and a hospital stay. Advancements in technology and endoscopic techniques have made the surgery safer and more successful.

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