The trachea, commonly called the windpipe, is the airway between the voice box and the lungs. When this airway narrows or constricts, the condition is known as tracheal stenosis, which restricts the ability to breathe normally.
There are two forms of this condition:
- Acquired - caused by an injury or illness after birth
- Congenital - present since birth
Most cases of tracheal stenosis develop as a result of prolonged breathing assistance known as intubation or from a surgical tracheostomy.
The symptoms of tracheal stenosis are similar to those of other conditions so it is important to see physician, particularly if the patient has experienced an injury to the throat. In addition to a feeling of fatigue or a general feeling being unwell (malaise), the symptoms of tracheal stenosis typically are:
- Wheezing, coughing or shortness of breath, including difficulty breathing
- A high-pitched squeal coming from your lungs when inhaling
- Frequent bouts of pneumonia or upper respiratory infections
- Asthma that doesn’t respond well to treatment
- Chest congestion
- Pauses in breathing (apnea)
- A blue color in the skin or mucous membrane of the mouth or nose
Causes and Risk Factors
Though rare, tracheal stenosis may be present at birth. More commonly, the condition is the result of an injury or illness, such as
- An external injury to the throat or chest
- Infections of a viral or bacterial nature, including tuberculosis
- An autoimmune disorder such as sarcoidosis, papillomatosis, Granulomatosis with polyangiitis and amyloidosis
- Tumors, benign or malignant, which may press against the trachea, thereby restricting air flow
- Occasionally, tracheal stenosis may develop after radiation therapy to the neck or chest
Tracheal stenosis typically is suspected in individuals with risk factors presenting with signs and symptoms of airway stenosis (see below). The condition may be further suspected based on spirometry with a flow-volume loop and computed tomography imaging of the neck and chest but fiberoptic bronchoscopy is generally required to confirm the presence and severity of tracheal stenosis.
There are several treatment options that can be used for tracheal stenosis and the type of treatment used will depend on the cause, location and severity of the tracheal narrowing. The surgeons at the Women's Guild Lung Institute use minimally invasive techniques whenever possible, although even those procedures require general anesthesia and a hospital stay. Some treatment options can provide immediate relief but are considered temporary solutions, while others can provide a better long-term solution.
Short-term treatment options for the condition include laser surgery and widening the trachea. Laser surgery can remove scar tissue that is causing tracheal stenosis. This treatment option can provide short-term relief but usually isn’t considered a permanent solution. For some patients, laser surgery can make the condition worse, so it is important for patients to see a knowledgeable specialist when being evaluated for treatment.
For some patients, the trachea may be widened using a small balloon or dilator to expand the airway. This also may not be a long-term solution.
Treatment options that are generally considered to work long term include stenting and tracheal reconstruction. Stenting includes inserting a small tube of metal or high-density polyethylene or polypropylene mesh into the trachea. This tube then keeps the airway open and allows the patient to breathe more easily.
Reconstruction of the trachea is an option when only a small portion of the trachea is involved. During the procedure, the surgeon removes the damaged portion and joins the remaining ends together.