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Airway Stenosis

What Is Airway Stenosis (Laryngotracheal Stenosis)?

Laryngotracheal stenosis, or airway stenosis, is the narrowing of the trachea, often called the windpipe, which connects the nose and mouth to the lungs. This narrowing results in difficulty breathing and can also make cold symptoms worse and impact the voice and the ability to swallow.

Many things can cause the trachea to narrow. Some common causes include:

  • Abnormalities present at birth
  • Autoimmune diseases, such as Wegener’s granulomatosis
  • Benign or malignant tumors
  • Caustic ingestion — either accidentally or intentionally swallowing caustic or corrosive substances, such as laundry detergent
  • External injury to the throat
  • Gastroesophageal (acid) reflux
  • Infections, such as croup, or inflammatory growths
  • Prolonged endotracheal intubation from a breathing tube placed into the throat via the mouth or nose
  • Scar tissue
  • Throat surgery
  • Tracheostomy, a medical procedure that opens a hole in the trachea

The most common cause of airway stenosis is when scar tissue forms in the trachea due to a lengthy (more than 10 days) endotracheal intubation.

Symptoms

Common symptoms of airway stenosis include:

  • Breathing issues — Coughing, wheezing, shortness of breath and stridor (noisy, high-pitched breathing) are common symptoms.
  • Feeding issues — The narrowed trachea often causes people to have difficulty eating or swallowing.
  • Pneumonia — Airway stenosis is likely to allow for recurrent bouts of pneumonia.

Treatment Options

Treatment of airway stenosis depends on the severity and location of the narrowing of the trachea. Diagnosis is made by physical examination and a variety of tests, which could include biopsies, blood work, ultrasound, X-rays, computed tomography scans and MRI (magnetic resonance imaging).

Common treatments include:

  • Dilation — Minimally invasive insertion (usually performed under general anesthesia) of a surgical balloon or tracheal dilators can be performed to temporarily expand the trachea to allow improved airflow. Because this is a temporary solution, it may be performed more than once or in conjunction with another treatment.
  • Lasers — Lasers are used to destroy growths narrowing or obstructing the trachea. Laser treatment is considered sufficient for short-term relief but isn’t a recommended long-term solution. In certain circumstances ― if there is an underlying disorder, for example ― using lasers may actually worsen the narrowing.
  • Medication — Sometimes medications, such as antibiotics or steroids, may be used to slow or reverse inflammatory processes that cause the narrowing.
  • Stents — A metal or silicone tube (a stent) is put in the trachea to keep it open for long- or short-term treatment of the narrowing.
  • Surgery — In severe cases, surgery is performed to remove the damaged part of the trachea. The remaining sections are either rejoined during a resection procedure or reconstructed. Resection and reconstruction surgeries usually have good long-term outcomes for patients.

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