Tracheal Stenosis: Symptoms, Causes, Treatment

What are the symptoms of tracheal stenosis?

The symptoms of tracheal stenosis typically develop gradually as the airway narrows and can include:

• Shortness of breath (dyspnea): Difficulty breathing, especially during physical activity, which may worsen over time.
• Noisy breathing (stridor): A high-pitched, wheezing sound when breathing, often more noticeable when inhaling.
• Chronic cough: Persistent coughing that does not resolve with typical treatments.
• Hoarseness or voice changes: The voice may become raspy or weak.
• Difficulty breathing while lying flat (orthopnea): Some people may find it difficult to breathe comfortably while lying down.
• Frequent respiratory infections: Recurrent infections like bronchitis may occur due to the restricted airflow.
• Feeling of tightness in the throat or chest: A sensation of constriction can be present.

In severe cases, complete airway obstruction can occur, leading to a life-threatening emergency that requires immediate medical attention.

What are the causes of tracheal stenosis?

The causes of tracheal stenosis can be grouped into a few categories:

1. Prolonged intubation or tracheostomy: The most common cause is injury to the trachea from long-term use of a breathing tube or tracheostomy. Scar tissue can form and narrow the airway.
2. Trauma or injury: Direct trauma to the neck or chest, such as a car accident, can cause damage and lead to scarring or narrowing of the trachea.
3. Infections: Severe respiratory infections, particularly those involving the trachea, can lead to inflammation and scarring.
4. Autoimmune diseases: Conditions like granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) or sarcoidosis can cause inflammation and fibrosis in the trachea.
5. Tumors: Both benign and malignant growths in the trachea can obstruct the airway and cause stenosis.
6. Congenital defects: Some individuals are born with structural abnormalities in the trachea that can cause stenosis.
7. Radiation therapy: Radiation to the neck or chest can lead to scarring and narrowing of the trachea over time.

In many cases, tracheal stenosis is a result of a combination of these factors, especially in individuals with complex medical histories.

What is the treatment for tracheal stenosis?

The treatment for tracheal stenosis depends on the severity and underlying cause of the condition. Common approaches include:

1. Medications: Anti-inflammatory drugs, such as corticosteroids, may be used to reduce swelling and inflammation in the trachea. Antibiotics can be prescribed if an infection is contributing to the stenosis.
2. Tracheal Dilation: This procedure involves using a balloon or dilator to widen the narrowed area of the trachea. While this can provide temporary relief, the stenosis may recur, requiring repeated procedures.
3. Bronchoscopy with Laser or Stenting: A bronchoscope can be used to remove scar tissue with a laser, or a stent can be placed to keep the airway open. Stents are typically reserved for cases where other treatments are less effective.
4. Surgical Resection and Reconstruction: In more severe cases, a surgical approach may be necessary. The narrowed portion of the trachea is removed, and the remaining healthy sections are reconnected. This can offer a long-term solution.
5. Tracheostomy: In cases where immediate relief is needed or other treatments are not effective, a tracheostomy (an opening in the neck with a tube inserted into the trachea) may be performed to bypass the obstruction.

The choice of treatment depends on factors such as the length and location of the stenosis, the patient’s overall health, and the cause of the condition. A multidisciplinary team involving an ENT specialist, thoracic surgeon, and pulmonologist typically manages tracheal stenosis.