Tracheal Stenosis

What is tracheal stenosis?

Tracheal stenosis involves narrowing of your trachea (windpipe) that makes it harder to breathe. Your trachea is a tube made of cartilage and soft tissue. Air travels through your trachea on the way from your nose and mouth to your lungs. When you have tracheal stenosis, inflammation, injury or scar tissue in your trachea makes it harder for air to flow through.

“Stenosis” is the medical term for atypical narrowing in a body passage. It can develop in different parts of your throat. For example, a related condition called laryngotracheal stenosis involves narrowing in both your trachea and larynx (voice box). Subglottic stenosis is narrowing in the area above your trachea and below your vocal cords.

Regardless of the part of your throat that’s affected, you should contact a healthcare provider if you’re having difficulty breathing.

Types

There are two types of tracheal stenosis:

• Acquired tracheal stenosis is acquired (developed) during your lifetime because of an injury or illness. The most common type, it affects both adults and children.
• Congenital tracheal stenosis (CTS) is present at birth. A rare and potentially fatal condition, it affects 1 out of every 64,500 babies. Most are diagnosed at birth or within the first few months of being born.

Tracheal stenosis is life-threatening in infants. Seek emergency care if your newborn is showing signs of tracheal stenosis, like struggling for air.

That said, both forms of tracheal stenosis make it harder to breathe, which can affect your quality of life. That’s why seeing a healthcare provider is so important if you or your child has this condition.

What are the symptoms of tracheal stenosis?

Many tracheal stenosis symptoms are the same for children and adults. Common symptoms include:

• Difficulty breathing after everyday activities like climbing stairs or walking
• Stridor (sounds like a wheeze or whistle when you breathe both in and out)
• Persistent cough
• Difficulty coughing up phlegm
• Frequent colds, bouts of pneumonia or other respiratory infections
• Persistent asthma that isn’t better after treatment
• Chest congestion
• Gaps in breathing (apnea) and sleep apnea

Children are more likely to have additional symptoms:

• Infants might have difficulty breastfeeding (chestfeeding) or bottle feeding. They might also seem unusually tired after feeding.
• Older children might choke or have difficulty breathing while they eat.
• Older children’s skin around their noses and their gums might appear blue (cyanosis).

What causes tracheal stenosis?

With congenital tracheal stenosis (CTS), the cartilage that makes up an infant’s trachea doesn’t form correctly, causing their windpipe to be too narrow.

Long-term intubation is the most common cause of acquired tracheal stenosis. Intubation is a lifesaving treatment that involves inserting a tube into your trachea so you can breathe. Sometimes, intubation causes damage that leads to stenosis. Children may develop tracheal stenosis if they were born with premature lungs and their provider used breathing tubes to help them get air.

You might also develop tracheal stenosis if you:

• Have an autoimmune disorder, like granulomatosis with polyangiitis (GPA)
• Have an inflammatory condition, like pulmonary sarcoidosis
• Have an infectious disease, like tuberculosis, or other bacterial and viral infections that affect your respiratory system
• Have a benign or malignant tumor pressing on your trachea
• Inhaled a substance that damaged your trachea, including chemicals or poisonous gases
• Had radiation therapy directed toward your neck or chest
• Had a tracheostomy (emergency surgery that creates a hole in your trachea so that you can breathe)

How is tracheal stenosis diagnosed?

Otolaryngologists (ENTs) use several tests to diagnose tracheal stenosis and decide how to treat it. Tests may include:

• Endoscopic procedures. Bronchoscopy is the primary procedure for diagnosing tracheal stenosis. Your healthcare provider may also perform a laryngoscopy.
• Imaging procedures. A computed tomography (CT) scan of your chest and neck is the most common imaging procedure that shows tracheal stenosis. Sometimes, healthcare providers recommend magnetic resonance imaging (MRI) to help plan treatment.
• Pulmonary function test. Providers will ask you to complete several breathing tests. This helps them check things like how your trachea size and lung function affect your breathing.

You may need other tests to check for what’s causing your condition. Tests may include a blood test to check for inflammation or infection or a biopsy to see if unusual growths in your airway are cancerous.

How is tracheal stenosis treated?

Surgeries and procedures that widen your trachea are the most common treatments for tracheal stenosis. Treatment options include:

• Tracheal dilation. Healthcare providers place a balloon or tracheal dilator in your trachea. The balloon or dilator stretches your trachea so that you can breathe.
• Laser bronchoscopy. Providers direct a laser beam at scar tissue in your trachea. The laser burns away the tissue, opening up your airways.
• Trachea airway stent. A provider places a small, plastic or metal tube called a stent that holds your trachea open. (Stenting may or may not be an option, depending on the location of the stenosis.)
• Tracheal resection and reconstruction. A provider cuts away (resects) the tissue that’s causing the narrowing. Then, they join the two remaining ends of your trachea together. This procedure reconstructs your trachea to create an unobstructed airway.

The best treatment for tracheal stenosis depends on lots of things, including where the narrowing is and how severe it is. Your provider will explain how these factors inform which procedures will work best for you.

What can I expect if I have tracheal stenosis?

You’ll likely need surgery or a nonsurgical procedure if you have tracheal stenosis. Each treatment option has different recovery times and outcomes.

For example, tracheal resection and reconstruction surgeries are invasive. But they’re more likely to eliminate the narrowing in your trachea in the long term. Nonsurgical procedures, like tracheal dilation, are less invasive. They may be the only treatment you need, or you may repeat procedures.

Regardless of the procedure, your healthcare provider will monitor you to check for recurrence. Tracheal stenosis sometimes comes back because treatment can cause new scar tissue to form. Your provider will explain how likely it is that your condition will return.

How do I take care of myself?

You might start by asking your healthcare provider how your surgery will affect you. Every procedure to treat tracheal stenosis will require different at-home care. Your healthcare provider will have information about your next steps. They may advise you on:

• What you can eat. For the first 24 hours, you may need to stick with soft foods that are easy to swallow. It may be a good idea to limit yourself to bland foods that won’t upset your stomach.
• How you should sleep. For the first few days, you may need to keep your upper body elevated as you try to sleep.
• How to manage pain. Your provider can recommend over-the-counter (OTC) medications or prescribe pain medicines as needed.
• How active you should be. You may have activity restrictions for the first week or so following surgery.

When should I see my healthcare provider?

Your healthcare provider will schedule follow-up appointments to check on your recovery after treatment. At first, you may need to see your provider every few weeks or so. If you’re healing well, your provider may extend follow-up visits to every few months until they’re confident the stenosis won’t return.

Contact your provider anytime you’re experiencing shortness of breath. While next steps vary depending on your condition, it can be dangerous to put off getting help when you’re having difficulty breathing. It’s essential to seek care.

When should I go to the emergency room?

You should go to the emergency room if you can’t breathe or have other tracheal stenosis symptoms. The symptoms might be a sign your tracheal stenosis has come back.

If you’re caring for a newborn or infant who’s having difficulty breathing, get them to an emergency room immediately.

What questions should I ask my healthcare provider?

If you develop tracheal stenosis, you might want to ask your healthcare provider the following questions:

• Why did I develop tracheal stenosis?
• Will I need surgery?
• What are the typical side effects of surgery to treat tracheal stenosis?
• How likely is it that my tracheal stenosis will come back after surgery?
• How can I care for myself during recovery?