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Tracheal Stenosis

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  3. Tracheal Stenosis

Overview of Tracheal Stenosis

Tracheal stenosis is a constriction and narrowing of the airway that leads to shortness of breath and scar development in the trachea. It may be congenital and acquired.

Tracheal stenosis also known as (zarf nali ka suhkrna) is defined as the narrowing and constriction of the trachea windpipe. It may lead to shortness of breath. It is majorly developed due to the following reasons:

  • Injury to trachea after prolonged intubation
  • Opening of the trachea for operation
  • When the breathing tube is inserted into the trachea

Tracheal Stenosis Prevalence
Tracheal stenosis affects 4-13 % of adults and  1-8 % of neonates after prolonged intubation.

Signs and Symptoms of Tracheal Stenosis

The following are the most common symptoms which have been observed in tracheal stenosis patients.

  • Breath shortness
  • Lungs inflammation and pulmonary infections
  • Hard to breath
  • Stridor (high pitch audible sound)
  • Fatigue
  • Wheezing 
  • Cough
  • Cyanosis (blue lips)
  • Breath shortness (dyspnea)

Types of Tracheal Stenosis

There are two types of tracheal stenosis based on its condition:

  • Acquired Tracheal Stenosis: It develops later in life. This is caused by an injury or serious illness after birth such as prolonged endotracheal tubes after surgery (tracheostomy).
  • Congenital Tracheal Stenosis: It is a birth defect present since birth. This type may be associated with other genetic syndrome or narrowing of airways because of cartilage malformation.

Causes of Tracheal Stenosis

Normally there are a few significant causes that lead to tracheal stenosis.

  • Placement of the endotracheal tube for a longer time
  • Inflammatory bowel disease
  • Collagen vascular disease
  • Tracheal infections
  • Burns
  • Cancer
  • Autoimmune disease Sarcoidosis
  • Ulcerations (elevates inflammation of tissue with scarring)
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Risk Factors of Tracheal Stenosis

Following are risk factors that can increase tracheal stenosis.

  • Being overweight
  • Hypertension
  • Heart disease
  • Smoking
  • Diabetes
  • Granulomatosis

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Prevention

Certain preventive measures that are important to control tracheal stenosis and breathing issues are as follows:

  • Pursed lip breathing is for deep and effective breathing and pursed lips as do for the whistle.
  • Slowly breathe through your nose.
  • The use of endotracheal tubes with low-pressure cuffs is carefully inserted to the trachea to avoid unnecessary trauma or any other complications.
  • Sitting in the forward direction to facilitate breathing.
  • Usage of support at your back at standing position.
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Diagnosis

There are following lab tests that a Pulmonologist usually recommends for the diagnosis of tracheal stenosis.

  • X-ray examines the neck and chest blockage.
  • Computerized Tomography (CT) Scan is conducted for a chest examination.
  • Ultrasound to check the air spaces in the trachea.
  • Magnetic Resonance Imaging (MRI) is an alternative test for chest examination but it takes more time.
  • Pulmonary Function Testing is used to measure the effect of stenosis on the breathing rate.
  • Laryngoscopy for larynx (voice box) examination.
  • Arterial Blood Gases Test for measurement of oxygen.
  • Sputum Culture is also performed to check any infection in the lungs.
  • Biopsy is used to diagnose tracheal malignancy or tumour

Treatment of Tracheal Stenosis | When to Consult a Doctor

Common surgical options apply for removal of tracheal stenosis on the basis of its duration whether it is long term or short term.

  • Tracheal Resection and Reconstruction:
    In tracheal resection, the surgeon removes the constricted section of the trachea and rejoins the ends again. This surgery is very successful and gives better results for a longer time.
  • Tracheal Laser Surgery:
    In some cases, doctors suggest laser surgery for the removal of scar tissues that mainly cause tracheal stenosis. Tracheal laser surgery gives temporary results so it is not an effective treatment. Even sometimes surgery may worsen the patient's condition. Because of these reasons, a doctor will consider underlying complications before laser surgery.
  • Tracheal Dilation:
    For temporary relief, tracheal constriction can be treated by using a tracheal dilator or insertion of a balloon in the trachea that widens the trachea. It helps to determine the magnitude of stenosis affecting the trachea. In this way, a doctor can also diagnose an underlying cause of stenosis
  • Tracheobronchial Airway Stenting:

          To facilitate ventilation, it's compulsory to keep airways open by using the tracheal stent. The stent is made of metal which is placed in the stenosis trachea This type of treatment persists for long term as well as a short term basis, depending on the condition of patients.

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