Airway narrowing or stenosis represents a serious problem for many individuals. Narrowing may occur anywhere along the airway (from the throat to the trachea and lungs). Such narrowing results in difficulty breathing as the person has difficulty getting adequate amounts of air to the lungs. People with this condition may produce noise while breathing. Typically, narrowing in the voice box or above results in noise during inspiration, while narrowing in the lower trachea or the lungs results in noise during expiration.
Airway stenosis can have many causes and oftentimes depends on the location. Stenosis of the voice box may be due to bilateral vocal cord paralysis (which results in an inability of the vocal cords to open while breathing), scarring due to surgery or intubation; conditions such as sarcoidosis or amyloidosis (which cause blockage of the air passages through benign growths), or cancer. Stenosis of the trachea is most commonly caused by prolonged or traumatic intubation or as a complication of long-term tracheostomy. Other causes may include LPR, Wegener’s granulomatosis, or cancer.
Diagnosis of stenosis is typically made by endoscopy. Stenosis of the larynx is diagnosed with flexible fiberoptic laryngoscopy. Tracheal stenosis may require tracheoscopy to diagnose. Alternatively, a CT scan may be useful in diagnosing or mapping a tracheal stenosis.
Treatment may take many forms, depending upon location. Typically, endoscopic techniques are utilized to incise and dilate the stenosis. Several endoscopic treatments may be necessary to obtain optimal results. If endoscopic techniques fail, temporary stent placement may be necessary to maintain an airway. If endoscopic techniques and stent placement both fail or if the stenosis is severe, an open approach may be necessary. This open approach my include widening the airway by placement of a graft or resection (removal) of the stenotic area. An alternative to surgical correction of a stenosis is to bypass the stenosis by performing a tracheostomy. A tracheostomy, if below the stenotic area, will allow the passage of air through the neck into the lungs. The potential risks and benefits of the various techniques depend upon the individual person and should be discussed on a case-by-case basis.
