Tracheal and Subglottic Stenosis

Overview and Facts about Tracheal and Subglottic Stenosis

Tracheal stenosis and subglottic stenosis refers to a narrowing of the trachea (windpipe) that can obstruct breathing.

It often occurs when a patient has been intubated for a long time, a process that involves the insertion of a breathing tube into the trachea to help the patient breathe during surgery.

Tracheal stenosis is typically treated by a physician who specializes in otolaryngology, or medical issues involving the ear, nose, and throat (ENT).

Symptoms and Signs of Tracheal and Subglottic Stenosis

Patients with tracheal and subglottic stenosis may not always experience symptoms. However, signs and symptoms of tracheal stenosis may include:

• Wheezing or difficulty breathing
• Hoarseness or coughing
• A bluish tint to the skin
• Coughing up blood
• Shortness of breath
• High-pitched or noisy breathing
• Frequent respiratory infections

Tests and Diagnosis of Tracheal and Subglottic Stenosis

Tests and diagnosis for tracheal stenosis typically involve the following:

• X-ray of the trachea and chest
• CT scan of the chest and neck
• Laryngoscopy
• Bronchoscopy

Causes and Risk Factors of Tracheal and Subglottic Stenosis

Typically, tracheal stenosis is caused by scarring and inflammation of the tracheal lining following intubation. However, it may also be due to:

• Autoimmune disorders, such as granulomatosis with polyangiitis (GPA, or pulmonary sarcoidosis
• Radiation therapy or thermal burns
• Trauma to the throat or chest
• An infection, such as tuberculosis
• Tumors in or around the trachea

Treatment and Care for Tracheal and Subglottic Stenosis

Treatment of tracheal and subglottic stenosis will depend on the cause, severity, and length of the condition. Treatment options may include:

• Tracheal resection and reconstruction: During this procedure, a surgeon will remove the section of the trachea that has become constricted and join the upper and lower sections. This type of treatment has an excellent prognosis. 
• Tracheobronchial airway stents: In this procedure, a silicon or metal tube is placed inside the trachea to keep it open. An airway stent is a successful long- or short-term treatment for tracheal stenosis. 
• Endoscopic laser microsurgery with balloon dilation: A surgeon will use a laser to remove the scar tissue that’s causing the stenosis.  The airway is then further widened with tracheal dilators or balloons. In addition, steroids, which have been shown to slow down the recurrence of the stenosis, are injected into the scar tissue. Serial injections of the scar tissue may be recommended to be performed in the office or back in the operating room to permanently halt the recurrence of the scar tissue.