Tracheal stenosis

Tracheal stenosis is a medical condition in which the windpipe (trachea) narrows, eventually causing respiratory disease.¹ This narrowing of the windpipe is caused by various factors including:

Risk factors

1. Trauma: Injuries in the neck area or chest region can be one of the reasons for tracheal stenosis²
2. Infection: Certain infections, such as pneumonia and tuberculosis, can be the reasons for tracheal stenosis³
3. Tumors: Tumors in the tracheal region or its surrounding areas of trachea can cause narrowing of the trachea⁴
4. Post intubation: Prolonged intubation can lead to inflammation in trachea, which can lead to tracheal stenosis⁵
5. Inflammatory disorders: In disease like recurrent polychondritis (an autoimmune disorder that usually leads to damage and inflammation in the cartilage and other connective tissues of the body) can cause tracheal stenosis⁶

Pathophysiology 

The pathophysiological changes that can lead to tracheal stenosis are mainly 3 changes which are inflammation, fibrosis, and scarring.⁷ We will discuss each change in detail.

1. Inflammation: It is a condition which is usually caused by the inflammation of the tracheal mucosa which can usually lead to narrowing of the tracheal region
2. Fibrosis: Excessive formation of fibrous tissue in the tracheal region can also lead to narrowing, ultimately leading to tracheal stenosis
3. Scarring: Scarring of the tracheal mucosa tissue, which can lead to narrowing of trachea and formation of tracheal stenosis

Different factors which can contribute to the development of tracheal stenosis, but some are more crucial than others. However, it should be kept in mind that less critical factors may still play a role in development.

Clinical presentation 

The clinical picture of tracheal stenosis can be different from one other; it usually depends on the intensity of stenosis.⁸ Common symptoms of tracheal stenosis are as follows:

• Coughing: A recurrent and persistent cough, especially worse at night
• Wheezing: A high pitched whistling sound which comes usually during exhalation, representing the narrowing of the airway
• Stridor: Whenever there is some kind of obstruction/narrowing of the airway then a high pitched sound is produced during breathing
• Dyspnea: Shortness of breath occurs whenever there is little exertion or especially at night

Other factors are also present, but these 4 are main symptoms of tracheal stenosis.

Diagnostic evidence 

Diagnosis of the tracheal stenosis can be conducted by these methods:⁹

• Imaging studies

To evaluate the trachea and identifying its location, CT and MRI scans are used to identify the tracheal stenosis

• Pulmonary Function Test (PFT): Spirometry and flow volume loops to assess lung function and detect obstruction of airway
• Endoscopy: A flexible tube with a camera to visualise the trachea and tracheal stenosis
• Biopsy: A tissue sample of trachea is taken to rule out the conditions

Treatments

Treatment options for tracheal stenosis depend on the severity of the stenosis and other factors. There are medication options, interventional procedures and surgical procedures.¹⁰ The treatment options are selected based on the severity of tracheal stenosis.

Medications

Antibiotics

Antibiotics are used to treat infection of the trachea and stop the spread of the infection in it.

Bronchodilators

They are used to relax the muscle of the airway route and help improve breathing.

Corticosteroids

These help reduce infection, inflammation and swelling associated with tracheal stenosis.

Interventional procedures 

Dilation 

In this procedure, the tracheal tube is widened by the use of a balloon or stent and the narrowing of passage is reduced. 

Stenting

A stent is used to keep the trachea open. This helps in broadening of trachea and enables normal breathing in patients.

Surgical options

Resection

In this surgical procedure, the narrowed part of the trachea is removed and it usually helps to eliminate the diseased part / damaged part and helps to preserve the healthy part as much as possible. There are different types of resection such as partial resection, total resection, segmental resection and wedge resection. The surgeon decides the type based on the disease involvement and helps in recovery of the patient.

Tracheoplasty 

In this surgical procedure, there is repair or reconstruction of the windpipe due to stenosis. It is usually used to improve breathing and eliminate symptoms as much as possible.

Complications

There are many complications can be seen in tracheal stenosis, which are as follows:

• Respiratory failure: In severe cases of stenosis, there are chances of respiratory failure which ultimately requires mechanical ventilation
• Cardiac arrest: In severe cases of tracheal stenosis, it can lead to cardiac arrest due to lack of oxygen supply in the lungs and blood
• Pneumonia: Tracheal stenosis also increases the risk of pneumonia due to impaired clearance of secretions
• Chronic Obstructive Pulmonary Disease (COPD): If proper treatment is not provided in tracheal stenosis, it can lead to obstruction in the pulmonary region
• Lung abscesses: Tracheal stenosis also increases the risk of lung abscesses in which there is impaired drainage of secretions
• Tracheal rupture: Severe tracheal stenosis may also cause tracheal rupture.
• Aspiration pneumonia: Tracheal stenosis leads to an increased risk of aspiration pneumonia because of impaired swallowing
• Respiratory distress: Tracheal stenosis can often lead to respiratory distress, including dyspnea, wheezing and coughing too¹²

FAQs

What is tracheal stenosis?

Tracheal stenosis is a narrowing of the windpipe(trachea) that can lead to difficulties in breathing.

What are the symptoms of tracheal stenosis?

Wheezing, coughing, shortness of breath and involuntary inability to speak are main symptoms of the tracheal stenosis.

What causes tracheal stenosis?

There are various causes but it mostly include injury, infection, tumors, and congenital conditions.

How is the diagnosis of tracheal stenosis done?

There are various diagnostic methods, which are through imaging tests (e.g., CT scans, X-rays), bronchoscopy, and endoscopy.

What are the treatment options for tracheal stenosis?

Treatment options such as medication, interventional procedures and surgical procedures are available, which help in dilatation of the trachea. Stenting, surgery, and laser therapy also help in treating the stenosis.

Tracheal stenosis?

In some cases, tracheal stenosis can be cured; it always depends on the severity and the treatment undertaken. However, in some conditions, management should be carried out for a lifetime.

What are the complications of untreated tracheal stenosis?

There are many complications such as respiratory failure, cardiac arrest and in some cases there is even death.

Can tracheal stenosis be prevented?

In some cases of the tracheal stenosis it can be prevented by avoiding injury to the trachea and managing underlying medical conditions.

What is the prognosis for tracheal stenosis?

The prognosis of tracheal stenosis largely depends on the severity of the condition. When appropriate treatment is taken by the patient, he may experience improvement in symptoms and may have improved quality of life.

Summary

Tracheal stenosis is a condition in which there is narrowing of the trachea, leading to respiratory disease. The risk factors are trauma, inflammatory disorders, post-intubation, tumor etc. It’s clinically presented as coughing, wheezing, dyspnea and stridor. The diagnosis can be done by CT, X-Ray and MRI. The treatment options are medications, interventional procedure and surgical options. It can also lead to complications like asthma, lung abscess, cardiac arrest, respiratory failure, etc. It can often be differentiated from diseases like asthma, COPD, bronchitis, tracheomalacia, and recurrent polychondritis. Proper care and treatment should be taken in cases of tracheal stenosis.