Adult Airway Disorders

Idiopathic Subglottic Stenosis

Idiopathic means “unknown cause” and subglottic refers to the part of the airway that is immediately below the vocal cords. Stenosis refers to circumferential narrowing, usually due to scar tissue. Idiopathic subglottic stenosis has become one of the most common indications for tracheal resections and reconstruction. This condition, which is uncommon, affects women more than men. Symptoms include noisy breathing (stridor), recurring croup, hoarseness and/or inability to breathe without a tracheostomy tube.

Tracheal Stenosis

Tracheal Stenosis is a condition where the windpipe (trachea) narrows or becomes constricted (stenosis). When you breathe in through your nose or mouth, air travels down your throat (pharynx) and through the voice box (larynx). Air then travels through the largest airway, the windpipe. The windpipe has springy hoops of a tissue called cartilage in it, which keeps it open while you breathe. The windpipe branches into two smaller airways called the bronchi, which lead to the two lungs.

The entrance to the voice box (larynx) is covered by a small flap of tissue called the epiglottis, which automatically closes when we swallow to stop food or drink from entering the airways. In the voice box, there are two vocal cords (or vocal folds), with a space between them, which is called the glottis. If you have a sub-glottal stenosis, this means that the narrowing in your windpipe is below the glottis, so it is below your vocal cords. Supra-glottic means above the glottis, so if you have a supraglottic stenosis, it is higher up, above the larynx.

There are several different types of tracheal stenosis. These can be divided in to stenoses conditions that are present from birth (congenital), and acquired conditions, which have developed later in life. Causes include: conditions resulting from treatments such as: Endotracheal intubation, Tracheostomy, Radiotherapy or past surgery; external injury; cancer; and/or autoimmune conditions such as: Polychodritis, Sarcoidosis or Wegener’s granulomatosis.

It is important to note that some patients with a tracheal stenosis do not exhibit any symptoms while others may have one or more of the following symptoms: shortness of breath, coughing, wheezing, difficult or labored breathing (dyspnoea), a breathing noise that is louder and harsher than a wheeze in someone with a windpipe or voice box obstruction, a bluish color in the skin or mucous membranes such as in the mouth or nose and/or frequent lung inflammation.

Diagnostic Testing and Treatment for Adult Airway Disorders

Laboratory Testing

During the initial evaluation and work-up the patient will have a series of blood work completed. Through the blood work, it may help determine the underlying cause for the patient’s airway disorder. The following is the required blood work for the new airway patient: Canca, Panca, Sedimentation rate (Sed Rate), complete blood count (CBC), urinalysis, Thyroid Stimulating Hormone (TSH), Chemistry panel, Rheumatoid factor, antinuclear antibodies (ANA), Hemoglobin A1C.

Voice Evaluation

Many airway disorders can affect one’s ability to speak properly. Prior to any formal airway reconstructive procedure the patient will be seen by one of our staff Speech Pathologists who will perform a voice evaluation. This evaluation will fully evaluate the patient’s speech and swallowing mechanism.

Gastroenterology

The majority of patients who present with airway disorders either have been diagnosed with gastric reflux disease (GERD) or have symptoms of GERD. It is well documented the airway symptoms are worse in those patients with GERD.

During the initial airway evaluation, those patients with GERD or suspected GERD will be sent to a gastroenterologist for evaluation and treatment. The patient will undergo an endoscopy with pH or impedance probe monitoring.

Bariatrics

On occasion if it is felt by the surgeon the patient is at a high risk for complications undergoing an airway reconstructive procedure due to the patient’s obesity, they may be referred to a weight loss management program. This may include both surgical and non-surgical management for weight loss.

Microlaryngoscopy, Bronchoscopy (MLB)

To fully evaluate and to plan for a formal airway reconstructive procedure the patient will have an MLB. The patient is brought to the operating room and put to sleep. During this procedure the entire voice box and airway is evaluated including taking measurements and sizing the airway. This procedure normally will take less than half an hour.

Serial balloon dilations, Cricotracheal/Tracheal resections (CTR) (TR)

Upon completing a diagnostic evaluation and MLB, a treatment plan is developed. Treatment plans range from simple serial balloon dilations to Cricotracheal/Tracheal resections (CTR) (TR).

Typically, patients with Idiopathic Subglottic Stenosis will first undergo repeated balloon dilations to provide temporary relief for their breathing difficulty. However, over time, more frequent dilations are necessary to relieve symptoms. Ultimately, a CTR or TR is often performed to fully remove the diseased portion of the trachea. Once a CTR or TR is performed, the trachea usually returns to normal.

For patients with a Tracheal Stenosis resulting from trauma or a tracheotomy, which can narrow the trachea as it heals, a TR is often needed to correct airway deformities.

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