Tracheal Stenosis

Overview

The trachea, or windpipe, is the main airway that carries air between the throat and the lungs. Tracheal stenosis is a narrowing of this airway, which restricts the flow of air and makes breathing harder. The narrowing can be mild and barely noticeable, or severe enough to cause significant breathing difficulty.

Tracheal stenosis often develops after the airway has been irritated or injured, such as by a breathing tube during a hospital stay, an injury, or chronic inflammation. As scar tissue forms and contracts, it tightens the airway. Symptoms may be mistaken for asthma or other lung conditions at first. With proper diagnosis, many cases can be treated effectively to open the airway and relieve breathing problems.

A telling feature of tracheal stenosis is that, unlike asthma, the narrowing is fixed and does not come and go. People are sometimes treated for asthma for a while before the true cause is found, especially when wheezing does not improve with inhalers. Noisy breathing on inhaling, called stridor, and a history of a breathing tube or tracheostomy are important clues that point toward the windpipe rather than the lungs.

Symptoms

Symptoms reflect the reduced airflow and may worsen as the narrowing progresses or with exertion.

• Noisy breathing, often a high-pitched sound called stridor, especially when breathing in
• Shortness of breath, particularly with activity
• Wheezing that may be mistaken for asthma
• A persistent cough
• Difficulty clearing mucus, and repeated chest infections
• A feeling of tightness or difficulty getting enough air

Rapidly worsening breathing, severe stridor, blue-tinged lips, or struggling to breathe are signs of a critically narrowed airway and require emergency care.

Causes

Tracheal stenosis usually results from injury, scarring, or inflammation of the airway.

• Prolonged or repeated intubation: A breathing tube left in place for a long time, or a tracheostomy, can irritate and scar the windpipe. This is one of the most common causes.
• Injury: Trauma to the neck or chest, or inhalation of hot or caustic substances.
• Inflammatory and autoimmune conditions: Diseases that cause inflammation of the airway.
• Infections, tumors, or external compression: Growths or pressure from nearby structures.
• Idiopathic: In some cases no clear cause is found.

Risk Factors

• A history of being on a ventilator with a breathing tube, especially for a long time
• Having had a tracheostomy
• Neck or chest trauma
• Inhalation injuries from heat, smoke, or chemicals
• Certain autoimmune or inflammatory diseases
• Prior airway surgery or radiation to the area

Diagnosis

Diagnosis confirms the narrowing and measures its location, length, and severity.

• Bronchoscopy: A thin camera passed into the airway to directly view and measure the narrowing; this is the key test.
• CT scan of the neck and chest: Detailed images that show the location and extent of the stenosis.
• Pulmonary function tests: Breathing tests that can reveal a pattern suggesting airway narrowing.
• Laryngoscopy: To examine the voice box and upper airway.

Treatment

Treatment depends on the cause, location, length, and severity of the narrowing.

• Endoscopic procedures: Through a scope, the airway can be widened by dilation (stretching), laser treatment to remove scar tissue, or other techniques.
• Airway stent: A small tube placed to hold the airway open in selected cases.
• Surgery: Removing the narrowed segment and rejoining the healthy ends (tracheal resection and reconstruction) can offer a lasting solution for suitable patients.
• Treating the underlying cause: For example, medication for inflammatory diseases.
• Ongoing monitoring: Because narrowing can recur, follow-up is important.

Prevention

• Tracheal stenosis is not always preventable, but careful airway management during intubation lowers the risk
• Seek prompt care for neck or chest injuries and inhalation exposures
• Manage underlying inflammatory or autoimmune conditions as directed
• Report new or worsening noisy breathing early so it can be evaluated
• Attend follow-up visits after treatment, since narrowing can return

When to See a Doctor

See a doctor for ongoing noisy breathing, unexplained shortness of breath, wheezing that does not respond to asthma treatment, or repeated chest infections, especially if you have had a breathing tube or tracheostomy. Seek emergency care immediately for severe difficulty breathing, loud stridor at rest, blue-tinged lips or skin, or a feeling that you cannot get enough air, as these can signal a dangerously narrowed airway that needs urgent treatment.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Tracheal disorders.
2. American Lung Association. Airway conditions.
3. Cleveland Clinic. Tracheal stenosis.
4. National Heart, Lung, and Blood Institute (NHLBI). How the Lungs Work.