What is tracheal stenosis?
Tracheal stenosis is a narrowing of the windpipe. The word is made up of two terms: “trachea” means “windpipe” and “stenosis” means “narrowing”. The obstruction can affect different sections of the trachea and can vary in size. In most cases, the obstruction in the windpipe develops gradually over a longer period of time.
Tracheal stenosis can have various causes. It is rarely congenital – babies are born with a malformation of the windpipe. However, a person usually acquires it in the course of their life, for example due to a tumor, an injury or after long-term intubation or a tracheotomy. In addition, some diseases are associated with tracheal stenosis, for example a pathologically enlarged thyroid gland (goiter) or infections.
A major symptom of tracheal stenosis is shortness of breath – initially during physical exertion and later also at rest. Audible breathing noises are also common. In the long term, too little air enters the lungs due to the narrowing of the windpipe and the oxygen supply is restricted.
Doctors treat narrowing of the windpipe with various procedures – which one is used depends on the cause. For example, the trachea can be expanded and stabilized with a stent as a support or reconstructed as part of an operation.
Tracheal stenosis – frequency and age
There are no precise figures on the incidence of tracheal stenosis. Obstruction of the windpipe can affect people of all ages, as there are many different causes. In adults, a narrowed trachea is often the result of previous medical procedures, such as a tracheotomy or intubation and artificial respiration, which can cause injuries that ultimately lead to tracheal stenosis.
Tracheal stenosis: there are many causes
There are many different causes of tracheal stenosis. The narrowing can be congenital (rare) or acquired in the course of life – this is more often the case. This is usually caused by injuries to the windpipe or various diseases.
Chronic tracheal stenosis – causes
The causes of tracheal stenosis, which develops slowly, can be
- Scarring, e.g. after medical procedures such as long-term ventilation (intubation) or a tracheotomy, injuries (blunt, sharp or thermal) or after foreign body aspiration
- Tumors – benign or malignant, which press on the trachea from the outside or obstruct the airflow from the inside
- Thyroid enlargement (goiter) – the organ lies in the immediate vicinity of the windpipe and exerts pressure on it from the outside
- Inflammations: Infections with viruses, bacteria(tuberculosis) and some fungi; various diseases such as sarcoidosis (disease of the connective tissue), polychondritis (diseases of the cartilage), scleroderma (rheumatic autoimmune disease) or granulomatosis with polyangiitis (rheumatic inflammation of the blood vessels).
- Special forms such as amyloidosis (deposition of insoluble protein bundles) or tracheomalacia (the cartilage of the windpipe is too soft)
Sometimes doctors are unable to find a cause for the narrowed windpipe and the reasons remain unclear. In this case, experts speak of idiopathic tracheal stenosis.
Symptoms: Tracheal stenosis causes shortness of breath
The symptoms of tracheal stenosis do not usually set in suddenly, but develop slowly and gradually. The more the trachea narrows, the worse the symptoms become. Most people experience symptoms from an inner diameter of ten millimeters.
The following symptoms can occur with tracheal stenosis:
- Shortness of breath, initially only during physical exertion such as climbing stairs. If the trachea continues to narrow, shortness of breath sets in even with little physical activity or at rest.
- Breathing sounds (stridor) – a breathing sound is often audible when inhaling.
- Cough with sputum that cannot be coughed up properly
Tracheal stenosis: Diagnosis with us
The diagnosis of tracheal stenosis always begins with a discussion of your medical history, the anamnesis. For example, we are interested in answers to the following questions:
- What symptoms do you experience exactly – shortness of breath or noises when breathing?
- How long have the symptoms been present – acute or slow development?
- How pronounced are the symptoms?
- In which situations do the symptoms occur – during physical exertion or at rest?
- Do you have any known illnesses, such as an enlarged thyroid, tumors, inflammations or infections?
- Have you undergone a medical procedure under general anesthesia in the past?
- Have you had an accident in the past in which your windpipe was injured?
Your answers already provide us with initial clues as to the reason for your symptoms. This is usually followed by a physical examination. For example, we palpate the neck and chest region to detect possible changes. In addition, we usually listen to the lungs with a stethoscope and listen for unusual noises when breathing in and out. Further examinations then follow to get to the bottom of the cause of the symptoms.
Further investigations:
- Pulmonary function test: spirometry with measurement of the flow-volume curve (it is flattened). This examination is of great importance, as tracheal stenoses are occasionally misinterpreted as bronchial asthma.
- Blood test to detect possible inflammation (e.g. C-reactive protein, CRP), autoimmune diseases and other illnesses.
- Computed tomography (CT) of the neck and chest: CT is an X-ray examination that provides very precise cross-sectional images – constrictions of the windpipe and other changes can be clearly seen on the images.
- Magnetic resonance imaging (MRI ) of the neck and chest: Due to the high soft tissue contrast, CT provides additional information on the extent to which inflammatory processes are the cause.
- Tracheobronchoscopy: An endoscopic examination of the trachea and lungs shows where the constriction is located and how severe it is.
Tracheal stenosis: prevention, early detection, prognosis
There are no special measures for the prevention and early detection of tracheal stenosis. As a general rule, always visit us promptly if you experience breathing problems or other complaints.
Course and prognosis of tracheal stenosis
The course and prognosis for tracheal stenosis are generally good if we treat the obstruction adequately. Most patients are then able to lead a normal and pain-free life again and cope well with everyday life. Without therapy, the shortness of breath continues to increase. Unfortunately, even after correct treatment, recurrences occur, i.e. the stenosis forms again.
Tracheal stenosis: treatment depending on the cause
The treatment of tracheal stenosis always depends on the underlying cause. However, the extent and location of the narrowing also play a role in the choice of treatment. Your age, general state of health and personal wishes are also important.