Laryngotracheal stenosis refers to narrowing of the airway that affects the larynx (voice box) and trachea (windpipe). A person can be born with this condition, but laryngotracheal stenosis can also be caused by a specific disease, occur as the result of a medical treatment, or occur without a clear cause.
Laryngotracheal stenosis refers to narrowing of parts of the upper airway. It may be caused by systemic diseases such as granulomatosis with polyangiitis, relapsing polychondritis, or amyloidosis. It can also be caused unintentionally by a doctor or a medical treatment (for example, prolonged intubation), or after direct injury to the airway. Some people (primarily White females) may develop laryngotracheal stenosis in the absence of an identifiable cause.
Symptoms of Laryngotracheal Stenosis
Symptoms of laryngotracheal stenosis depend on how severe the narrowing is and include shortness of breath (dyspnea), a high-pitched noise that occurs when breathing through the narrowed airway (stridor), and a cough.
The voice may sound weak, hoarse, or otherwise abnormal. Painful swallowing may affect the mouth, throat, or esophagus. People with mild narrowing of the airway may not have any symptoms at all.
Diagnosis of Laryngotracheal Stenosis
A doctor's evaluation (particularly of the larynx and trachea)
Sometimes blood tests
Sometimes lung function tests
Sometimes CT imaging
The doctor assesses the person's level of distress, including the degree of stridor, which can indicate how much the airway has narrowed. A person showing signs of severe distress may require emergency treatment, including a procedure called a tracheostomy, during which an opening is made in the trachea [windpipe] to make breathing easier.
Laboratory tests are performed to determine if the laryngotracheal stenosis is caused by a systemic disease, particularly an autoimmune disorder.
Lung function tests are useful for characterizing the degree of narrowing and monitoring its progression. Laryngotracheal stenosis is frequently missed or misdiagnosed as asthma with few key exceptions:
Symptoms typically get worse over time.
Symptoms do not respond to bronchodilators, which are used to treat asthma.
However, the steroids (sometimes also called corticosteroids or glucocorticoids) that are used to manage asthma may provide some relief and complicate diagnosis.
Endoscopic evaluation is the best way to diagnose and monitor laryngotracheal stenosis. This can be performed in the office using flexible bronchoscopy or in the operating room with direct laryngoscopy and bronchoscopy. This approach also allows for tissue biopsies, which can help the doctor identify any systemic causes.
CT imaging can be valuable for characterizing the extent of the stenosis and assessing which tissues and structures are involved. It is typically performed before any surgical reconstruction.
Treatment of Laryngotracheal Stenosis
Medical management
Office procedures (endoscopic monitoring)
Endoscopic interventions
Open airway surgery
When stenosis is caused by systemic disease, the doctor's management of the underlying disease may improve the stenosis as well. In other cases, medications are prescribed to reduce inflammation or scarring. These may include, depending on the cause, reflux medications, inhaled or oral steroids, antibiotics, and nebulized saline treatments. Other medications can be administered during surgery to enhance clinical outcomes.
Office-based procedures rely on a procedure called endoscopy, which uses a flexible fiberoptic scope to visualize and monitor disease in people with laryngotracheal stenosis. Endoscopic interventions may include the use of rigid and balloon dilators to open up the narrowed airway, lasers and cryotherapy (targeted freezing temperatures applied to remove affected tissues) and sometimes grafts to reconstruct the treated tissues. Medications may be injected at the time of the procedure to decrease the rate of restenosis. These treatments are typically performed under general anesthesia.
Surgery, including reconstruction of the stenotic area, is often considered for treating airway stenosis. In some cases, a procedure called a tracheostomy may be performed to bypass the stenotic area and facilitate breathing. Whether that tracheostomy is temporary (left in place while the person undergoes other interventions, after which it is removed) or permanent depends on the degree of airway stenosis and other factors.
