Excessive scar tissue in the trachea (“windpipe”) may cause a progressive narrowing that can make it difficult to breathe. This narrowing is characteristic of a condition known as subglottic stenosis. Even if breathing isn’t severely affected, patients may experience high-pitched noises that can seem similar to what happens during an asthma attack. Once the condition is properly diagnosed, surgery is the most common treatment recommendation.
There are several possible causes of subglottic stenosis and some contributing factors. The condition may occur as a result of an inflammatory or autoimmune disease the patient already had prior to the stenosis developing in the throat. It may also develop when patients have to use a breathing tube because of other medical issues.
Signs and Symptoms
The scar-like narrowing of subglottic stenosis develops just below the vocal cords (“voice box”) at the top of the trachea. Symptoms will depend on the severity of the narrowing. The most noticeable symptom is noisy breathing (stridor).
Patients may experience shortness of breath with some type of strenuous activity or exertion. Exercising, walking, jogging, and climbing stairs are among the activities that may trigger breathing issues. Symptoms may also include:
- Chronic or recurring hoarseness
- Breathing difficulties that occur while resting or sleeping
- Feelings of having something stuck or caught in the throat
Diagnosing the Condition
Subglottic stenosis may be misdiagnosed as bronchitis or asthma when a patient first complains of recurring shortness of breath. It may become evident that there is another issue when treatment attempts fail to provide relief. A correct diagnosis is often made when a patient is asked to breathe into a machine to test their breathing abilities.
Further evaluation may involve direct examination of the trachea. A numbing medication is applied and a camera is inserted through the nose to the affected part of the throat. The special camera will allow the ear, nose, and throat specialist to clearly view the trachea. A CT scan may be done to positively make a diagnosis and determine the most appropriate treatment.
Treating Subglottic Stenosis
If the narrowing around the trachea is mild or not severe enough to require removal of the trachea, endoscopic surgery may be performed. It’s a minimally invasive, outpatient procedure that’s done through the mouth. The scar tissue is removed with a laser and a balloon is inserted into the airway to create sufficient space.
When the narrowing of the throat is severe or if endoscopic surgery cannot be safely performed, the trachea may need to be altered (tracheal resection). During the procedure, a cut is made in the neck to remove the constricted part of the airway. The other parts of the trachea are surgically attached.
Success with subglottic stenosis treatment will depend on the severity of the narrowing and whether or not there are underlying health issues. Medications, including steroids and anti-reflux drugs, may be needed following surgery to manage the condition and prevent the stenosis from recurring around the trachea.