What Is Laryngeal Stenosis?
Laryngeal stenosis is a congenital or acquired condition where there is a narrowing of the upper airway between the larynx and the trachea. It can affect the supraglottis, glottis, and/or subglottis. But the most common site affected is the glottis. It is characterized by inflammation and the formation of fibrosis.
There are two types of laryngeal stenosis. They are:
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Congenital Laryngeal Stenosis: It is the condition where a child is born with an abnormally narrow airway. It is diagnosed when there is no surgical or intubation history and there is a narrowing of the airway. Congenital stenosis can also be a reason for the acquired stenosis happening later in life. Congenital subglottic stenosis is divided into two: membranous and cartilaginous. Membranous is more common than the cartilaginous type. It is circumferential and may extend upward to include the vocal folds. The cartilaginous type is the deformity of the cricoid cartilage or tracheal ring projecting into the lumen. The diagnosis of congenital stenosis is made by the exclusion of acquired stenosis.
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Acquired Laryngeal Stenosis: The main reason for acquired laryngeal stenosis is the instrumentation of the airway. The majority of subglottic stenosis in children and infants is due to endotracheal intubation. The factors which add to the risk of stenosis following intubation are prolonged duration of intubation, traumatic intubation, use of an oversized endotracheal tube for intubation, gastroesophageal reflux, and infections.
What Causes Laryngeal Stenosis?
The causes of laryngeal stenosis include the following:
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In children, the narrowest portion of the airway is at the subglottis, and can get injured following intubation.
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Infections and trauma can cause narrowing of the airway.
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Due to the deposition of granulation tissue and fibrotic tissue, the lumen can get narrowed.
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Following endotracheal intubation, the secondary infection takes place and can result in the formation of granulation tissue which leads to scar formation and possible arytenoid fixation.
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Any growth that could be benign or malignant can cause obstruction of the airway.
What Are the Symptoms of Laryngeal Stenosis?
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As laryngeal stenosis interferes with the passage of air to the lungs, the symptoms are related to breathlessness. The most commonly seen presentation of laryngeal stenosis is exertional dyspnea, which is breathlessness on doing any physical activity. The exertional dyspnea is seen gradually worsening over time. The patient complains of feeling breathless on doing any small activity; even on walking, the patient will feel breathless.
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These patients might have hoarseness of the voice since the vocal cord is affected.
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The other signs to look for are unusual breathing sounds. This sound is known as stridor, which is a high-pitched whistling sound heard while breathing. This sound is mistaken in most cases as wheezing, which would result in misinterpretation of the disease.
How to Diagnose Laryngeal Stenosis?
The diagnosis is made by taking the history of the patient and doing a physical examination. If subglottic stenosis is suspected, then multiple tests will be advised to confirm the diagnosis.
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Flexible Laryngoscopy- In this test, a flexible tube with a camera fitted at the end is inserted into the throat. This is done to visualize the larynx and the trachea for any inflammation or growth.
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Pulmonary Function Test- A pulmonary function test is performed using a spirometer, which will measure breathing and how well the lungs are functioning.
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Imaging Tests- Imaging tests such as a CT scan could be performed, which would reveal any abnormality of the structure. Also, sometimes simple X-rays could be performed so as to assess the structure.
How Is Laryngeal Stenosis Treated?
Laryngeal stenosis in mild forms does not require surgery or any treatment. Wait and watch are advised to observe for the progression of symptoms. The treatment depends upon various factors, such as age and severity of the disease. If treatment is needed, then it is mostly steroid injection or surgery.
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Steroid Injection: Steroid injection is the first line of treatment in some people with laryngeal stenosis. In other instances, this injection is given after endoscopic dilatation. This procedure is done by numbing the neck, windpipe, and nose with local anesthesia, followed by a laryngoscope (a tube with a fitted camera that is inserted through the nose to visualize the inside lumen). The needle is then inserted into the airway from the neck region to inject steroid medication. This procedure can create swelling at the site of injection for a transient period, so this is done only in patients who can tolerate small airway swelling.
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Surgery for Laryngeal Stenosis
The laryngeal stenosis is surgically treated in one of the following methods:
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Endoscopic Dilatation- An endoscope is introduced into the airway with a balloon-like piece attached to it which can be inflated at the place of stenosis. Sometimes laser treatment would be needed to remove the tissue from the narrowed portion of the windpipe. This endoscopic dilatation procedure will provide only temporary relief, and the procedure needs to be repeated on the recurrence of the condition.
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Cricotracheal Resection- Cricotracheal resection is an open surgery where an incision is made on the front of the neck and scarred tissue is removed. The problematic part of the larynx is reconstructed.
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Endoscopic Resection- This procedure is similar to endoscopic dilatation, but a laser is used to cut the part of the windpipe affected. Following surgery, antibiotics, anti-reflux, and corticosteroids may be required.
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Laryngotracheoplasty- Laryngotracheoplasty is another type of open surgery in which a piece of cartilage is added into the windpipe once it has been stretched. The piece of cartilage is taken from ribs. Following this procedure, a stent or breathing tube is often placed post-surgery.
Conclusion
Laryngeal stenosis is a condition in which there is a narrowing of the larynx, which can result in noisy breathing. Living with this condition can be difficult because this will present breathing difficulty as well. So, the person with this condition will find it difficult to carry out his day-to-day activities. Along with exertional dyspnea, the person will have hoarseness of the voice which can affect the social life of the patient. If you suspect you have this condition, consult a specialist so as to acquire the treatment.
