The most common causes of a narrowing of the trachea are
- Inflammation in the windpipe due to a bacterial or viral infection or inhalation of irritant gases
- Tumors in the trachea (benign or malignant), for example tracheal cancer
- Growths or tumors in the immediate vicinity press on the trachea and narrow its cross-section (often in connection with thyroid enlargement)
- Scarring in the trachea after inflammation, injury, long-term ventilation or after a tracheotomy
- Obstruction due to accidental penetration of an object
- Congenital narrowing of the trachea (genetic causes)
The causes listed show that there are hardly any preventive measures. However, frequent inhalation of harmful aerosols such as those contained in tobacco smoke promotes inflammation in the trachea. The narrowing of the trachea due to genetic predisposition is extremely rare and is already apparent in childhood.
The trachea is an elastic tube and starts at the larynx @ Paweł Kacperek /AdobeStock
Depending on the cause, the narrowing of the trachea develops slowly or suddenly, as is the case with a foreign body, for example. Initially, patients do not notice the tracheal stenosis. Breathing difficulties and pronounced shortness of breath only occur during physical exertion.
Those affected find the shortness of breath very uncomfortable and sometimes even threatening. A severe narrowing of the trachea typically leads to breathing noises that are noticeable as a kind of humming or whistling.
The ENT doctor uses three main methods for diagnosis:
Ultrasound and CT are non-invasive and completely painless. Endoscopy of the trachea, on the other hand, is performed under local anesthesia or a short general anesthetic.
The ENT doctor recognizes the nature of the narrowing in the ultrasound and therefore knows which treatment is suitable. A CT scan as an X-ray imaging procedure can provide information about tissue changes or abnormalities in the trachea.
Examination with an endoscope gives the doctor a direct view of the windpipe. A small camera at the tip of the endoscope provides the images. During the examination, the doctor can remove tissue using a laser or take tissue samples for histological examination.
Depending on the cause and severity of the condition, the doctor can choose between non-invasive and invasive treatment options.
Mild narrowing of the trachea that does not affect the oxygen supply is treated by the internist or ENT specialist with anti-inflammatory medication. It is also possible for the body's own immune system to heal the narrowing of the trachea itself.
Tracheal stenosis, which impairs breathing, usually also results in an inadequate supply of oxygen to the body. This leads to increased cell ageing and damage to our central nervous system.
The following minimally invasive and surgical treatment options are used to eliminate the bottleneck in the trachea:
- Laser therapy for endoscopic removal of tissue (scar tissue)
- Endoscopic insertion of local anti-inflammatory medication into the trachea
- Tracheal surgery, the surgeon removes the affected section and stitches the slightly shortened trachea back together again
- Insertion of a stent into the trachea for stabilization
- Tracheotomy to create an artificial access to the windpipe (tracheostoma)
The attending physician will discuss the advantages and disadvantages of all possible treatment methods with you. Together you will then decide on the most suitable form of therapy.
The course and prognosis after treatment depend heavily on the cause. If the doctor is able to eliminate the cause, the patient has a good prognosis.
Possible causes that can be eliminated:
- Removal of growths outside the trachea
- Surgical removal of the constriction in the trachea with subsequent restoration of patency
Overall, the prognosis is good for all forms of treatment, especially for surgical procedures on the trachea. If the narrowing in the trachea is high and close to the larynx, specially trained doctors should perform the procedure. The aim is to minimize risks such as vocal cord damage and the like.
A tracheotomy is an artificial access to the windpipe and secures breathing @ Jeniffer /AdobeStock
Although the TV media often portray it differently, tracheotomies are generally rare. If the entrance to the trachea is blocked, this is an extreme case that can lead to death by asphyxiation.
If a foreign body is the cause of the blockage, doctors can grasp the object with their fingers or tweezers. It is also possible that a wasp sting in the throat triggers an allergic reaction and the entrance to the windpipe swells up.
In an emergency, i.e. if the blockage cannot be cleared in a few minutes, a tracheotomy is life-saving. A tracheotomy with insertion of a tracheal cannula is part of the treatment for certain pre-existing conditions. This procedure is carried out by experienced doctors in specialist clinics.
