Tracheal stenosis: causes, symptoms, diagnosis and treatment

Tracheal stenosis is a painful condition characterized by difficulties in passing air from the nasal cavity to the lower parts of the respiratory system. Both organic and functional factors can provoke the disease. Pathology is congenital or acquired. According to statistics, tracheal stenosis is diagnosed in 0.4-21% of all cases of upper respiratory tract damage.

Reasons for the development of pathology

This pathology is dangerous to life and health, so you need to fight it immediately. But first you need to find out what triggered the disease. The causes of stenosis of the trachea are as follows:

• Mechanical compression of an organ by a tumor or enlarged lymph nodes. Changing the size of the thyroid gland can also cause a problem.
• Purulent pathologies.
• Surgical intervention, in which scars appear on the surface of the trachea.
• Chemical or thermal burn of mucous membranes.
• Congenital malformations of the respiratory tract.
• Tuberculosis or other pathologies of an infectious nature, the inflammatory process.
• The presence of a foreign body in the larynx.

An allergic reaction can provoke stenosis of the trachea if it is accompanied by Quincke's edema. Long-term intubation has a negative effect on the respiratory tract. Tissues, not performing their functions, begin to atrophy.

Stages of the development of pathology

So, if it is clear what caused stenosis of the trachea, it is also necessary to consider the stages of its development. They are as follows:

1. Compensated. At this stage, the symptoms are almost invisible. A person may sometimes experience shortness of breath and shortness of breath. More often this happens after physical exertion.
2. Subcompensated. In this case, breathing problems appear even with a slight load. A person is not able to climb the stairs, walk for a long time.
3. Decompensated. At this stage, symptoms appear even at rest. To facilitate them, a person has to take a forced position.
4. Stage of asphyxiation. This is a deadly condition. In the absence of emergency care, a person dies within a few minutes.

The faster the tracheal stenosis develops, the higher the chance of death, so you can not ignore the symptoms.

Disease classification

The specified pathology can occur in acute or chronic form. In the first case, the symptoms develop rapidly, the danger to life increases. The acute form often requires resuscitation.

In addition, the classification of tracheal stenosis provides for its types:

1. Congenital (appears due to intrauterine malformations).
2. Primary. Its cause is a pathological change in the tissues of the trachea due to mechanical, chemical or thermal damage.
3. Secondary. Here external factors can cause stenosis: tumors, enlarged lymph nodes.
4. Idiopathic. In this case, the cause cannot be determined.
5. Expiratory. It develops due to overflow of lung tissue with air.
6. Cicatricial. Its cause is the appearance of strictures after surgery.

If the pathological process captures only some areas, then it is limited. With a common form, the entire organ is affected. Classification of tracheal stenosis will allow you to accurately determine the type of pathology and apply effective treatment.

Symptoms of pathology

Manifestations of the disease depend on the form of its development. Symptoms of tracheal stenosis include:

Congenital stenosis of the trachea appears immediately. The child behaves uneasily, it is difficult for him to take a chest, he cannot eat normally.

Diagnosis of stenosis

Before you begin treatment for tracheal stenosis, you need to be thoroughly examined. Diagnostics involves the use of such techniques:

1. Blood tests (general and biochemical), urine. Laboratory diagnostics also include analysis of the contents of the trachea. Here, typing of the present organisms is carried out, as well as a test of their sensitivity to drugs.
2. Spirography. Thanks to her, the speed of air passage through the trachea, as well as the degree of its narrowing, is determined.
3. Direct laryngoscopy.
4. Stroboscopy.
5. Fibrobronchoscopy. Here, inspection of the tracheal tissue is carried out using a probe equipped with a miniature video camera. In this case, doctors can take their fragments for subsequent histological analysis.
6. Arteriography. Such a study is carried out using a contrast medium. It is necessary to confirm or deny the presence of angioma.
7. CT or MRI. These methods will help to accurately determine the cause and type of pathology.
8. Bodyplethysmography. A study is used to determine the degree of narrowing of the trachea, loss of respiratory function.

Only a comprehensive examination will establish an accurate diagnosis. Incorrectly selected treatment contributes to the further development of the pathological process.

Emergency assistance to the injured

If it is not provided to a person with an acute attack, then he will die. Moreover, all activities are best carried out at the first stage of the development of the pathological process, since then they simply will not help. It is necessary to carry out such actions:

1. Organize air flow. It is necessary to open windows in the room, remove all clothing that prevents breathing, restricts movement.
2. Reassure the patient. The more he worries, the stronger the spasm.
3. If an attack has begun in a child, mustard plasters are allowed to distract his attention on the feet.
4. The patient can be given warm tea, and in small sips.

An ambulance should be called even if the condition of the victim has improved.

Conservative treatment

There are many ways to treat tracheal stenosis. If the pathology is chronic, then in the first stages conservative therapy will help. The following drugs are prescribed to the patient:

1. Mucolytics: "ACC", "Lazolvan."
2. Antitussive: "Sinecode."
3. Vitamin complexes, antioxidants: "Tocopherol".
4. NSAIDs: Nimesil.
5. Immunostimulants.

Treatment of cicatricial stenosis of the trachea is performed using tracheoscopy. A special preparation is introduced into the formed strictures, which contains enzymes, glucocorticoids. Irrigation with antiseptics and antibacterial drugs is also practiced.

No less useful methods of treatment of pathology are acupuncture, physiotherapeutic procedures, as well as massage. Special exercises for tracheal stenosis also help. Here are a few of them:

• paired short breaths through the mouth, long, slow exhalation through the nose;
• long, slow inhalation through the mouth, paired short exhalations through the nose;
• with a pinched nose: a long, slow breath, paired short exhalations;
• imitation of paired inhalations-exhalations using the abdominal muscles with a closed nose and mouth.

As for the acute form of the disease, steroid preparations are infused intravenously to improve the condition of the patient. Such therapy lasts 3-4 days, after which treatment is carried out for another week with the help of oral agents.

Surgical intervention

In the absence of the effect of conservative therapy, the patient is prescribed surgical treatment for tracheal stenosis. Moreover, operations may be different. Some of them are aimed at preserving the organ and restoring its function, while others are radical and require the installation of an artificial prosthesis.

Organ-preserving operations include:

• Probing with an endoscope.
• Removal of scars and their adhesions.
• Balloon dilatation.
• Laser vaporization.

Equally popular is the installation of a stent. However, this intervention is temporary. After 1.5 years, the device is removed. If such procedures are ineffective, then a narrowed tracheal fragment is removed in a person with the subsequent application of an anastomosis.

If the cause of the development of stenosis is a tumor, then it must be removed. Here the nature of the neoplasm and the risk of cancer are already taken into account. Tracheal transplantation is sometimes used.

Features of preparation for surgery

Any surgical intervention requires preparation. With its proper implementation, the risk of complications is reduced. Only an experienced surgeon should do the operation. In this case, the patient undergoes a comprehensive preliminary diagnosis.

If an acute form of stenosis has occurred, then a tracheostomy will have to be done urgently. Moreover, in order to avoid infection of the wound, the incision site must be thoroughly disinfected.

Features of the operation

The indicated procedure is very serious. 2 days before it, the patient will have to undergo a course of antibiotic therapy. It will help to avoid purulent complications, as well as infection of the wound surface. If the situation is difficult and you have to do an emergency tracheostomy, then antibiotics are administered right during the intervention.

When appointing an operation, the doctor evaluates the anatomical features of the patient, the degree of hypoxia. Any intervention of this type is carried out under general anesthesia.

Surgery on the larynx and trachea requires high skill from the doctor. It is complex and technological. If you need to install a prosthesis, you need to determine whether it will be permanent or temporary. In the second case, the product is removed from the trachea after a positive result is achieved.

When choosing a prosthesis, you need to pay attention to hypoallergenicity, quality of materials (they must be biocompatible, non-toxic, environmentally friendly). Also, an artificial tube must be flexible enough, but resilient, be resistant to the effects of internal and external negative factors.

The duration of the use of a temporary prosthesis is determined individually. It all depends on how quickly the functionality of the organ is restored.

Rehabilitation period

After the patient is discharged from the hospital, he continues to be under the supervision of the surgeon who operated on him. Every 2-3 weeks, a person is diagnosed with respiratory functionality. In the period of postoperative recovery, the patient is prescribed physiotherapeutic procedures, inhalations, and also breathing exercises.

A person can start work no earlier than in 2-3 weeks. If the patient is diagnosed with a chronic form of pathology, then the period of disability is much longer. It is important to remember that during recovery, heavy physical exertion, alcohol and cigarettes are contraindicated. Sports training can be resumed as soon as the doctor permits.

Pathology Prevention

In order to avoid a second attack or to prevent the development of the acquired form of the disease. To do this, observe the following preventative measures:

• In time to treat any inflammatory and infectious processes in the body. Particular attention should be paid to the lymphatic system and the thyroid gland.
• Prevent respiratory system diseases, respiratory infections.
• Every year undergo a routine examination, do fluorography.
• Avoid breathing tobacco smoke or chemicals.
• If there is a tracheostomy tube, it must be carefully looked after.

Stenosis is a severe pathology in which the lumen of the upper respiratory system narrows. It is very life-threatening, so if you have symptoms, you should definitely consult a doctor.