Tracheal (tracheal) disorders

Disorders of the trachea (trachea) may cause airway obstruction, leading to respiratory symptoms such as chest tightness and difficulty breathing. Learn about its diagnosis and treatment methods in Turkey.

What are the types of tracheal (tracheal) disorders?

There are two main types of tracheal disorders:

1. Tracheal stenosis: It is a narrowing of the trachea that prevents air from adequately reaching the lungs. The effects of this narrowing can range in severity from mild to more severe. In severe cases, the patient may have to rely on a tube to breathe.
2. Tracheomalacia: It is a condition characterized by the absence of cartilage from the walls of the trachea, causing weakness in the trachea, which must be rigid in order to function in normal breathing. Babies can be born with tracheomalacia, but adults can also develop it later in life.

While tracheal tumors are rare, they can cause a narrowing of the trachea that prevents air from fully reaching the lungs. They can also cause coughing up blood.

Tumor types include:

Polyps:

Polymorphous adenoma, squamous cell tumor, chondrosarcoma, granulosa cell tumor, glomus tumor, neurofibromatosis

Malignant tumors:

Adenoid cyst carcinoma, squamous cell carcinoma, epithelial tissue carcinoma, mucosal carcinoma, lung carcinoma.

Another tracheal disorder is a tracheal fistula, which is an abnormal connection (fistula) between the esophagus and the windpipe.

What are the causes of tracheal disorders?

• tracheal stenosis:

The most common cause of tracheal stenosis is intubation, when a breathing tube is inserted into the windpipe to perform Surgery or other medical procedures.

Other causes may include:

1. External injury to the throat or chest.
2. Heat or caustic injuries.
3. Chronic inflammatory disease.
4. Infections, including tuberculosis.
5. Tumors pressing on the trachea.
6. Radiotherapy.
7. There are common cases in young women of unknown cause.
8. Pressure from other tissues in the chest, such as blood vessels.
9. autoimmune disorders 

• Tracheomalacia:

Tracheomalacia can have many causes, the most common of which are:

1. Damage from surgery or procedures in the windpipe or esophagus.
2. Damage from a long-term breathing tube or tracheostomy.
3. Chronic infections such as bronchitis.
4. Costochondritis (inflammation of the cartilage of the trachea).
5. Emphysema.
6. Gastroesophageal reflux disease.
7. Inhalation of irritants.

What are the symptoms of tracheal disorders?

• Tracheal stenosis:

Many patients do not have any symptoms of tracheal stenosis. However, the patient may have one or more of the following:

1. whistling.
2. stridor (a high-pitched musical breathing sound).
3. shortness of breath.
4. Breathing difficulty.
5. coughing;
6. Hoarseness.
7. Frequent upper respiratory infections, such as pneumonia.
8. Treatment-resistant asthma.
9. bluish color to the skin;
10. bluish color in the mucous membrane of the mouth or nose;
11. coughing up blood

• Tracheomalacia:

1. shortness of breath.
2. Chronic cough.
3. Hoarseness.
4. Frequent respiratory infections.
5. Abnormal breathing sounds that improve when changing position or sleeping.
6. High-pitched, noisy breathing, sometimes with a rattling sound.
7. Difficulty swallowing food.

How are tracheal disorders diagnosed?

Tracheal stenosis:

In addition to a careful physical exam, the following procedures may be done to determine if symptoms are caused by tracheal stenosis:

• Pulmonary function tests, or PFTs, which assess the function and strength of the lungs. In the most common of these tests, the patient blows air forcefully into a tube. A device called a spirometer measures the volume of air the patient can hold in the lungs, and the speed with which they can exhale air. Compared with normal values, airway obstruction can be identified.
• Computed tomography that uses a combination of X-rays and computer technology to produce horizontal or axial images of any part of the body, including bones, muscles, fats, and organs. A 3D chest CT scan takes a closer look at the area of stenosis during inhalation and exhalation to outline the surgical procedure.
• Chest X-ray to produce images of internal tissues, bones, and organs.
• bronchoscopy A procedure in which a lighted tube is inserted into the windpipe and allows the doctor to examine the trachea and bronchi (the air passages leading to the lungs). The procedure allows the doctor to make an accurate diagnosis and measure the length of the non-medical airway section

Tracheomalacia:

After taking your medical history and performing a thorough physical exam, the following procedures can be done to confirm a diagnosis of tracheal stenosis or tracheobronchomalacia:

• Functional exercise capacity is measured by a gait test that measures the distance an individual can walk over a period of 6 minutes on a hard, flat surface.
• Measurement of heart and lung function during exercise on a treadmill or stationary cycling.
• Do a bronchoscopy to examine the inside of the trachea and bronchi. This allows for accurate diagnosis of the problem and measurement of the affected area to determine the best possible treatment options.
• Use of computed tomography.
• Chest X-ray. 
• Laryngoscopy to enable the doctor to examine the back of the throat, larynx, and vocal cords with an endoscope. 
• Magnetic resonance imaging (MRI) which is a non-invasive method for evaluating the trachea.
• Pulmonary function test to measure how well the lungs are working.
• Checking pulmonary ventilation/perfusion using two nuclear scanning tests: injecting radioactive albumin into your veins and inhaling radioactive gas through a mask to allow the scanner to measure your circulation (perfusion) and breathing (ventilation).

What are the treatment options for disorders of the windpipe (trachea)?

Tracheal stenosis:

There are many surgical options for treating tracheal stenosis. Your thoracic surgeon will recommend the best option for you based on the cause, location and severity of the stenosis. Possible treatments and procedures are:

• Argon plasma coagulation (APC) is a form of contactless electrocoagulation using a flexible bronchoscope that allows rapid coagulation with minimal mechanical trauma to tissues. This procedure is used for patients who are unable to undergo tracheal reconstruction due to medical or personal reasons.

• Bronchial artery occlusion (BAE), a procedure that involves examining the bronchial arteries with X-rays using a special dye to determine the cause of the hemoptysis so the bleeding can be stopped.
• Bronchoscopy using a balloon, tracheal dilator, or electrocautery to dilate the trachea. This procedure provides immediate relief to the patient and helps the thoracic surgeon determine the extent of the stenosis.

• Laser bronchoscopy to remove scar tissue and give excellent short-term relief.
• Endotracheal airway stenting. It is a non-surgical procedure that uses a bronchoscope to place a stent to keep the airway open.
• Tracheostomy and reconstruction, in which the scarred and narrowed part of the trachea is removed and the parts reattached. This treatment has excellent long-term results and is the first procedure indicated for certain tumors and stenosis.
• Tracheoplasty, a procedure performed in a few hospitals, involves stitching an opening that leads out of the patient's windpipe through a series of nodes, which open the collapsed tissue in the wall of the windpipe to create an opening for air to pass. The goal is to create a scar in the area that will permanently strengthen the tissue.

Tracheomalacia:

Often, tracheomalacia can improve without treatment. However, you should be closely monitored if you have frequent respiratory infections. Treatments may include:

• Use a continuous positive airway pressure (CPAP) machine to keep the airway open.
• Chest treatment, including deep breathing exercises and chest taps to break up the mucus.
• Speech and language therapy to modify breathing patterns and swallowing problems.
• Use of a tracheobronchial stent.