Tracheal Stenois and Tracheomalacia - Samantha Conner CSD Graduate Student

Two conditions affecting the trachea include tracheomalacia and tracheal stenosis. Tracheal stenosis is a narrowing or constriction of the tracheal cartilage that can cause shortness of breath, coughing, wheezing, stridor, dyspnea, (and pneumonia - are you sure there is a direct cause-effect relationship?) Tracheal stenosis consists of two types, including congenital and acquired. Congenital stenosis occurs at birth. Acquired stenosis can be secondary to tracheostomy, radiation treatment, surgery, and cancer. Also, stenosis can be caused by bacterial infection, external injury, and autoimmune conditions such as polychondritis and sarcoidosis that cause inflammation. However, the majority of cases are due to prolonged intubation.The most common treatments for tracheal stenosis include endoscopic surgery, open surgery and medical treatment. The treatment varies according to the etiology of the stenosis. For example, if the condition is secondary to an infection, it may be treated using antibiotics or antifungals. Also, if it is secondary to a malignant growth, chemotherapy or corticosteroids may be used for treatment. Although surgery is not necessary in most cases, some stenosis requires surgery. Minimally invasive surgery such as endoscopic surgery can be an effective treatment, as well as open surgery such as a tracheal resection. Tracheal stenosis also can be treated by dilation, either performed by a health care provider or at home by savvy patients.

In contrast to tracheal stenosis, tracheomalacia is a condition characterized by weakness of tracheal cartilage. Symptoms of malacia include stridor, dypnea, upper respiratory infections, and pneumonia. Tracheal malacia can be congenital or acquired. Congenital tracheal malacia occurs when the tracheal cartilage is not properly formed. It is often associated with fistulas. Congenital malacia can be treated with humidified air, physical therapy, careful feeding and monitoring, and antibiotics for infections associated with malacia. Acquired stenosis can occur as type II malacia from pressure on the trachea from an outside force such as a tumor. Another acquired malacia, type III, occurs from prolonged intubation or chronic infections. Acquired tracheomalacia can be treated through CPAP (continuos positive airway pressure), or surgery sometimes followed by the placement of a stint.