Airway stenosis

Airway stenosis is a narrowing of the airway, which can affect the larynx, trachea and surrounding structures and disrupts breathing and speech.

A person with stenosis of the airway may experience:

• Shortness of breath
• Noisy breathing
• Hoarseness
• Persistent throat clearing or cough
• Asthma that is not responsive to medication

There are several reasons why someone may develop airway stenosis, including:

• Side effect of tracheotomy
• Illness
• Inflammatory disease
• Trauma (e.g. inhalation burn)

Penn laryngologists have deep expertise in all forms of airway stenosis, including:

• Subglottic stenosis: a narrowing of the larynx below the vocal cords, usually from trauma or an inflammatory problem
• Laryngeal stenosis: scarring in the larynx that occurs at or above the vocal cords and limits the larynx’s ability to open normally. Posterior glottic stenosis is a type of laryngeal stenosis that may occur in conjunction with subglottic stenosis.
• Tracheal stenosis: a narrowing of the trachea, often due to intubation or tracheotomy placement

The main tool used by Penn Laryngology specialists when evaluating an airway disorder is diagnostic endoscopy. This is an outpatient procedure that takes less than 5 minutes and is performed with local anesthetic. During this exam, a flexible endoscope — a thin, flexible tube with a light and camera on the end — is passed through the nose to the larynx. Videos of the laryngeal structures and function are taken and used for diagnosis and treatment planning.

Your case will be reviewed by Penn Medicine’s Complex Airway Disorders Group. This multidisciplinary team includes Penn Laryngology physicians, as well as Penn Medicine specialists from interventional pulmonary medicine, thoracic surgery, and others as needed. Together, this group will tailor a personalized plan to care for your airway disorder. Medicine

Penn Laryngology offers the latest endoscopic and open surgical approaches to provide you with relief from your airway stenosis.

• Endoscopy is a minimally invasive approach that uses lasers and balloon dilation to "break up" the stenosis and open the airway. Advanced endoscopic maneuvers may also be used to create flaps to hold the airway open.
• Endoscopy can provide you with relief from your stenosis for between six months and five years. If you tolerate it well, it can be repeated as needed. You should expect to spend between one and two nights in the hospital following your first endoscopy. If you have had the procedure before without complication, you may go home the same day provided swelling isn’t an issue. This approach can be used to treat subglottic stenosis, laryngeal stenosis, and tracheal stenosis.
• Laryngofissure and cricoid split are open procedures for severe laryngeal stenosis. These approaches may also be used in cases where an endoscopic approach was unsuccessful. During this surgery, the larynx is accessed through an incision in front of the neck. The larynx is then opened and a rib graft, stent, or combination of both are placed to keep it open on a more permanent basis. You will spend several days in the hospital following surgery. Once home, you will likely require speech therapy and/or homecare nursing.
• Surgical resection is an option for severe tracheal stenosis. During this procedure, the stenosis is removed, and the two remaining parts of the larynx are reconnected to create a new airway. You will spend several days in the hospital following surgery. Once home, you will likely require speech therapy and/or homecare nursing.