Acute and chronic stenosis of the larynx and trachea

Laryngeal or tracheal stenosis is a narrowing of the lumen of the larynx and/or trachea, which disrupts the flow of air into the respiratory tract and lungs. Depending on the time frame, stenosis is divided into acute, developing over a short period of time (up to 1 month), and chronic, developing slowly (more than 1 month).

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Epidemiology of acute and chronic stenosis of the larynx and trachea

In the practice of an otolaryngologist, stenosis of the larynx and trachea is diagnosed frequently - 7.7% of all diseases of the ear, throat and nose. The main cause of cicatricial stenosis of the larynx and trachea at present is prolonged artificial ventilation of the lungs. The frequency of cicatricial changes in the larynx and trachea during resuscitation measures accompanied by artificial ventilation of the lungs ranges from 0.2 to 25%, according to various authors. In 67% of cases, patients who have undergone tracheostomy are found to have tracheal damage of varying degrees - from the formation of a granuloma to cicatricial stenosis and tracheomalysis. After surgical interventions on the neck, complications in the form of paralysis and paresis of the larynx are observed in 15% of cases, of which the majority - after strumectomy. In 3-5% of patients, central laryngeal paralysis develops after severe traumatic brain injury; in 6-8%, the etiology is unclear.

Neck injuries are accompanied by respiratory tract trauma in 7-10% of cases: isolated tracheal injuries are most often diagnosed, less often larynx and trachea simultaneously, which is much more severe. Untimely diagnostics and incorrect treatment tactics lead to the formation of persistent respiratory tract deformation with the development of cicatricial stenosis during the healing process.

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Causes of acute and chronic stenosis of the larynx and trachea

Among the etiological factors are infectious-allergic, iatrogenic, neurogenic, traumatic, idiopathic, compression (compression of the laryngeal tracheal structures from the outside). The causes of acute laryngeal stenosis may be:

• acute inflammatory processes of the larynx or exacerbation of chronic ones (edematous, infiltrative, phlegmonous or abscessing laryngitis, exacerbation of chronic edematous-polyposis laryngitis);
• mechanical, thermal and chemical injuries to the larynx;
• congenital pathology of the larynx;
• foreign body of the larynx;
• acute infectious diseases (diphtheria, scarlet fever, measles, typhus, malaria, etc.):
• allergic reaction with the development of laryngeal edema;
• other diseases (tuberculosis, syphilis, systemic diseases).

Acute and chronic stenosis of the larynx and trachea - Causes and pathogenesis

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Symptoms of acute and chronic stenosis of the larynx and trachea

Regardless of the cause of acute stenosis, the clinical picture is uniform. A sharp negative pressure in the mediastinum during intense inspiration and hypoxia cause a characteristic symptom complex: a change in the breathing rhythm, retraction of the supraclavicular fossae and retraction of the intercostal spaces, a forced position of the patient with a thrown back head, a lowering of the larynx during inspiration and a rise during expiration. The severity of the clinical manifestations of acute and chronic stenosis depends on the nature of the traumatic impact on the body, the degree of damage to the hollow organs of the neck, the length of the stenosis, the duration of its existence, individual sensitivity (resistance) to hypoxia, and the general condition of the body.

Classification of acute and chronic stenosis of the larynx and trachea

Laryngeal and tracheal stenosis is classified by the etiologic factor, duration of the disease, localization and degree of narrowing. Chronic laryngeal and tracheal stenosis is divided into paralytic, post-traumatic and post-intubation. By the localization of stenosis relative to the vertical plane, there are stenosis of the glottis, subglottic space and tracheal: horizontal - anterior, posterior, circular and total stenosis. This requires careful identification of the location of the narrowing and allows you to choose an adequate treatment method for a specific situation. In recent years, the percentage of extended stenosis of the larynx and trachea has been growing, when the narrowing area covers several anatomical areas at once, the larynx, cervical and thoracic trachea. When determining indications for various types of surgical treatment, stenoses are classified into two groups;

• limited laryngeal and laryngeal-tracheal stenosis, characterized by a favorable course of the wound process without disruption of the reparative properties of tissues;
• widespread laryngeal-tracheal stenosis, characterized by an unfavorable course of the wound process with gross structural and functional damage.

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Screening

Laryngeal and tracheal stenosis is detected by the nature of dyspnea and the presence of stridor during examination of the patient. A history of trauma or surgery in the neck and chest area or intubation will allow one to suspect the presence of upper respiratory tract stenosis.

Diagnosis of acute and chronic stenosis of the larynx and trachea

Examination of patients is carried out to assess the functional state of the respiratory organs, the degree and nature of the narrowing of the upper respiratory tract, and the general condition of the body. When collecting anamnesis, attention should be paid to the duration and severity of symptoms of respiratory failure, its relationship with the etiological factor (trauma, surgery, intubation, presence of acute infectious diseases).

Acute and chronic stenosis of the larynx and trachea - Diagnostics

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Treatment of acute and chronic stenosis of the larynx and trachea

Treatment methods for acute and chronic stenosis of the larynx and trachea are divided into conservative and surgical. Conservative treatment methods are used when acute stenosis of moderate severity with mild clinical manifestations is detected; acute trauma not accompanied by significant damage to the mucous membrane; early post-intubation changes in the larynx and trachea without a tendency to progressive narrowing of their lumen. Conservative management of patients with acute and chronic stenosis of grades I-II in the absence of pronounced clinical manifestations is also allowed.

Acute and chronic stenosis of the larynx and trachea - Treatment

Prevention of acute and chronic stenosis of the larynx and trachea

Prevention of acute stenosis consists of timely diagnosis and treatment of inflammatory diseases of the upper respiratory tract, infectious diseases, and general somatic pathology.

Prevention of chronic stenosis of the larynx and trachea consists of observing the timing of tracheostomy in patients on long-term artificial ventilation, using modern tracheotomy cannulas, timely reconstructive interventions in case of injuries to the hollow organs of the neck, long-term dynamic monitoring of patients who have suffered injuries to the hollow organs of the neck and surgical interventions on them.

Forecast

The success of treatment of acute and chronic stenosis of the larynx and trachea depends on the timeliness of the patient's request for medical care, the qualifications of the medical staff and the equipment of the medical institution.

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