Stenosis of the trachea is a painful condition characterized by difficulty 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 involvement.
Causes for the development of pathology
This pathology is dangerous to life and he alth, so it must be de alt with immediately. But first you need to find out what provoked the disease. The causes of tracheal stenosis are:
- Mechanical compression of an organ by a tumor or swollen lymph nodes. A change in the size of the thyroid gland can also trigger the problem.
- Purulent pathologies.
- Surgery 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,inflammatory process.
- Presence of a foreign body in the larynx.
An allergic reaction can provoke tracheal stenosis if it is accompanied by Quincke's edema. Prolonged intubation adversely affects the airways. The tissues, not fulfilling their functions, begin to atrophy.
Stages of development of pathology
So, if it is clear what causes tracheal stenosis, it is also necessary to consider the stages of its development. They are:
- Compensated. At this stage, the symptoms are almost invisible. A person may sometimes experience shortness of breath and difficulty breathing. More often this happens after exercise.
- Subcompensated. In this case, breathing problems appear even with a slight load. A person is not able to climb stairs, walk for a long time.
- Decompensated. At this stage, symptoms appear even at rest. To relieve them, a person has to take a forced posture.
- Stage of asphyxia. This is a deadly condition. In the absence of emergency care, a person dies within minutes.
The faster the tracheal stenosis develops, the higher the chance of death, so the symptoms cannot be ignored.
Disease classification
This 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 requiresresuscitation.
In addition, the classification of tracheal stenosis provides for the following types:
- Congenital (appears due to malformations of intrauterine development).
- Primary. Its cause is a pathological change in the tissues of the trachea itself due to mechanical, chemical or thermal damage.
- Secondary. Here external factors can cause stenosis: tumors, enlarged lymph nodes.
- Idiopathic. In this case, it is impossible to determine the cause.
- Expiratory. It develops due to overflow of lung tissue with air.
- 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 accurately determine the type of pathology and apply effective treatment.
Symptoms of pathology
Manifestations of the disease depend on the form of its development. There are the following symptoms of tracheal stenosis:
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Congenital tracheal stenosis appears almost immediately. The baby is restless, it is difficult for him to breastfeed, he cannot eat normally.
Diagnosis of stenosis
Before starting the treatment of tracheal stenosis, you need to carefully examine. Diagnostics involves the use of such techniques:
- Blood tests (general and biochemical), urine. Also, laboratory diagnostics involves the analysis of the contents of the trachea. Here, typing of the organisms present is carried out, as well as testing their sensitivity to drugs.
- Spirography. Thanks to it, the speed of air passage through the trachea, as well as the degree of its narrowing, is determined.
- Direct laryngoscopy.
- Stroboscopy.
- Fibrobronchoscopy. Here, the examination of the tissues of the trachea is performed using a probe equipped with a miniature video camera. At the same time, doctors can take their fragments for subsequent histological analysis.
- Arteriography. Such a study is carried out using a contrast agent. It is necessary to confirm or deny the presence of an angioma.
- CT or MRI. These techniques will help to accurately determine the cause and type of pathology.
- Bodyplethysmography. Used research to determinedegree of narrowing of the trachea, loss of respiratory function.
Only a comprehensive examination will make it possible to establish an accurate diagnosis. Incorrectly chosen treatment contributes to the further development of the pathological process.
Emergency assistance to the victim
If it is not given to a person during an acute attack, he will die. Moreover, it is better to carry out all activities at the first stage of the development of the pathological process, since then they simply will not help. You need to perform the following actions:
- Organize air flow. You should open the windows in the room, take off all the clothes that interfere with breathing and restrict movement.
- Reassure the patient. The more he gets excited, the more the spasm will be.
- If a child has an attack, it is allowed to put mustard plasters on the feet to divert his attention.
- The patient can be given warm tea to drink, and in small sips.
It is imperative to call an ambulance, even if the victim's condition has improved.
Conservative treatment
Treatment of tracheal stenosis is done in many ways. If the pathology is chronic, then conservative therapy will help in the first stages. The patient is prescribed the following medications:
- Mucolitics: ACC, Lazolvan.
- Antitussives: "Sinekod".
- Vitamin complexes, antioxidants: "Tocopherol".
- NSAIDs: Nimesil.
- Immunostimulants.
Treatment of cicatrici altracheal stenosis 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 ways of treating pathology are acupuncture, physiotherapy, and massage. Special exercises for tracheal stenosis also help. Here are a few:
- 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 pinched nose: long, slow inhalation, paired short exhalations;
- imitation of paired inhalations-exhalations with the help of abdominal muscles with a closed nose and mouth.
As for the acute form of the disease, steroids are injected intravenously to improve the patient's condition. This therapy lasts 3-4 days, after which treatment is carried out for another week using oral agents.
Surgery
In case of failure of conservative therapy, the patient is prescribed surgical treatment of tracheal stenosis. Moreover, operations can be different. Some of them are aimed at preserving the organ and restoring its function, while others are radical and involve the installation of an artificial prosthesis.
The organ-preserving operations include:
- Bougienage with an endoscope.
- Removal of scars and their adhesions.
- Dilatation usingballoon.
- Laser vaporization.
No less 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 fragment of the trachea is removed from the person, followed by an anastomosis.
If the cause of stenosis is a tumor, then it must be removed. Here, the nature of the neoplasm and the risk of oncological disease are already taken into account. Sometimes a tracheal transplant is used.
Features of preparation for surgery
Any surgical intervention requires preparation. When performed correctly, the risk of complications is reduced. Only an experienced surgeon should perform 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. At the same time, in order to avoid infection of the wound, the incision site must be thoroughly disinfected.
Features of the operation
This procedure is very serious. 2 days before the procedure, 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 prescribing an operation, the doctor assesses 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 andthe trachea requires high skill from the doctor. It is complex and technological. If you need to install a prosthesis, then you need to determine whether it will be permanent or temporary. In the second case, the device is removed from the trachea after a positive result is achieved.
When choosing a prosthesis, you need to pay attention to hypoallergenicity, the quality of materials (they must be biologically compatible, non-toxic, environmentally friendly). Also, an artificial tube must be flexible enough, but elastic, be resistant to 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 will be 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's respiratory functionality is diagnosed. During the postoperative recovery period, the patient is prescribed physiotherapy, inhalation, and breathing exercises.
A person can start work no earlier than in 2-3 weeks. If a patient is diagnosed with a chronic form of pathology, then the period of disability is much longer. It is important to remember that heavy physical activity, alcohol and cigarettes are contraindicated during recovery. Sports training can be resumed as soon as the doctor allows.
Prevention of pathology
In order to avoid a second attack or notprevent the development of an acquired form of the disease. To do this, you need to follow the following preventive measures:
- Timely treat any inflammatory and infectious processes in the body. Particular attention should be paid to the lymphatic system and the thyroid gland.
- Prevent respiratory diseases, respiratory infections.
- Every year, undergo a preventive examination, do x-rays.
- Avoid breathing tobacco smoke or chemicals.
- If you have a tracheostomy tube, it must be carefully looked after.
Stenosis is a severe pathology in which the lumen of the upper part of the respiratory system narrows. It is very life-threatening, so if you have symptoms, you should definitely consult a doctor.
