UC Health has one of the most experienced programs in the country for diagnosing and treating airway problems and voice problems.
Injury, infection, inflammatory conditions, tumors, autoimmune diseases and reflux disease can narrow your airway and prevent you from breathing normally. UC Health has the only Adult Airway Reconstruction Program in Ohio, with a multidisciplinary team of otolaryngologists, pulmonologists, speech pathologists, sleep specialists, gastroenterologists, thoracic and general surgeons and critical care specialists.
Why Choose UC Health for Adult Airway Conditions?
As a national referral center and the only Adult Airway Reconstruction Program in Ohio, we offer:
- Several full-time surgeons who perform the most highly complex procedures.
- A physician assistant available 24 hours a day to respond to emergencies, provide education, answer questions and coordinate testing.
- Open airway procedures if someone is not a candidate for a minimally invasive technique or if dilation of a narrowed airway fails.
- In-hospital, post-surgical intensive care especially for airway reconstruction patients.
- Speech and language pathologists who have special experience with difficult airways. They provide speech, swallowing and breathing rehabilitation.
- Help for people who have not found help elsewhere.
Conditions We Treat
We commonly treat conditions that narrow the airway just below the vocal cords. At this level, the airway is enclosed by two cartilaginous structures: the cricoid and the trachea. The cricoid lies just below the Adam’s apple (thyroid cartilage). The trachea connects the cricoid to the lungs; part of the trachea is in the neck and part is in the lungs.
Subglottic stenosis describes a narrowing at the level of the cricoid cartilage. The obstruction can be due to fracture or narrowing of the cartilage or it can be due to swelling of the soft tissue inside. The condition causes a high-pitched wheezing-like noise when inhaling and sometimes when exhaling. This noise is called “stridor” and can become worse with exertion. It is often misdiagnosed as asthma. The wheezing seen during asthma is produced only during exhalation.
Sometimes stenosis is caused by scarring from trauma to the throat, if a tube is placed in the throat during surgery. Many times the stenosis is “idiopathic,” meaning there is no known cause. Idiopathic stenosis occurs more commonly in women.
Tracheal stenosis is a narrowing of the trachea (windpipe) below the vocal cords. It also causes difficulty breathing and stridor, a wheezing noise that can be brought on by exertion. The condition can progress so the stridor occurs even during rest, simple exertion or sleep.
Tracheomalacia is a condition in which the walls of the windpipe (trachea) are very weak or soft. Usually this occurs at the non-cartiliginous back wall of the trachea. The symptoms of tracheomalacia include noisy breaths, wheezing (especially at the end of expiration) and breathing difficulty.
We also treat airway conditions that affect the airway at the level of the vocal cords (also called vocal folds, or voice box). The vocal cords lie below the back of the tongue inside the thyroid cartilage, commonly called the Adam’s apple.
Conditions that narrow the airway at the level of the cords include:
- Bilateral paralysis of the vocal cords
- Glottis stenosis (narrowing of the area containing the vocal cords [glottis])
- Vocal dysfunction
- Subglottic stenosis that affects the voice
Diagnosis and Treatment
For diagnosis, scopes are inserted into the throat through the nose or mouth. These minimally invasive procedures limit the need for external neck incisions.
Breathing techniques, such as closing the mouth when you breathe out, can ease breathing in patients with tracheomalacia. In other conditions, breathing is improved by certain exercises that increase the strength of the breathing muscles.
Continuous positive airway pressure (CPAP) may be helpful if a narrowed airway disrupts your sleep. While you are sleeping, you wear a mask over your mouth and nose. The mask is connected to a pump that provides airflow into your nasal passages to keep your airway open.
Minimally Invasive Procedures
Dilation is an outpatient procedure to enlarge the airway narrowing and restore better air flow. With endoscopy, our physicians can insert a scope into the narrowed airway to make small incisions and inflate a balloon in the narrowed area to stretch and increase the size of the airway. You also receive an injection of steroids to decrease inflammation. If narrowing recurs over time, the dilation can be repeated.
Surgeons occasionally insert airway stents into the airway to keep it open or to prevent new scarring. The stent can be used as a short-term or long-term solution for a narrowed or weakened airway.
Resection is an operation to surgically remove the narrowed area if dilation fails. After removing the constricted area, the surgeon reconnects the areas of the airway above and below the problem area.