Treatment of Complex Airway Disorders – FAQs

[MUSIC] Laryngotracheal stenosis is
a rare disease of scar that affects the airway, principally
the larynx and the trachea. It occurs probably, we don’t know
exactly, but new cases probably occur one in every 50,000
people in the United States. And if you think about what
the normal functions of the larynx are it’s to open and
close the vocal cords. And when we open we breath and it closes it’s how we
generate sound to speak. And if scare develops there, then you can have problems
opening your vocal cords. And you have a limited size to
the airway which translates into problems breathing. Similarly in the trachea which is
really just an air tube that takes air to your lungs. If you have a build
up of scar there, that can also lead to
problems with breathing. [MUSIC] So the principle symptom of
laryngotracheal stenosis is problems breathing, and it’s usually breathing when
you’re exerting yourself. So with activities of daily living,
such as walking upstairs or with exercise, I know that a lot of
my patients will stop exercising because it simply causes too
much stress on their system. So they just stop that activity or
other activities that cause that stress while normal activities
such as sitting down, standing up are usually okay and so many
people will ignore that symptom. Secondary symptoms
are affecting patient’s voice, where it can cause hoarseness. [MUSIC] There are three primary ideology or
causes o laryngotracheal stenosis, the most common is iatrogenic which
means that our breathing tube or a tracheostomy caused
the scar in your airway. Other causes, and these are probably
each a little bit less than a quarter of all causes would be
autoimmune disease, specifically granulomatosis with polyangiitis or
formally known as Wegener’s disease. Which can effect the airway, where scar builds up due
to a autoimmune cause. And then,
idiopathic subglottic stenosis. Idiopathic meaning we don’t
know what the cause is. But this is primarily affecting
homogeneous population of middle-aged Caucasian women
who are primarily affected by the idiopathic cause. And overall,
women tend to be disproportionately affected by
laryngotracheal stenosis. Both with the idiopathic cause and then probably because of in the
iatrogenic, the breathing tubes that we put in are a little bit too big
for their larynx and their trachea. [MUSIC] So often times patients with
laryngotracheal stenosis can have a winding course before
they’re accurately diagnosed. A lot of times their shortness of
breath is mistakenly diagnosed as asthma or another lung problem, primarily because that’s
a more common disease. But these patients don’t usually
respond to common asthma treatments such as inhalers. And they’re then usually referred to
a laryngologist, a thoracic surgeon or an interventional pulmonologist
who usually through laryngoscopy and or bronchoscopy identifies the scar. That is causing
the limitations in breathing. [MUSIC] Treatment options for
laryngotracheal stenosis can range from conservative treatment plans
such as observation especially in cases where individuals
aren’t as affected. Where their breathing
isn’t as affected. To endoscopic procedures, where the procedures are surgery
done through the mouth. And it can be ranged from cutting
out the scar either with an laser, or with scissors, to balloon dilatation of the scar In
an attempt to open up the airway. And those are usually chronic
procedures which are repeated at certain interval such as
six months to a year. Sometimes it stands to it’s
place endoscopically to stand to open the narrowed
area in the airway. And then, other procedures
can be opened meaning through the neck where the area
of scar is cut out and then the trachea zone back together. That would be a tracheal resection
or a trico-tracheal resection. And then, sometimes especially when
the larynx is involved we can’t cut out the larynx for this disease, because of what it could affect for
voice or breathing and swallowing. So what we’ll do is laryngotracheal
plasty where we put often times using cartilage graph will open up
the air way at the level of the, the vocal folds or at the level
of the cricoid cartilage, which is just below the vocal folds. [MUSIC] So at Johns Hopkins,
we have a complex airway clinic, which is unique. And that it’s a multidisciplinary
clinic that’s staffed by laryngologists. A thoracic surgeon and
an interventional pulmonologist. So we’re a full service clinic that offers the entire
gambit of treatment options. And also importantly, we have really a wealth of
experience in treating this disease, and I think that really can provide
in advantage when you are, one of the individuals who’s effected
by laryngotracheal stenosis. [MUSIC]