[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]