Tracheal Disorders Overview Vector

Tracheal Disorders: Types, Symptoms, and Treatment (2024)

by | Updated: Feb 9, 2024

The trachea, commonly known as the windpipe, is a vital part of the respiratory system. It serves as the main conduit for air to move from the nose and mouth to the lungs.

Various conditions can affect the trachea, impacting respiratory function and overall health.

This article provides a comprehensive overview of the types of disorders that affect the trachea, including their causes, symptoms, diagnostic procedures, and the latest treatment options. 

What is the Trachea?

The trachea is a cylindrical tube made of rings of cartilage, which are connected by muscles and ligaments. These cartilage rings maintain the trachea’s shape, preventing it from collapsing and ensuring an unobstructed passage for air. The trachea begins just under the larynx and extends down behind the sternum. There, it divides into two smaller tubes called the bronchi, each leading to a lung.

Trachea Vocal Cords Anatomy Vector

The inner lining of the trachea is composed of ciliated epithelial cells and mucus-producing cells. This lining plays a vital role in the respiratory defense system.

The mucus traps inhaled particles like dust and microbes, while the cilia (i.e., tiny hair-like projections) move these trapped particles upward toward the larynx, where they can be coughed out or swallowed.

This mechanism is essential in keeping the lungs clear of contaminants and preventing respiratory infections.

An interesting aspect of the trachea is its ability to adjust its diameter, allowing more air to pass through during intense physical activity and less during rest.

The trachealis muscle, which spans the gap between the ends of the cartilage rings at the back of the trachea, makes this adjustment possible.

When this muscle contracts, it narrows the trachea, and when it relaxes, the trachea widens.

Moreover, the trachea’s position in the neck makes it susceptible to injury, and its role in air passage means that any obstruction, whether from swelling due to an allergic reaction, compression from outside, or an ingested object, can be life-threatening.

Therefore, understanding and maintaining the health of the trachea is essential for overall respiratory health.

What is a Tracheal Disorder?

A tracheal disorder refers to any medical condition that affects the trachea and its ability to carry air to and from the lungs. Disorders can include structural abnormalities, obstructions, inflammation, or traumatic injuries. They can potentially impact breathing and require medical attention for diagnosis and treatment.

Tracheal Disorder Inflammation Trachea Vector

Types of Tracheal Disorders

  1. Tracheitis
  2. Tracheal stenosis
  3. Tracheomalacia
  4. Tracheoesophageal fistula
  5. Tracheal tumors
  6. Foreign bodies in the trachea
  7. Tracheal trauma
  8. Tracheal compression
  9. Gastroesophageal reflux disease (GERD)

Tracheitis

Tracheitis is an inflammation of the trachea, often characterized by a bacterial infection following an initial viral infection of the upper respiratory tract.

This condition can cause severe breathing difficulties and a barking cough, resembling symptoms of croup.

The most common cause of bacterial tracheitis is Staphylococcus aureus.

Patients typically exhibit symptoms like high fever, difficulty breathing, hoarseness, and stridor – a high-pitched wheezing sound indicative of airway obstruction.

Tracheitis is more common in children but can affect adults, particularly those with weakened immune systems.

Treatment usually involves antibiotics to combat the bacterial infection and sometimes requires hospitalization for close monitoring and supportive care, including oxygen therapy or breathing support in severe cases.

Tracheal Stenosis

Tracheal stenosis refers to the narrowing of the trachea, which restricts airflow and makes breathing difficult. This condition can be congenital or acquired later in life.

Acquired tracheal stenosis is often a result of prolonged intubation or tracheostomy, where the insertion of tubes causes scarring and narrowing of the trachea.

Other causes include trauma, autoimmune disorders, or infections.

Symptoms vary depending on the severity of the narrowing and may include shortness of breath, especially during exercise, wheezing, coughing, and stridor.

Diagnosis is usually made through imaging studies like CT scans and direct visualization using bronchoscopy.

Treatment options vary from surgical intervention, such as tracheal resection or balloon tracheoplasty, to non-surgical methods like steroid injections or stent placement.

Tracheomalacia

Tracheomalacia is a condition characterized by the weakening and floppiness of the tracheal walls.

This weakness causes the trachea to collapse, particularly when breathing out, leading to airway obstruction and difficulty in clearing secretions.

Tracheomalacia can be congenital, often associated with developmental anomalies like esophageal atresia, or it can develop later in life due to chronic infection, prolonged intubation, external compression, or chest surgery.

Symptoms include high-pitched or noisy breathing (i.e., stridor), recurrent respiratory infections, cough, and, in severe cases, breathing difficulties that may require emergency intervention.

Diagnosis is typically made through bronchoscopy, which allows direct visualization of the trachea.

Management varies based on severity, ranging from conservative monitoring and treating associated conditions to surgical interventions like aortopexy or tracheal stenting to support and stabilize the tracheal walls.

Tracheoesophageal Fistula

A tracheoesophageal fistula is an abnormal connection (i.e., fistula) between the trachea and the esophagus.

This condition is most commonly congenital and often presents alongside esophageal atresia, a condition in which the esophagus does not form properly.

However, it can also occur later in life due to trauma, cancer, or following surgical procedures involving the esophagus or trachea.

In newborns, symptoms include coughing, choking, and cyanosis (i.e., bluish skin) during feeding, and in adults, recurrent respiratory infections, coughing, and difficulty swallowing.

A tracheoesophageal fistula allows food and saliva to enter the lungs, leading to aspiration, pneumonia, and other respiratory complications.

Diagnosis is typically made through imaging studies and endoscopic evaluations.

Treatment usually involves surgical correction to separate the trachea and esophagus and repair the fistula, which is critical to prevent life-threatening complications.

In adults, non-surgical options like stent placement may be considered depending on the underlying cause and the patient’s overall health.

Tracheal Tumors

Tumors in the trachea are relatively rare and can be benign or malignant.

Benign tumors, such as papillomas or chondromas, typically grow slowly and might not cause symptoms until they are large enough to obstruct the airway.

Malignant tumors, like squamous cell carcinoma or adenoid cystic carcinoma, are more aggressive and can invade surrounding tissues.

Symptoms of tracheal tumors include difficulty breathing, wheezing, coughing (sometimes with blood), and recurrent respiratory infections.

The symptoms often mimic those of more common respiratory conditions, which can lead to delays in diagnosis.

Diagnostic tools include imaging studies like CT scans and bronchoscopy.

Treatment depends on the type, size, and location of the tumor, as well as the overall health of the patient.

Options may include surgical removal of the tumor, radiation therapy, chemotherapy, or a combination of these. In some cases, palliative care to relieve symptoms and improve quality of life is the main focus of treatment.

Foreign Bodies in the Trachea

The inhalation of foreign objects into the trachea is a significant and potentially life-threatening event, particularly common in young children.

Small objects, such as toys, food particles, or other small items, can become lodged in the trachea, causing partial or complete airway obstruction.

Symptoms include sudden onset of coughing, choking, inability to speak or breathe, wheezing, and in severe cases, cyanosis. Immediate medical attention is crucial.

The Heimlich maneuver or back blows may be used to dislodge the object in emergency situations.

In a medical setting, bronchoscopy is often employed both to confirm the presence of a foreign body and to remove it.

Prevention, especially in children, involves supervision and keeping small objects out of reach.

Tracheal Trauma

Tracheal trauma can result from either blunt or penetrating injuries to the neck and chest. This can occur due to accidents, falls, sports injuries, or acts of violence.

The trachea’s susceptibility to injury stems from its location and relatively exposed position in the neck.

Symptoms of tracheal trauma vary depending on the severity and type of injury but may include pain, difficulty breathing, hoarseness, coughing up blood, swelling in the neck, and subcutaneous emphysema (i.e., air trapped under the skin).

Tracheal trauma is a medical emergency due to the risk of airway obstruction and respiratory failure.

Immediate medical attention is crucial, and treatment often involves securing the airway, possibly through intubation or a tracheostomy, and addressing the underlying injury, which may require surgical repair.

The prognosis depends on the extent of the injury and the speed of medical intervention.

Tracheal Compression

Tracheal compression refers to the narrowing or constriction of the trachea, often caused by external pressure from surrounding structures such as tumors, enlarged thyroid glands, or abnormal blood vessels.

Conditions like mediastinal masses, cysts, or lymphadenopathy can also contribute to this compression.

The physical constriction impedes normal airflow, leading to respiratory difficulties. Symptoms may include shortness of breath, wheezing, stridor, recurrent respiratory infections, or a feeling of tightness in the throat.

Diagnosis typically involves imaging studies like CT scans or MRI to identify the compressing factor, along with pulmonary function tests to assess the impact on breathing.

The management of tracheal compression depends on the underlying cause. Treatments may range from medical management to alleviate symptoms to surgical intervention to remove the compressive factor or reconstruct the trachea. In some cases, stenting may be required to keep the trachea open.

Prompt diagnosis and tailored treatment are crucial in preventing the progression of severe respiratory compromise and ensuring the best possible outcome for the patient.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a condition where stomach acid frequently flows back into the esophagus, the tube connecting the mouth and stomach.

This backwash (i.e., acid reflux) can irritate the lining of the esophagus and, in some cases, affect the trachea.

When stomach acid enters the trachea, it can cause inflammation and spasms, leading to symptoms like chronic cough, hoarseness, or worsening of asthma symptoms.

This condition, known as laryngopharyngeal reflux (LPR), is a variant of GERD and can impact the trachea and larynx.

Diagnosis often involves a detailed medical history, laryngoscopy to view the throat, and sometimes esophageal pH monitoring to measure acid levels.

Management of GERD-related tracheal symptoms typically includes lifestyle changes, such as dietary modifications and weight loss, along with medications that reduce stomach acid. In severe cases, surgery may be considered to prevent reflux.

Managing GERD effectively is crucial to prevent complications and improve quality of life.

FAQs About Tracheal Disorders

What is the Most Common Disorder of the Trachea?

Tracheal stenosis is among the most common disorders of the trachea. It involves the narrowing of the trachea, which can arise due to prolonged intubation, chronic infections, autoimmune conditions, or external trauma.

This narrowing obstructs the airflow, leading to breathing difficulties and reduced oxygen intake.

What Does Tracheal Stenosis Feel Like?

Individuals with tracheal stenosis often experience symptoms such as shortness of breath, especially during physical exertion, wheezing, frequent bouts of pneumonia or bronchitis, a high-pitched breathing sound (i.e., stridor), and sometimes coughing up blood.

The sensation is typically described as a tightening in the throat or a constant need to clear the throat, making breathing laborious and uncomfortable.

What is the Treatment for a Tracheal Disorder?

The treatment for a tracheal disorder varies based on the specific condition and its severity. Treatments can range from conservative approaches like bronchodilators and corticosteroids to reduce inflammation and ease breathing, to more invasive procedures.

Surgical options include tracheal resection and reconstruction for stenosis, stenting to keep the trachea open, or a tracheostomy for severe blockages. The choice of treatment is tailored to the individual’s condition, overall health, and the underlying cause of the tracheal disorder.

How Do You Know if Your Trachea Is Inflamed?

If your trachea is inflamed, a condition known as tracheitis, you may experience symptoms such as a persistent cough, pain or discomfort in the throat, difficulty breathing, hoarseness, and a high-pitched sound when breathing.

Fever and a general feeling of malaise can also accompany these symptoms. The inflammation can make the trachea very sensitive and prone to irritation, leading to these distinctive signs.

What Condition Causes Inflammation of the Trachea?

Tracheitis, the inflammation of the trachea, can be caused by bacterial, viral, or fungal infections. Bacterial tracheitis is often a secondary infection following a viral illness, leading to a more severe condition.

Inhalation of irritants, such as smoke or chemical fumes, or autoimmune conditions like Wegener’s granulomatosis can also lead to tracheal inflammation.

When to See a Doctor for a Tracheal Disorder?

You should seek medical attention for a tracheal disorder if you experience symptoms such as difficulty breathing, persistent coughing, unexplained wheezing, coughing up blood, or a high-pitched sound when breathing.

Additionally, if you notice swelling in your neck, have trouble swallowing, or feel a severe tightness in your throat, it’s crucial to see a doctor.

These symptoms can indicate a serious condition that requires prompt diagnosis and treatment to prevent complications like airway obstruction or respiratory failure.

Final Thoughts

The trachea plays a crucial role in the respiratory system and overall health.

Tracheal disorders, ranging from infections and inflammation to structural abnormalities and traumatic injuries, can significantly impact breathing and quality of life.

Understanding the various disorders that can affect the trachea, their symptoms, and treatment options is essential for healthcare providers and patients alike.

This knowledge not only aids in timely and effective treatment but also underscores the trachea’s importance in respiratory health and the need for its protection and care.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Mieczkowski B, Seavey BF. Anatomy, Head and Neck, Trachea. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
  • Al-Qadi MO, Artenstein AW, Braman SS. The “forgotten zone”: acquired disorders of the trachea in adults. Respir Med. 2013.

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