Diagnosis of idiopathic tracheal stenosis and treatment with papillotome electrocautery and balloon bronchoplasty.

Tracheal stenosis has numerous possible etiologies, including iatrogenic trauma from an over-inflated endotracheal/tracheostomy tube cuff, malignancy, chronic inflammatory diseases (eg, sarcoidosis), and various collagen vascular diseases (eg, Wegener disease, relapsing polychondritis). If an underlying etiology cannot be identified, the condition is termed idiopathic tracheal stenosis. First reported by Brandenburg in 1972, idiopathic tracheal stenosis is a condition of the upper trachea and occurs overwhelmingly in females, in their third to fifth decade of life.1,2 Patients with idiopathic tracheal stenosis typically present with symptoms of dyspnea, limited exercise tolerance, stridor, cough, and wheezing.1-3 Diagnosis of idiopathic tracheal stenosis is usually made after other causes have been ruled out, and may be concurrently made with taking of medical history and physical examination. The diagnosis is confirmed with chest radiograph, computed tomogram, pulmonary-function tests, and/or bronchoscopy. It has been suggested that gastroesophageal reflux disease can cause idiopathic tracheal stenosis, and some authors have reported improvement in idiopathic tracheal stenosis with treatment for gastroesophageal reflux disease.4-6 An accurate diagnosis and proper treatment plan are required to restore an adequate patent airway in a patient with idiopathic tracheal stenosis. The definitive treatment routinely entails single-stage laryngotracheal resection. Successful airway restoration and voice preservation occurs in more than 90% of patients; however, post-procedural tracheal scarring and stenosis recurrence are potential complications.7 Factors determining surgical resection versus endoscopic management include the patient’s age; location, size, and appearance of the stenosis; comorbidities; and previous interventions.8