Endoscopic balloon dilation for subglottic or tracheal stenosis

The condition

3.1 Subglottic or tracheal stenosis is a narrowing of the airway. It can be congenital, traumatic or, most commonly, iatrogenic after prolonged endotracheal intubation. Symptoms include hoarseness, stridor, exercise intolerance and respiratory distress. In severe cases complete obstruction may happen, needing continued intubation or tracheostomy.

Current treatments

3.2 Treatment options include inhaled or oral steroids to treat inflammation and reduce the severity of stenosis. A cricoid-split operation can decompress the subglottis and prevent development of stenosis in babies. For people with severe and established stenosis, endoscopic techniques such as stent insertion or laser ablation are used. Alternatively, open surgical repair is done to increase the diameter of the stenosed segment with a graft or stent (expansion surgery) or to remove the stenotic area (resection surgery).

The procedure

3.3 The aim of endoscopic balloon dilation is to dilate airway strictures with minimal mucosal trauma by applying pressure to an area of stenosis. The procedure is most commonly done on iatrogenic stenoses, which are typically soft. It is less commonly done on harder, established stenoses.

3.4 The procedure is usually done under general anaesthesia, using direct laryngoscopic or bronchoscopic visualisation. A balloon device is introduced into the airway and the balloon is gently inflated, applying radial pressure circumferentially to the stricture. After dilation, the balloon is deflated and the device is withdrawn. The procedure may be used in combination with other treatments. It can be repeated if needed. The aim is to widen the stenotic airway and improve symptoms.