If stridor is caused by a narrowing of the airway, NYU Langone doctors may recommend surgery.
Our experts at the Voice Center often use a minimally invasive procedure called endoscopy, in which surgery is performed using a slender tube called an endoscope inserted through the mouth or nose.
A doctor may recommend airway dilation if the results of diagnostic tests indicate that you have subglottic stenosis, a narrowing of the airway below the vocal cords, or tracheal stenosis, a narrowing of the trachea, or windpipe. Airway dilation can make breathing easier. It is usually performed on an outpatient basis.
In this procedure, the surgeon inserts a long, thin tube called a catheter, which has a small, deflated balloon attached to it, into the mouth or nose and passes it into the narrowed area of the airway. He or she positions the balloon, then uses a handheld pump to gently inflate it. Often, the surgeon may use lasers or other instruments before inflating the balloon to help treat the stenosis.
As the balloon inflates, or dilates, it stretches soft tissue or scar tissue inside the airway, widening the space so that more air is able to pass to and from the lungs. After a few seconds, the doctor deflates the balloon and removes the catheter.
You may feel some discomfort in your throat and airway for a few days after surgery. This can be treated with over-the-counter pain medication such as acetaminophen. You return for a follow-up visit a few weeks after the procedure so the doctor can perform a laryngoscopy to see whether the airway has remained open.
If stenosis returns, doctors may perform the balloon dilation procedure again over the course of a few months or recommend surgery to remove tissue that is blocking the airway.
If the cause of stridor is bilateral vocal cord paralysis, a doctor may recommend arytenoidectomy. This procedure widens the airway by removing some of the arytenoid cartilage, which is attached to the vocal cords and can narrow the airway. This type of surgery is performed under general anesthesia.
During the surgery, the doctor inserts an endoscope through the mouth and often uses a laser to remove the arytenoid cartilage. The amount of cartilage removed depends on the extent to which the airway is narrowed. As your body heals, a small gap is left between the vocal cords, which allows you to breathe more easily and with less noise.
If stridor developed as a result of inhaling an object, such as a piece of food, the object can remain stuck inside the trachea. Your doctor may recommend a procedure called a bronchoscopy to remove the object.
This procedure is performed under general anesthesia. The surgeon inserts a long, slim instrument with a camera on the end, called a bronchoscope, through your nose or mouth and passes it into the lungs. The bronchoscope sends an image of the airway and lungs to a computer monitor. The doctor uses the image to position a grasping device attached to the bronchoscope near the object. He or she uses the grasping device to retrieve the object and then slowly removes the bronchoscope, and the object, from the airway.
Bilateral vocal cord paralysis may require a procedure called a cordectomy to widen the airway by removing a vocal cord. During this procedure, which is performed under general anesthesia, the surgeon inserts the endoscope through the mouth and into the larynx. He or she removes a portion of the vocal cord by using either a small surgical instrument placed into the scope or a laser beam.
If endoscopic techniques do not eliminate the noisy breathing, open surgical procedures may be needed. These may include tracheal resection, in which a surgeon removes the constricted section of the trachea and rejoins the ends, or a laryngotracheal reconstruction, which widens the airway.
Other surgical procedures, such as implanting a stent, which is a type of surgical scaffolding, can also keep the airway open and reduce stridor.
Open surgical procedures are complex, and experts at the Voice Center are experienced in performing these specialized surgeries.
Tracheostomy, which is the insertion of a tube into the trachea through the neck to enable easier breathing, may also be performed. Many people who come to the Voice Center have tracheostomy tubes. Our doctors develop treatment plans for each person with the goal of eventually being able to remove the tube. Until that time, NYU Langone doctors can instruct you in its care and maintenance.