Some patients undergo a surgery known as a tracheostomy (or tracheotomy), which is the placement of a specialized plastic breathing tube in the neck. This can be done for a variety of reasons, including:
Prolonged mechanical ventilation in an ICU (coma)
Obstruction of the upper airway by swelling or tumor
Scarring of the larynx causing restriction of the airway
Need for constant cleaning of the airway after brain injury
Severe, life-threatening obstructive sleep apnea
Keeping a tracheostomy tube in place requires a great deal of time and effort, and many patients are understandably looking for possible ways to have the tube removed. Dr. Rosow manages more tracheostomy patients than anyone in Florida and has extensive experience in endoscopic techniques and complex tracheal reconstruction for people with airway disorders.
Bilateral Vocal Fold Paralysis
The vocal folds come together and vibrate so that we can speak, sing, and perform a variety of functions. When we need to breathe, they open and allow air into the trachea (windpipe). There are some disorders that can cause one or both of the vocal folds to become paralyzed, or immobile. While we can survive with one vocal fold paralyzed, having both not moving leaves us with an airway the size of a coffee straw!
Signs of this disorder include difficulty breathing with activity and loud, noisy breathing. Treatment may require placement of a tracheostomy tube, or other endoscopic approaches.
Some patients can develop scar tissue in the trachea (windpipe) after being intubated. Intubation often happens in the setting of a surgery under general anesthesia, or in an emergency such as a cardiac arrest. Over time, the scar tissue can grow to the extent that the airway is the size of a pinhole, and breathing and speaking become very difficult. Sometimes this can happen in the setting of autoimmune conditions. Other patients, particularly women, can develop scar tissue for no apparent reason, a condition known as Idiopathic Subglottic Stenosis.
Dr. Rosow has special expertise in managing these conditions endoscopically -- most patients are able to avoid tracheostomy or other open surgeries. Occasionally, in more severe cases, a larger reconstructive surgery may be necessary. Since 2014, Dr. Rosow has been treating patients with airway stenosis using in-office injections of steroids to reduce the scar tissue. This new technique has tremendously improved the effectiveness of endoscopic surgery and helped numerous patients avoid more invasive surgeries.
This condition can happen episodically, sometimes during periods of extreme stress, during exercise, or sometimes for no reason at all. When it occurs, the vocal folds receive a scrambled signal from the nervous system, such that they try to close during breathing, rather than opening. This results in a narrowed airway and causes a distinctive musical sound during breathing. This can be an extremely worrisome experience, and it is important to have an ear, nose, and throat specialist (ENT) look down the throat to make sure nothing else is going on. In most cases of laryngospasm, simple breathing exercises can keep it under control.