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Summary:
what interventions are available?

The following pages describe the various surgical approaches in more detail, however, here is a summary of the surgical, medical, and adjunct therapies you may come across in your treatment: 

Surgical procedures

Medical therapies

Complementary therapies 

ENDOSCOPIC (Using a flexible tube, inserted via the nose or mouth)o Endoskopische Dilatation der Luftröhre (mit oder ohne Schnitt oder Laser, mit oder ohne topisches oder injiziertes Kortikosteroid, mit oder ohne Mitomycin-C)

  • Endoscopic tracheal dilation/dilatation (with or without cuts or laser, with or without topical or injected corticosteroid, with or without Mitomycin-C) o Endoscopic resection with laser and medical therapies (e.g., antibacterial, inhaled corticosteroids, anti-reflux) o Endoscopic tracheal reconstruction (Maddern technique)

 

​OPEN ANTERIOR NECK SURGERY

  • Cricotracheal resection

  • Laryngotracheoplasty:

    • Cartilage tracheoplasty

    • Slide tracheoplasty

  • Tracheostomy (rare)

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IMMUNOTHERPY to inhibit immune system response

Your doctor may suggest immune suppressant medication if you have inflammation in your airway, and/or a quickly returning stenosis (6mthly or more often) even if you haven’t tested positive for vasculitis (e.g. GPA). This may include one or more of the following drugs:

  • Rituxan/Rituximab

  • Mycophenolate mofetil (MMF)/ Cellcept

  • Methotrexate (MTX)

  • Azathioprine/Imuran

  • Cyclophosphamide/Cytoxan 

ANTIBIOTICS to tackle bacteria which may be causing inflammation

  • Bactrim, a sulpha drug

  • Azithromycin

  • Erythromycin, if allergic to sulpha drugs

 

CORTICOSTEROIDS to inhibit fibroblast formation and reduce inflammation

  • Oral tablet (e.g. prednisone)

  • Oral inhalation (e.g.nebulized albuterol, budesonide, eg., pulmicort)

  • Injected (e.g., triamcinolone, i.e. Kenalog, between dilations inoffice or "awake")

 

PROTON-PUMP INHIBITORS (PPIs)to reduce gastric acid reflux (GERD) if this is an issue for you’.

 

It is not recommended PPIs are taken for longer than 6 months.

 

Please talk to your doctor if you have been taking these for longer – research has shown prolonged use leads to decreased intestinal absorption of calcium resulting in negative calcium balance, increased osteoporosis, development of secondary hyperparathyroidism, increased bone loss and increased fractures.

 

Sodium alginate liquid

HYDRATION to keep mucus thin and slippery (not thick and sticky) and to keep vocal folds moist

  • Internal hydration:

    • Drink plenty of water

    • Reduce caffeine and alcohol

  • External hydration:

    • Steam inhalation

    • Nebulisation with sodium chloride solution

    • Warm air room humidification

    • Nasal rinse

    • Nasal spray

 

MUCOLYTIC THERAPY to help expel mucus

Mucolytic medication:

  • OTC expectorant cough syrup (e.g., guaifenesin)

  • Throat lozenge with glycerine, pectin, or slippery elm (not menthol or eucalyptus)

  • Amino acid (N-Acetyl Cysteine, NAC):

    • OTC oral capsule

    • Oral inhalation (nebulized NAC, i.e., Mucomyst)

 

Airway Clearance Technique or Device:

  • ‘Huff cough or ‘’huffing exercise

  • Flutter valve, e.g., Acapella

 

LIFESTYLE CHANGES

  • Dietary change, anti-inflammatory diet, anti-reflux diet

  • Weight loss

  • Vitamins, herbs

  • Probiotics

  • Enzymes (e.g. bromelain)

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