Laryngeal Trauma from Intubation
People have been using tubes inserted down the throat for anesthesia since the 1880s. Endotracheal tubes became routine in anesthesia for thoracic (body cavity) surgery as early as 1910. Their acceptance then led to prolonged intubation in comatose patients and in conscious patients with respiratory diseases. Also, intubation became preferred in neonatal cases over tracheotomy (an incision in the windpipe) for childhood diseases and premature deliveries.
The problem is, it isn’t possible to leave a large anesthetic tube in the larynx without changes and damage occurring.
What begins as irritation, progresses to inflammation, congestion, and edema (excess fluid) within the first few hours after intubation. Although most of this damage usually heals naturally after the tube is removed, sometimes it doesn’t. That’s when the expertise of Coastal Ear, Nose, and Throat can be needed.
When Laryngeal Intubation Trauma Occurs
Different signs of trauma occur at various times after the tube is removed.
- Immediately — Severe obstruction caused by flap-like pieces of granulation tissue (tissue that forms at the site of an injury).
- In the first hours — Worsening obstruction caused by edema (swelling caused by excess fluid trapped in your body's tissues).
- In the first days — Partial obstruction and husky, weak voice caused by persistent edema and granulation tissue.
- Weeks later — Husky voice caused by a granuloma, a mass of granulation tissue.
- Months later — Increasing obstruction continues to develop as the airway below the vocal cords continues to narrow, due to increasing scar tissue.
What Can Happen?
Symptoms that can develop in a patient after intubation range from irritation and inflammation on the low end of the trauma scale up to complete stenosis (blockage) and vocal cord paralysis. When the mucous tissue doesn’t fully heal, granulation tissue can turn into granulomas. The patient will feel “something in there” and will have noisy breathing because the airway is being partially obstructed.
Persistent scar tissue can form on the edges of the vocal cords. This happens when the granulation tissue that initially formed during intubation resolves itself, leaving a fibrous nodule of scar tissue. This can affect the quality of your voice.
Posterior glottic stenois, a narrowing of the larynx at the level of the glottis, is created by scar tissue or webbing that continues to mature in the weeks following intubation. In severe cases it causes breathing problems during exertion and can evolve to nearly complete obstruction.
Diagnosis and Treatment
For all of these degrees of laryngeal trauma after intubation, the experts at Coastal Ear, Nose, and Throat can conduct various endoscopic procedures to remove granulomas, lesions, and cysts that form after intubation. We can use lasers to remove scar tissue or webbing, or at least break it up. Microsurgery is incredibly accurate, which is important when dealing with sensitive areas such as the vocal cords.
To gauge the extent of your trauma, we will likely opt to perform a direct laryngoscopy to identify the extent of the damage and possible courses of treatment.
Signs to Watch For
While most cases of laryngeal trauma from intubation resolve themselves over time, there are other symptoms to watch out for. If you notice hoarseness in your voice, tiring of the voice, a change in your timber or range, these can be signs of trauma that is not resolving itself and may need intervention. The same is true with breathing issues, as they are indicators of an obstruction in your airway.