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Suggest Treatment For Laryngo-tracheal Stenosis

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Posted on Mon, 29 Dec 2014
Question: This one may be very difficult but here goes. My husband August 31st had 9 code blues was hit with paddles 26 times, 3 vents, 3 feeding tubes down the throat, has a trach, feeding tube in the stomach, broken steptum, cracked ribs, etc. He is home now still with the trach and feeding tube. He pasted the swallow test at rehab but apparently has damage above the trach and airway doesn't allow air out but tiny amount in. If he lays down his oxygen goes down to 82-85 but if he immediately sets up it goes right back up to 92-95 day or night. We have been in 5 hospitals over the last 90 days but are not sure what kind of doctor would be involved with this issue. His first heart doctor was in Oklahoma City but when he had a relapse, he was taken to XXXXXXX and the new heart doctor says his heart is ok (the ICU nurses said Dr Sheneen is the best) and he would not have anyone take him to the cat lab, the lung doctor says it is not caused by the lungs, the gastorigist did the tests on the stomach and bowls and says ok. The ear, nose and throat surgeon who put in the trach says he did see something unusual above the trach and wants us to go to Kansas City but do not think it would be causing the oxygen drop do you? Have you ever heard of something like this one.
I also wanted to add that my husband lost 30 pounds in 30 days at Oklahoma Heart hospital, he had to have 2 blood transfusions because the blood count dropped to 6.7 and when he came home it was 8.3. It took me 24 days to get the blood count back up to 12 but then low potassium level took us to a local hospital who felt he needed more attention and that is how we ended up in XXXXXXX

He gained at home but at the rehad he again lost right down to where we were to begin. He currently is coming out of dirreah and I think we may be on the upward run with that.

We live in a remote area that does not have respiratory home health and we have had to learn much just to run the trach machines. Each day he seems to improve except for the weight.
doctor
Answered by Dr. Abubakar Siddiqh (21 minutes later)
Brief Answer:
laryngotracheal stenosis, requires evaluation.

Detailed Answer:

Hi,

I had gone through your question and understand your concerns that you husband had 9 code blues, doctor kept tracheal and feeding tube, he passed swallow test at rehab, he is now at home with tubes and apparently has damage above the trachea and airway doesn't allow air out but tiny amount in. If he lies down his oxygen goes down to 82-85 but if he immediately sets up it goes right back up to 92-95 day or night. You have visited Cardiologist, pulmonologist, gastroenterologist and ENT doctor (He told something unusual and asked you to go to Kansas City).


As per your clinical details, it appears to be (most likely) laryngo-tracheal stenosis .

It is common in patients, direct trauma to voice box or also seen in patients who are on endo tracheal tube along with feeding tube for prolonged period or trauma due to intubation.

They usually presents with desaturation (falling oxygen levels), hoarse voice and noisy breathing (stridor).



I suggest you to consult an ENT surgeon and get detailed ENT examination. laryngoscopy, CT SCAN neck to rule out the degree of obstruction. Treatment can be started according to the findings.


If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Wishing you good health

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Abubakar Siddiqh (7 hours later)
I had a call from my husbands primary doctors office yesterday and the nurse said that KU medical center doctors would not allow us to transfer him right into the hospital. They said without him being able to first have a office visit he would have to be driven up to the hospital and just brought into the ER. We have plenty of insurance (2) and we also have a ENT surgeon recommending from XXXXXXX plus a local ENT recommending if need be from Ponca City. The drive is 6 hours and he has much to go before we could make a drive like that - do you understand why they would require this?
doctor
Answered by Dr. Abubakar Siddiqh (1 hour later)
Brief Answer:
First ER, then office visit.

Detailed Answer:
Hello again,

Thanks for considering my answer and for your follow up.

I suggest you to stabilize his condition first by taking him to ER, and then plan to shift him to the particular centre as you have mentioned (6 hours journey).

Shifting/transferring the patient in this condition is it self a high risk.

Hope, I have answered your query.

Take care.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Answered by
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Dr. Abubakar Siddiqh

ENT Specialist

Practicing since :1994

Answered : 2038 Questions

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Suggest Treatment For Laryngo-tracheal Stenosis

Brief Answer: laryngotracheal stenosis, requires evaluation. Detailed Answer: Hi, I had gone through your question and understand your concerns that you husband had 9 code blues, doctor kept tracheal and feeding tube, he passed swallow test at rehab, he is now at home with tubes and apparently has damage above the trachea and airway doesn't allow air out but tiny amount in. If he lies down his oxygen goes down to 82-85 but if he immediately sets up it goes right back up to 92-95 day or night. You have visited Cardiologist, pulmonologist, gastroenterologist and ENT doctor (He told something unusual and asked you to go to Kansas City). As per your clinical details, it appears to be (most likely) laryngo-tracheal stenosis . It is common in patients, direct trauma to voice box or also seen in patients who are on endo tracheal tube along with feeding tube for prolonged period or trauma due to intubation. They usually presents with desaturation (falling oxygen levels), hoarse voice and noisy breathing (stridor). I suggest you to consult an ENT surgeon and get detailed ENT examination. laryngoscopy, CT SCAN neck to rule out the degree of obstruction. Treatment can be started according to the findings. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing you good health