Medical disclaimer: This page is for educational purposes only. It does not constitute medical advice and must not be used as a substitute for consultation with a qualified doctor. Last reviewed May 2026 by Dr. Kunal Waghray, MD DM DNB MNAMS EDRM.
Tracheal Stenosis Treatment in Hyderabad
Most patients referred here for post-intubation tracheal stenosis carry a prior diagnosis of new-onset asthma. They have been on inhalers for weeks, sometimes months. The breathing difficulty is real, but bronchodilators do nothing for a scarred, narrowed windpipe.
The clue is stridor: a coarse, high-pitched noise on breathing in that does not ease with a puff of salbutamol. That single sign, in a patient who has been in an ICU, changes everything.
Dr. Kunal Waghray, MD DM DNB MNAMS EDRM, is an interventional pulmonologist in Hyderabad at Respire Airway Clinics, with consultation rooms at Basheer Bagh and Jubilee Hills. He manages tracheal stenosis using bronchoscopic techniques, offering patients a path to restored breathing without open chest surgery.
Why Tracheal Stenosis Develops After Intubation
The role of the endotracheal tube cuff
When a patient is placed on mechanical ventilation, an endotracheal tube is inserted through the mouth or nose into the trachea. The tube is held in place by an inflatable cuff that presses against the tracheal wall. If cuff pressure is too high, or if intubation lasts more than a few days, that pressure compresses the blood vessels supplying the tracheal mucosa. The tissue loses its blood supply, a process called ischaemic injury.
How scar tissue forms
The ischaemic area breaks down, ulcerates, and heals with scar tissue rather than normal airway lining. As the scar matures over several weeks, it contracts into a ring-like stricture. The tracheal lumen narrows. The narrowing does not appear immediately. Most patients are extubated, discharged from the ICU, and feel well for two to eight weeks before progressive breathlessness begins. Because the timeline is separated from the hospital stay, the connection is frequently missed.
Post-COVID ICU admissions made this problem more visible across India. Patients who required prolonged mechanical ventilation during the 2020–2022 waves now present years later with progressive exertional breathlessness.
“The referral pattern I see most often is a patient who was discharged from a medical or surgical ICU, managed as asthma for six to twelve weeks, and then sent to me because inhalers stopped working entirely. When I pass the bronchoscope, I find a tight scar ring at the cuff site, sometimes reducing the airway to under eight millimetres. The good news is that in most of these cases, we can restore the airway without surgery.”
How Tracheal Stenosis Is Diagnosed
CT scan of the neck and chest
A CT scan with thin sections through the neck and chest gives a precise anatomical map of the stenosis. It shows the location, length, and degree of narrowing. Three-dimensional reconstruction lets the treating team measure the tracheal diameter above and below the stricture before any procedure. CT cannot assess the nature of the tissue, whether the cartilage is intact, or whether the stenosis is simple or complex. It is a roadmap, not a final answer.
Spirometry and the flow-volume loop
In tracheal stenosis, the flow-volume loop shows a characteristic fixed obstruction pattern, sometimes called the “box pattern.” Both the inspiratory and expiratory limbs flatten, unlike asthma, which shows only expiratory limitation. This pattern appears reliably once the tracheal diameter falls below roughly eight to nine millimetres.
Flexible bronchoscopy: direct assessment and grading
Bronchoscopy is the definitive diagnostic step. It allows direct visualisation of the stricture, its position relative to the vocal cords and carina, its circumferential extent, and whether associated tracheomalacia is present. Bronchoscopy also permits tissue biopsy when the cause is unclear, and it grades the stenosis using the Cotton-Myer classification, which directly guides the treatment decision.
Severity Grading: The Cotton-Myer System
The Cotton-Myer grading system classifies tracheal and subglottic stenosis by the percentage of airway lumen remaining. The grade determines first-line treatment. Morphology matters as much as grade: a short, web-like, simple stenosis responds well to endoscopic treatment, while a long-segment complex stenosis with cartilage damage is more difficult to treat bronchoscopically.
0–50% obstruction
Often asymptomatic or mildly symptomatic; bronchoscopic treatment as first line
51–70% obstruction
Symptomatic on exertion; bronchoscopic dilation with or without laser
71–99% obstruction
Significant symptoms at rest or on minimal exertion; may require repeat procedures or stenting
Complete obstruction
Surgical evaluation required; bronchoscopic bridging may be needed urgently
Bronchoscopic Treatment Approaches at Respire
The choice of technique depends on stenosis grade, morphology, and whether the narrowing is soft (early scar) or firm (mature fibrosis). Several techniques are often used together in a single session.
Balloon dilation (tracheoplasty)
A deflated balloon catheter is passed through the bronchoscope and positioned across the stenosis. The balloon is inflated under controlled pressure, stretching the scar tissue radially. Balloon dilation alone works best in early, soft scar tissue. Mature fibrotic strictures need additional techniques.
Laser-assisted radial incision
For firm, established scar rings, laser-assisted dilation produces better outcomes. Two to three radial incisions are made through the fibrotic tissue using a Holmium YAG or diode laser, and the resulting segments are then dilated. This mucosal-sparing approach reduces the risk of restenosis compared to unguided dilation. Most patients need two to three sessions over several months.
Airway stenting
When stenosis recurs rapidly after repeated dilation, a stent may be placed to keep the airway open. Silicone stents (Dumon stents) and self-expanding metallic stents (SEMS) each have specific indications. Silicone stents can be removed after a period of tissue remodelling.
More on airway stenting→Mitomycin C application
Mitomycin C, applied topically to the treated area after dilation, inhibits fibroblast proliferation and reduces re-scarring. A meta-analysis of 15 studies covering 387 patients found that patients receiving mitomycin C were four times more likely to remain symptom-free beyond one year compared to those who did not (Ravikumar et al., J Thorac Dis, 2023).
Intralesional triamcinolone
Intralesional triamcinolone injection is particularly useful when the stenosis has an autoimmune or inflammatory component, achieving airway patency in approximately 75% of patients at two years in that subset.
What to Expect on the Day of Treatment
Patients fast from the night before. On arrival at Respire's clinic at Basheer Bagh or Jubilee Hills, a short pre-procedure assessment confirms the plan. The procedure is performed under intravenous conscious sedation. Most patients do not require general anaesthesia.
The bronchoscope is passed through the nose or mouth, the stenosis is located, and the chosen technique is applied. Most sessions last between 30 and 60 minutes.
Recovery takes one to two hours. The majority of patients are discharged the same day. A follow-up bronchoscopy is typically scheduled at four to six weeks to assess the airway and plan the next steps.
When to contact the clinic after the procedure
- Breathlessness becomes suddenly worse within 24 to 48 hours of discharge
- Fever above 38.5°C with increased cough or coloured sputum
- Significant bleeding beyond a small pink tinge in the first day
- Voice that becomes progressively worse rather than returning to baseline
Success Rates and Long-Term Follow-Up
A detailed review published in the Journal of Thoracic Disease reports cure rates of 60% to 95% for post-intubation stenosis after two to three treatment sessions, with simple, web-like stenoses achieving 96% resolution compared to 79% in complex cases (Ravikumar et al., J Thorac Dis, 2023; PMCID: PMC10407490).
A 2024 multicentre Indian study, including Aster Hospitals, Bangalore, reported an 86.6% bronchoscopic success rate with no post-procedure complications such as pneumothorax or significant bleeding (Alaga et al., Respirology Case Reports, 2024; PMCID: PMC11381110).
Recurrence is most common in long-segment stenoses and in patients with ongoing inflammatory conditions. Patients who require more than three bronchoscopic sessions without sustained improvement are typically referred for surgical evaluation, specifically tracheal resection and end-to-end anastomosis. Long-term surveillance with periodic bronchoscopy helps detect early re-narrowing before symptoms return.
These figures reflect published cohort studies, not individual outcome predictions. Actual results depend on stenosis severity, morphology, underlying cause, and follow-up adherence.
Why an Interventional Pulmonologist for Airway Stricture
General pulmonologists diagnose and manage respiratory conditions with medications. Thoracic surgeons resect and reconstruct airways. The interventional pulmonologist sits between those two roles, performing therapeutic bronchoscopy procedures that do not require a surgical incision.
For post-intubation tracheal stenosis, an interventional pulmonologist trained in airway techniques is the appropriate first specialist, not a thoracic surgeon, unless endoscopic options have been exhausted.
Dr. Kunal Waghray completed his DM in Pulmonary Medicine and received advanced training in interventional pulmonology at Amrita Institute of Medical Sciences, Kochi, one of India's leading bronchoscopy training centres. He performs balloon dilation, laser-assisted resection, and stent placement at Respire Airway Clinics in Hyderabad.
Referrals from ICU teams
Direct referrals from intensivists and medical ICU consultants are welcome.
Cross-state referrals
Accepting referrals from chest physicians across Telangana and Andhra Pradesh.
Frequently Asked Questions
What causes tracheal stenosis after intubation?
The endotracheal tube cuff, when over-inflated or left in place for several days, compresses the blood supply to the tracheal wall. The damaged tissue heals as fibrotic scar tissue, which contracts into a ring-like narrowing. Symptoms usually appear two to eight weeks after the patient is discharged from the ICU.
Can tracheal stenosis be treated without surgery?
In many cases, yes. Bronchoscopic techniques including balloon dilation, laser-assisted radial incision, and stent placement can restore airway calibre without open surgery. Surgery is reserved for cases that do not respond to repeated bronchoscopic treatment or for long-segment stenoses with cartilage destruction.
How many bronchoscopic sessions are needed?
Most patients with simple, short-segment stenosis need two to three sessions over several months. Complex stenoses may require more. Each session is followed by a bronchoscopy at four to six weeks to assess the response.
Is tracheal stenosis permanent?
Without treatment, scar tissue does not resolve on its own. With appropriate bronchoscopic or surgical treatment, most patients achieve a durable improvement in airway diameter and symptoms. Some patients with complex stenosis require periodic maintenance bronchoscopy to prevent re-narrowing.
What is the difference between tracheal stenosis and subglottic stenosis?
Tracheal stenosis refers to narrowing of the trachea below the vocal cords. Subglottic stenosis is a narrowing in the subglottis, the narrow segment immediately below the vocal cords. Both can result from intubation, and they often coexist. The Cotton-Myer grading system was originally developed for subglottic stenosis and is now applied to both locations.
How long is recovery after bronchoscopic dilation?
Most patients are discharged on the same day. A mild sore throat and temporary hoarseness are common for 24 to 48 hours. Strenuous activity is best avoided for a day or two. Return to normal daily activities is expected within 48 hours for most patients.
Can tracheal stenosis come back after treatment?
Recurrence is possible, particularly in complex stenoses or when the underlying cause is ongoing. Mitomycin C application and steroid injection reduce the rate of re-scarring. Scheduled follow-up bronchoscopy allows early detection of recurrence before symptoms return to baseline.
Clinical References
- Ravikumar N, Ho E, Wagh A, Murgu S. The role of bronchoscopy in the multidisciplinary approach to benign tracheal stenosis. J Thorac Dis. 2023;15(7):3998–4015. PMCID: PMC10407490.
- Alaga A, et al. Management of postintubation tracheal stenosis with bronchoscope methods: An experience from two centers. Respirology Case Reports. 2024;12(9):e70014. PMCID: PMC11381110.