Robert Lebovics, MD, has a famous observation in his practice: “It is amazing what you can see when you just take a look.” As an ear, nose, and throat physician who has specialized in treating autoimmune disorders that impact the airway for more than three decades, he likes to think of himself as the eyes and ears of his patients and other medical specialties—looking at places inside the nose, mouth, and windpipe where they cannot see.
Robert S. Lebovics, MD, FACS, Site Chair of Otolaryngology-Head and Neck Surgery and Co-Director of the Airway Center at Mount Sinai West
Autoimmune disorders occur when the body’s immune system mistakenly attacks healthy tissue and can cause significant damage to the upper airway.
Disorders like Sjogren’s syndrome, Systemic Lupus Erythematosus, and asthma, as well as rare conditions like granulomatosis with polyangiitis (GPA or Wegener’s granulomatosis), eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome), relapsing polychondritis, and sarcoidosis, can cause inflammation to develop within the airway that restricts both blood and air flow. Patients may experience symptoms like coughing, voice changes, facial pain, loss of smell, and difficulty breathing, swallowing, or hearing.
“The airway is ultimately a pipe system,” says Robert Lebovics, MD, Site Chair of Otolaryngology-Head and Neck Surgery and Co-Director of the Airway Center at Mount Sinai West. “If a pipe in your house is blocked it can’t drain or supply water. In the case of autoimmune disease, inflammation forms in the inner lining of these tissues and may cause it to swell, scar, or bleed. The ability of air to move is diminished.”
Typically, patients are diagnosed with an autoimmune disorder by a rheumatologist or immunologist. If the disease is known to affect the airway, they are often referred to an ear, nose, and throat physician. In general, autoimmune diseases are more common in women than men.
Dr. Lebovics uses specialized instruments like a bronchoscope — a thin tube with a camera that is inserted through the mouth and down the throat—to visualize the airway, voice box, windpipe, upper bronchi, and related structures. Even if patients are not experiencing symptoms like difficulty breathing or painful swallowing, it is vital to get a baseline breathing evaluation.
“The best way to deal with a problem is to prevent it,” says Dr. Lebovics. “I do a lot of surveillance. Sometimes patients do not have any damage yet, and other times they come to me and I see they have been breathing through a three millimeter airway that is significantly scarred from Wegener’s or relapsing polychondritis.”
Treatment for Autoimmune and Airway Disorders
Autoimmune and airway diseases are rarely curable and require lifelong monitoring and management. Many of these conditions have a high incidence of relapse and may be life-threatening if left untreated.
Fortunately, there are many therapies that can help. Depending on the severity of disease, patients may need medications like steroids and immunosuppressants, pulmonary rehabilitation, or surgical interventions. Dr. Lebovics works closely with rheumatologists and pulmonologists to develop a personalized treatment plan for every patient. For example, many individuals with granulomatosis with polyangiitis or Wegener’s have associated ear conditions. “These conditions can be multisystem disorders,” says Dr. Lebovics. “It is critical for physicians to work together and create long-term monitoring relationships with their patients.”
COVID-19 Impact on the Airway
Now, more than ever, it is important for anyone experiencing a breathing problem in the nose, mouth, or chest to seek medical attention. If someone becomes infected with COVID-19, it may cause damage to the lungs and lining of the airway. When someone is gasping for air, they often call 911 or visit the closest emergency room. But those who experience slower changes, like finding it progressively harder to climb the stairs or making noises when they breathe, often do not seek treatment fast enough.
“On a simple level, breathing is not underrated, and your physicians need to help you move air,” says Dr. Lebovics. “At Mount Sinai, we have a niche practice that specializes in treating rare disorders of the airway and autoimmune system, and a track record of success in partnering with patients living with chronic disease to improve their quality of life.”