SUBGLOTTIC STENOSIS

Subglottic stenosis is airway narrowing below the vocal folds. Subglottic stenosis causes shortness of breath, especially during times of exertion. When severe, subglottic stenosis, causes noisy breathing during inspiration and expiration.

Subglottic stenosis. Beyond the normal vocal folds is a circular narrowing of the airway.

Causes of subglottic stenosis include:

• Scar formed from the tip of a breathing tube
• Wegener’s granulomatosis – a condition of blood vessel inflammation
• Inflammatory diseases
• Trauma, such as an inhalation burn injury
• Idiopathic (unknown)

Idiopathic subglottic stenosis, or subglottic stenosis for an unknown reason, is a diagnosis made if their is no obvious cause. Patients with idiopathic subglottic stenosis are often young females aged 25-50 with no other significant history.

Symptoms of subglottic stenosis include:

• Shortness of breath during exertion and sometimes at rest
• Noisy breathing, also known as stridor
• Cough
• Voice changes
• Feeling of phlegm “stuck” within the airway

Diagnosis of subglottic stenosis:

Subglottic stenosis is a difficult diagnosis to make, as the subglottis is a difficult area for a physician to see and examine. Patients are often unsuccessfully treated for more common disorders such as asthma before the diagnosis of subglottic stenosis is made.

A laryngoscopy and bronchoscopy is used to diagnose subglottic stenosis. A camera is passed into the airway to look for narrowing. Previously this was performed in the operating room, but with advances in technology can be performed in the office after a patient breathes in local anesthesia.

A CT scan may also be used to evaluate the size of the airway and degree of narrowing.

Treatment for subglottic stenosis:

Treatment for subglottic stenosis enlarges the size of the airway, thus making breathing easier. In the operating room laryngoscopy is performed with the patient asleep. A laser is used to cut the narrowed portion of the airway from the inside. A high pressure balloon dilator is then used to expand the size of the airway. Steroids and other medications are applied to prevent scar formation. This entire procedure is performed through the mouth.

When balloon dilation is inadequate, open surgery can be performed. After making a skin incision in the neck the narrowed portion of the airway is resected. The normal airway is then reattached and sutured together.

A laryngotracheal reconstruction is a surgery in which a piece of cartilage is used to stent the airway open. This more commonly occurs when children are treated for subglottic stenosis.