Subglottic stenosis

Background

Cross section of a trachea and esophagus anatomy.

Tracheal anatomy.

• A narrowing of the trachea directly inferior to the vocal cords

Causes

• Idiopathic (more likely to affect females)
• Congenital abnormality in newborns
• Past mechanical trauma to the airway (intubation or surgery)
• Autoimmune disorders
• Wegener's granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis
• Rheumatoid arthritis
• Sarcoidosis

Clinical Features

• Tachypnea/ dyspnea/ hypoxia
• Inspiratory stridor
• Hoarseness/ dysphonia
• Respiratory accessory muscle usage
• Cough
• "Tightness" in the neck
• Patients with history of greater than 1 week of intubation

Differential Diagnosis

Stridor

Trauma

• Larynx fracture
• Tracheobronchial tear/injury
• Thyroid gland injury/trauma
• Tracheal injury
• Electromagnetic or radiation exposure
• Burns, inhalation injury

Infectious Disorders

• Bacterial tracheitis
• Diphtheria
• Tetanus
• Tracheobronchial tuberculosis
• Poliomyelitis, paralytic, bulbar, or acute
• Fungal laryngitis

Abscesses

• Retropharyngeal abscess
• Epiglottitis, acute
• Peritonsillar abscess
• Laryngotracheobronchitis (croup)
• Retropharyngeal abscess

Neoplastic Disorders

• Neoplasms/tumors

Allergic and Auto-Immune Disorders

• Spasmodic/tracheobronchitis
• Angioedema/Angioneurotic edema

Metabolic, Storage Disorders

• Cerebral Gaucher's of infants (acute)
• Tracheobronchial amyloidosis

Biochemical Disorders

• Tetany

Congenital, Developmental Disorders

• Angioedema/Angioneurotic edema, hereditary

Psychiatric Disorders

• Somatization disorder

Anatomical or Mechanical

• Foreign body aspiration
• Acute gastric acid/aspiration syndrome
• Airway obstruction
• Neck compartment hemorrhage/hematoma
• Paradoxical vocal fold motion

Vegetative, Autonomic, Endocrine Disorders

• Esophageal free reflux/GERD syndrome
• Laryngospasm, acute
  • Bilateral vocal cord paralysis
• Hypoparathyroidism

Poisoning

• Smoke inhalation
• Chemical burn/esophagus

Chronic Pediatric Conditions

• Laryngotracheomalacia
• Subglottic stenosis or prior intubation
• Vascular ring (double aortic arch)
• Vocal cord dysfunction/paroxysmal vocal fold movement

Evaluation

• Direct visualization via scope
• CT Neck

Management

• ENT referral or immediate securing of airway dependent upon respiratory distress
• Humidified oxygen
• Proton pump inhibitor
• Systemic steroids
• Treat underlying disorder if caused by autoimmune disorder

Definitive Management:

• Dilation
• Cricotracheal resection
• Tracheotomy

Disposition

• Admit