Difference between revisions of "Subglottic stenosis"

Line 1: Line 1:
 
==Background==
 
==Background==
*Subglottic Stenosis is a narrowing of the trachea directly inferior to the vocal cords.
+
*A narrowing of the trachea directly inferior to the vocal cords
*Causes:
+
 
**Idiopathic (more likely to affect females)
+
===Causes===
**Congenital abnormality in newborns
+
*Idiopathic (more likely to affect females)
**Past mechanical trauma to the airway (intubation or surgery)
+
*Congenital abnormality in newborns
**Autoimmune disorders  
+
*Past mechanical trauma to the airway (intubation or surgery)
**Wegener granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis <ref>Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.</ref>
+
*Autoimmune disorders  
**Rheumatoid Arthritis
+
*Wegener granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis <ref>Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.</ref>
**Sarcoidosis
+
*Rheumatoid Arthritis
 +
*Sarcoidosis
  
 
==Clinical Features==
 
==Clinical Features==
 
*Tachypnea/ Dyspnea/ Hypoxia
 
*Tachypnea/ Dyspnea/ Hypoxia
*Inspiratory stridor
+
*Inspiratory [[stridor]]
 
*Hoarseness/ Dysphonia
 
*Hoarseness/ Dysphonia
 
*Respiratory accessory muscle usage
 
*Respiratory accessory muscle usage
*Cough
+
*[[Cough]]
 
*"Tightness" in the neck
 
*"Tightness" in the neck
 
*Patients with history of greater than 1 week of intubation
 
*Patients with history of greater than 1 week of intubation
Line 47: Line 48:
  
 
==Disposition==
 
==Disposition==
 
+
*Admit
  
 
==See Also==
 
==See Also==

Revision as of 11:49, 10 August 2017

Background

  • 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 granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis [1]
  • 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

  • Vocal cord paralysis
  • Subglottic hemangioma
  • Tumor (metastatic, benign airway tumors, primary endoluminal malignancies)
  • Vascular ring
  • Smoke injury
  • Chemical burn
  • Foreign body
  • Tracheal stenosis (not at the subglottic region)
  • Tracheomalacia[2]

Evaluation

  • Direct visualization via scope Subglottic stenosis2.jpg
  • 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
  • Crichotracheal resection
  • Tracheotomy

Disposition

  • Admit

See Also

External Links

References

  1. Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.
  2. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004