Difference between revisions of "Subglottic stenosis"

(A narrowing of the trachea directly inferior to the vocal folds caused by mechanical trauma, autoimmune disorders, congenital malformation, or idiopathic causes.)
 
 
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==Background==
 
==Background==
 +
*A narrowing of the trachea directly inferior to the vocal cords
  
Subglottic Stenosis is a narrowing of the trachea directly inferior to the vocal cords.
+
===Causes===
 
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*Idiopathic (more likely to affect females)
Causes:
+
*Congenital abnormality in newborns
* Idiopathic (more likely to affect females)
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*Past mechanical trauma to the airway ([[intubation]] or surgery)
* Congenital abnormality in newborns
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*Autoimmune disorders  
* Past mechanical trauma to the airway (intubation or surgery)
+
*[[Wegener's 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]]
   
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*[[Sarcoidosis]]
# 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>
 
# Rheumatoid Arthritis
 
# Sarcoidosis
 
 
 
  
 
==Clinical Features==
 
==Clinical Features==
* Tachypnea/ Dyspnea/ Hypoxia
+
*Tachypnea/ [[dyspnea]]/ [[hypoxia]]
* Inspiratory stridor
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*Inspiratory [[stridor]]
* Hoarseness/ Dysphonia
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*Hoarseness/ [[dysphonia]]
* Respiratory accessory muscle usage
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*Respiratory accessory muscle usage
* Cough
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*[[Cough]]
* "Tightness" in the neck
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*"Tightness" in the neck
* Patients with history of greater than 1 week of intubation
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*Patients with history of greater than 1 week of intubation
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
* Vocal cord paralysis
+
{{Stridor DDx}}
* 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
 
<ref> Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004</ref>
 
  
 
==Evaluation==
 
==Evaluation==
* Direct visualization via scope [[File:Subglottic_stenosis2.jpg]]
+
*Direct visualization via scope
* CT Neck
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*CT Neck
  
 
==Management==
 
==Management==
* ENT referral or immediate securing of airway dependent upon respiratory distress
+
*ENT referral or immediate securing of airway dependent upon respiratory distress
* Humidified oxygen
+
*Humidified [[oxygen]]
* Proton pump inhibitor
+
*[[Proton pump inhibitor]]
* Systemic steroids
+
*Systemic [[steroids]]
* Treat underlying disorder if caused by autoimmune disorder
+
*Treat underlying disorder if caused by autoimmune disorder
 
 
  
 
Definitive Management:
 
Definitive Management:
* Dilation
+
*Dilation
* Crichotracheal resection
+
*Cricotracheal resection
* Tracheotomy
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*Tracheotomy
  
 
==Disposition==
 
==Disposition==
Dependent upon severity of respiratory distress.
+
*Admit
  
 
==See Also==
 
==See Also==
 +
  
 
==External Links==
 
==External Links==
 +
  
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
[[Category:ENT]]

Latest revision as of 22:44, 30 September 2019

Background

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

Causes

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

Infectious Disorders

Abscesses

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

Congenital, Developmental Disorders

Psychiatric Disorders

  • Somatization disorder

Anatomical or Mechanical

Vegetative, Autonomic, Endocrine Disorders

Poisoning

Chronic Pediatric Conditions

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

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. Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/
  3. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004