Difference between revisions of "Subglottic stenosis"

 
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==Background==
 
==Background==
*Subglottic Stenosis is a narrowing of the trachea directly inferior to the vocal cords.
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*A narrowing of the trachea directly inferior to the vocal cords
*Causes:
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**Idiopathic (more likely to affect females)
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===Causes===
**Congenital abnormality in newborns
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*Idiopathic (more likely to affect females)
**Past mechanical trauma to the airway (intubation or surgery)
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*Congenital abnormality in newborns
**Autoimmune disorders  
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*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>
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*Autoimmune disorders  
**Rheumatoid Arthritis
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*[[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>
**Sarcoidosis
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*[[Rheumatoid arthritis]]
 +
*[[Sarcoidosis]]
  
 
==Clinical Features==
 
==Clinical Features==
*Tachypnea/ Dyspnea/ Hypoxia
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*Tachypnea/ [[dyspnea]]/ [[hypoxia]]
*Inspiratory stridor
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*Inspiratory [[stridor]]
*Hoarseness/ Dysphonia
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*Hoarseness/ [[dysphonia]]
 
*Respiratory accessory muscle usage
 
*Respiratory accessory muscle usage
*Cough
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*[[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
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Vocal cord paralysis
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{{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]]
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*Direct visualization via scope
 
*CT Neck
 
*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
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*Humidified [[oxygen]]
*Proton pump inhibitor
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*[[Proton pump inhibitor]]
*Systemic steroids
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*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
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*Cricotracheal resection
 
*Tracheotomy
 
*Tracheotomy
  
 
==Disposition==
 
==Disposition==
 
+
*Admit
  
 
==See Also==
 
==See Also==

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