Subglottic stenosis
Background
- Subglottic Stenosis is 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
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