Subglottic stenosis

Revision as of 18:49, 5 August 2017 by Duck427 (talk | contribs) (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

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
  1. Wegener granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis [1]
  2. Rheumatoid Arthritis
  3. 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

Dependent upon severity of respiratory distress.

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