Subglottic stenosis

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's 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

Stridor

Trauma

Larynx fracture
Tracheobronchial tear/injury
Thyroid gland injury/trauma
Tracheal injury
Electromagnetic or radiation exposure
Burns, inhalation injury

Infectious Disorders

Bacterial tracheitis
Diphtheria
Tetanus
Tracheobronchial tuberculosis
Poliomyelitis, paralytic, bulbar, or acute
Fungal laryngitis

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

Tetany

Congenital, Developmental Disorders

Angioedema/Angioneurotic edema, hereditary

Psychiatric Disorders

Somatization disorder

Anatomical or Mechanical

Foreign body aspiration
Acute gastric acid/aspiration syndrome
Airway obstruction
Neck compartment hemorrhage/hematoma

Vegetative, Autonomic, Endocrine Disorders

Esophageal free reflux/GERD syndrome
Laryngospasm, acute
- Bilateral vocal cord paralysis
Hypoparathyroidism

Poisoning

Smoke inhalation
Chemical burn/esophagus

Chronic Pediatric Conditions

Laryngotracheomalacia[2]
Subglottic stenosis or prior intubation
Vascular ring (double aortic arch)
Vocal cord dysfunction/paroxysmal vocal fold movement

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

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

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