Subglottic stenosis

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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
  • Trachea injury
  • Electromagnetic or radiation exposure
  • Burns, inhalation

Infectious Disorders

Abscesses

Neoplastic Disorders

  • Neoplasms/tumors

Allergic and Auto-Immune Disorders

Metabolic, Storage Disorders

  • Cerebral Gaucher's of infants (acute)
  • Tracheobronchial amyloidosis

Biochemical Disorders

  • Tetany

Congenital, Developmental Disorders

Psychiatric Disorders

  • Somatization disorder

Anatomical or Mecanical

  • 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

Chronic Pediatric Conditions

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

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

  • 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. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004