Subglottic stenosis

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

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

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