Subglottic Stenosis: Symptoms, Causes, Treatment

What are the symptoms of subglottic stenosis?

Subglottic stenosis is a condition characterized by narrowing of the airway just below the vocal cords (in the subglottic region). Symptoms can vary based on the severity of the stenosis and the age of the patient. Common symptoms include:

In Infants and Young Children

Stridor: A high-pitched, wheezing sound when breathing in, especially noticeable during inspiration.
Difficulty Breathing: Noticeable respiratory distress, including rapid or labored breathing.
Coughing: Persistent or harsh cough, often with a characteristic sound.
Poor Feeding: Difficulty feeding due to breathing difficulties.
Recurrent Respiratory Infections: Frequent infections of the respiratory tract, such as pneumonia or sinus infections.

In Older Children and Adults

Hoarseness: Changes in voice, including hoarseness or a weak voice.
Stridor: Similar to infants, a high-pitched wheezing sound on inhalation.
Shortness of Breath: Difficulty breathing, especially during physical activity.
Persistent Cough: A chronic cough that does not resolve with standard treatments.
Increased Respiratory Effort: Noticeable effort to breathe, including use of accessory muscles.

Severe Cases

Cyanosis: A bluish tint to the skin, lips, or fingernails due to lack of oxygen.
Extreme Respiratory Distress: Severe difficulty breathing, which can be life-threatening if not addressed promptly.

Symptoms of subglottic stenosis can range from mild to severe and may worsen over time if not treated. Early diagnosis and management are important to address the condition and prevent complications. If any of these symptoms are observed, particularly in infants or young children, it is important to seek medical evaluation promptly.

What are the causes of subglottic stenosis?

Subglottic stenosis, the narrowing of the airway just below the vocal cords, can be caused by a variety of factors. The causes can be categorized into congenital (present at birth) and acquired (developing later in life) causes:

Congenital Causes

Congenital Abnormalities: Structural abnormalities present at birth can lead to subglottic stenosis. These include developmental issues where the cartilage in the subglottic region does not form properly.
Genetic Conditions: Certain genetic syndromes or conditions, such as congenital airway anomalies or syndromes affecting connective tissue, can contribute to subglottic stenosis.

Acquired Causes

Trauma: Injury to the airway, including trauma from intubation or surgical procedures, can lead to scar tissue formation and narrowing of the subglottic area.
Chronic Inflammation: Conditions causing chronic inflammation in the airway, such as chronic laryngotracheobronchitis or recurrent respiratory infections, can lead to scarring and stenosis.
Infections: Severe or repeated infections, such as croup or bacterial infections, can lead to inflammation and scarring of the subglottic region.
Iatrogenic Causes: Medical interventions, such as prolonged use of endotracheal tubes or tracheostomy, can cause subglottic stenosis as a complication.
Radiation Therapy: Radiation treatment for cancers in the head and neck region can lead to fibrosis and narrowing of the subglottic area.
Autoimmune Conditions: Certain autoimmune disorders, like granulomatosis with polyangiitis (Wegener’s granulomatosis), can cause subglottic stenosis due to inflammation and scarring.
Chronic Reflux: Gastroesophageal reflux disease (GERD) can lead to chronic irritation and inflammation of the airway, contributing to stenosis.

Idiopathic

Unknown Causes: In some cases, the exact cause of subglottic stenosis may not be identified, and it may be classified as idiopathic.

Understanding the underlying cause of subglottic stenosis is crucial for determining the most appropriate treatment and management strategies. If subglottic stenosis is suspected, medical evaluation is important to identify the cause and initiate appropriate care.

What is the treatment for subglottic stenosis?

The treatment for subglottic stenosis depends on the severity of the condition, the age of the patient, and the underlying cause. Management strategies aim to relieve symptoms, improve airway function, and address the underlying cause when possible. Treatment options include:

1. Conservative Management

Observation: In cases of mild stenosis without significant symptoms, regular monitoring may be sufficient.
Medications: Anti-inflammatory medications or steroids may be used to reduce inflammation and swelling, particularly if inflammation is contributing to the stenosis.

2. Surgical Interventions

Dilation: Balloon dilation involves using a balloon catheter to expand the narrowed area of the airway. This can provide temporary relief of symptoms.
Endoscopic Resection: Endoscopic techniques can be used to remove scar tissue or other obstructions within the subglottic region. This procedure is minimally invasive and may provide significant improvement.
Open Surgery: In more severe cases, open surgical procedures may be required. This can involve reconstructive surgery to widen the narrowed area or to correct underlying anatomical issues.

3. Airway Management

Tracheostomy: In cases of severe stenosis where other treatments are not effective, a tracheostomy (a surgical procedure to create an opening in the trachea) may be performed to bypass the obstructed area and ensure adequate airflow.
Intubation: Temporary intubation may be used in acute situations to manage airway obstruction.

4. Addressing Underlying Causes

Treating Infections: If an infection is contributing to the stenosis, appropriate antibiotics or antiviral treatments may be administered.
Managing Reflux: For patients with gastroesophageal reflux disease (GERD), treatments to manage reflux can help prevent further irritation and stenosis.
Treating Autoimmune Conditions: If an autoimmune condition is the underlying cause, treatment for the autoimmune disorder can help reduce inflammation and prevent further scarring.

5. Supportive Care

Speech Therapy: For patients with voice or swallowing difficulties related to subglottic stenosis, speech therapy can help improve function and quality of life.
Rehabilitation: Post-surgical or post-treatment rehabilitation may be needed to support recovery and improve airway function.

6. Follow-Up Care

Regular Monitoring: Ongoing follow-up with healthcare providers to monitor for recurrence of symptoms and assess the effectiveness of treatment.
Adjustment of Treatment: Based on response to initial treatments, adjustments may be made to optimize care and manage symptoms effectively.

Treatment plans are tailored to the individual patient’s needs, taking into account the severity of the stenosis, overall health, and any underlying conditions. Early diagnosis and appropriate management are key to improving outcomes and maintaining a clear airway.