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Subglottic stenosis: Treatment, symptoms, advice and help

 

About subglottic stenosis


Subglottic stenosis is a narrowing of the subglottic airway and is the most frequent cause of airway obstruction requiring tracheostomy in infants.


Subglottic stenosis: Incidence, age and sex


The incidence of congenital SGS is not known. SGS is observed more often in premature infants because they may require mechanical ventilation.


Signs & symptoms of subglottic stenosis: Diagnosis


Stridor is the typical presenting symptom for congenital subglottic stenosis. Recurrent or persistent noisy breathing occurs in these children. Hoarseness or vocal weakness can also be associated with glottic stenosis. The small amount of edema associated with an upper respiratory tract infection or gastroesophageal reflux events compromises the already narrowed airway and worsens the stridor. The diagnosis is suggested airway radiographs and confirmed by direct laryngoscopy.


Causes and prevention of subglottic stenosis


Subglottic stenosis is considered to be congenital when there is no other apparent cause. It is believed to be due to in-utero malformation of the cricoid cartilage. It may also be caused by laryngeal trauma, infections such as tuberculosis and diphtheria or intubation and prolonged mechanical ventilation. The factors that increase the risk are size of the endotracheal tube relative to the child's larynx, the duration of intubation, the motion of the tube, and repeated intubations.


Subglottic stenosis: Complications


Patients may die if they have significant SGS that is left untreated. Difficulty in breathing and exercise intolerance can occur with mild, moderate, or severe SGS.


Subglottic stenosis: Treatment


The timing of surgery is dictated by severity of the subglottic stenosis. Surgical intervention may be avoided if periods of airway obstruction are rare and may be treated with anti-inflammatory and vasoconstrictive agents, such as oral, intravenous, or inhaled steroids and inhaled epinephrine. For mild or granular SGS, success with serial endoscopic dilation with or without steroid injections has been reported. Because most cases of congenital stenosis are cartilaginous, dilatation or laser surgery are not uniformly effective. Anterior laryngotracheal decompression (cricoid split) or reconstruction with cartilage grafting usually avoid trachestomy.