Subglottic stenosis: Difference between revisions
(A narrowing of the trachea directly inferior to the vocal folds caused by mechanical trauma, autoimmune disorders, congenital malformation, or idiopathic causes.) |
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==Background== | ==Background== | ||
*Subglottic Stenosis is a narrowing of the trachea directly inferior to the vocal cords. | |||
Subglottic Stenosis is a narrowing of the trachea directly inferior to the vocal cords. | *Causes: | ||
**Idiopathic (more likely to affect females) | |||
Causes: | **Congenital abnormality in newborns | ||
* Idiopathic (more likely to affect females) | **Past mechanical trauma to the airway (intubation or surgery) | ||
* Congenital abnormality in newborns | **Autoimmune disorders | ||
* Past mechanical trauma to the airway (intubation or surgery) | **Wegener granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis <ref>Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.</ref> | ||
* Autoimmune disorders | **Rheumatoid Arthritis | ||
**Sarcoidosis | |||
==Clinical Features== | ==Clinical Features== | ||
* Tachypnea/ Dyspnea/ Hypoxia | *Tachypnea/ Dyspnea/ Hypoxia | ||
* Inspiratory stridor | *Inspiratory stridor | ||
* Hoarseness/ Dysphonia | *Hoarseness/ Dysphonia | ||
* Respiratory accessory muscle usage | *Respiratory accessory muscle usage | ||
* Cough | *Cough | ||
* "Tightness" in the neck | *"Tightness" in the neck | ||
* Patients with history of greater than 1 week of intubation | *Patients with history of greater than 1 week of intubation | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Vocal cord paralysis | *Vocal cord paralysis | ||
* Subglottic hemangioma | *Subglottic hemangioma | ||
* Tumor (metastatic, benign airway tumors, primary endoluminal malignancies) | *Tumor (metastatic, benign airway tumors, primary endoluminal malignancies) | ||
* Vascular ring | *Vascular ring | ||
* Smoke injury | *Smoke injury | ||
* Chemical burn | *Chemical burn | ||
* Foreign body | *Foreign body | ||
* Tracheal stenosis (not at the subglottic region) | *Tracheal stenosis (not at the subglottic region) | ||
* Tracheomalacia | *Tracheomalacia<ref> Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004</ref> | ||
<ref> Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004</ref> | |||
==Evaluation== | ==Evaluation== | ||
* Direct visualization via scope [[File:Subglottic_stenosis2.jpg]] | *Direct visualization via scope [[File:Subglottic_stenosis2.jpg]] | ||
* CT Neck | *CT Neck | ||
==Management== | ==Management== | ||
* ENT referral or immediate securing of airway dependent upon respiratory distress | *ENT referral or immediate securing of airway dependent upon respiratory distress | ||
* Humidified oxygen | *Humidified oxygen | ||
* Proton pump inhibitor | *Proton pump inhibitor | ||
* Systemic steroids | *Systemic steroids | ||
* Treat underlying disorder if caused by autoimmune disorder | *Treat underlying disorder if caused by autoimmune disorder | ||
Definitive Management: | Definitive Management: | ||
* Dilation | *Dilation | ||
* Crichotracheal resection | *Crichotracheal resection | ||
* Tracheotomy | *Tracheotomy | ||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | |||
Revision as of 04:52, 8 August 2017
Background
- Subglottic Stenosis is 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 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
- Vocal cord paralysis
- Subglottic hemangioma
- Tumor (metastatic, benign airway tumors, primary endoluminal malignancies)
- Vascular ring
- Smoke injury
- Chemical burn
- Foreign body
- Tracheal stenosis (not at the subglottic region)
- Tracheomalacia[2]
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
- Crichotracheal resection
- Tracheotomy