Subglottic stenosis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==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 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> | |||
*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 | ||
| Line 47: | Line 48: | ||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
Revision as of 11:49, 10 August 2017
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 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
Disposition
- Admit