Subglottic stenosis: Difference between revisions
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*Idiopathic (more likely to affect females) | *Idiopathic (more likely to affect females) | ||
*Congenital abnormality in newborns | *Congenital abnormality in newborns | ||
*Past mechanical trauma to the airway (intubation or surgery) | *Past mechanical trauma to the airway ([[intubation]] or surgery) | ||
*Autoimmune disorders | *Autoimmune disorders | ||
*[[Wegener's 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> | *[[Wegener's 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> | ||
| Line 12: | Line 12: | ||
==Clinical Features== | ==Clinical Features== | ||
*Tachypnea/ [[ | *Tachypnea/ [[dyspnea]]/ [[hypoxia]] | ||
*Inspiratory [[stridor]] | *Inspiratory [[stridor]] | ||
*Hoarseness/ | *Hoarseness/ [[dysphonia]] | ||
*Respiratory accessory muscle usage | *Respiratory accessory muscle usage | ||
*[[Cough]] | *[[Cough]] | ||
| Line 24: | Line 24: | ||
==Evaluation== | ==Evaluation== | ||
*Direct visualization via scope | *Direct visualization via scope | ||
*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]] | ||
| Line 36: | Line 36: | ||
Definitive Management: | Definitive Management: | ||
*Dilation | *Dilation | ||
* | *Cricotracheal resection | ||
*Tracheotomy | *Tracheotomy | ||
Revision as of 22:44, 30 September 2019
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's 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
Stridor
Trauma
- Larynx fracture
- Tracheobronchial tear/injury
- Thyroid gland injury/trauma
- Tracheal injury
- Electromagnetic or radiation exposure
- Burns, inhalation injury
Infectious Disorders
- Bacterial tracheitis
- Diphtheria
- Tetanus
- Tracheobronchial tuberculosis
- Poliomyelitis, paralytic, bulbar, or acute
- Fungal laryngitis
Abscesses
- Retropharyngeal abscess
- Epiglottitis, acute
- Peritonsillar abscess
- Laryngotracheobronchitis (croup)
- Retropharyngeal abscess
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
- Angioedema/Angioneurotic edema, hereditary
Psychiatric Disorders
- Somatization disorder
Anatomical or Mechanical
- Foreign body aspiration
- Acute gastric acid/aspiration syndrome
- Airway obstruction
- Neck compartment hemorrhage/hematoma
- Paradoxical vocal fold motion [2]
Vegetative, Autonomic, Endocrine Disorders
- Esophageal free reflux/GERD syndrome
- Laryngospasm, acute
- Bilateral vocal cord paralysis
- Hypoparathyroidism
Poisoning
Chronic Pediatric Conditions
- Laryngotracheomalacia[3]
- Subglottic stenosis or prior intubation
- Vascular ring (double aortic arch)
- Vocal cord dysfunction/paroxysmal vocal fold movement
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
- ↑ Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.
- ↑ Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/
- ↑ Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004