Summary about Disease
Glottic stenosis is a narrowing of the glottis, the part of the larynx (voice box) containing the vocal cords. This narrowing restricts airflow, causing difficulty breathing and affecting voice quality. The severity can range from mild, causing slight hoarseness, to severe, leading to significant airway obstruction requiring immediate medical intervention. It can be congenital (present at birth) or acquired due to various factors.
Symptoms
Hoarseness or a breathy voice
Stridor (a high-pitched, whistling sound during breathing, especially inhalation)
Difficulty breathing, especially during exertion
Chronic cough
Recurrent croup (in children)
Noisy breathing
Cyanosis (bluish discoloration of the skin due to lack of oxygen, in severe cases)
Fatigue or weakness due to increased effort to breathe
Causes
Congenital: Abnormal development of the larynx during fetal development.
Acquired:
Prolonged intubation: The most common cause in adults and children. The endotracheal tube can cause trauma and inflammation to the larynx.
Tracheostomy: Similar to intubation, a tracheostomy can lead to stenosis.
Trauma: External trauma to the neck or internal trauma from procedures.
Infection: Rare, but severe infections of the larynx can cause scarring and stenosis.
Laryngopharyngeal Reflux (LPR): Chronic acid reflux can irritate the larynx.
Autoimmune diseases: Conditions like granulomatosis with polyangiitis (GPA) or sarcoidosis.
Tumors: Rare, but tumors in the larynx can cause narrowing.
Idiopathic: In some cases, the cause is unknown.
Medicine Used
Corticosteroids: To reduce inflammation, especially in acute cases or after surgical repair.
Proton Pump Inhibitors (PPIs): If LPR is a contributing factor, to reduce stomach acid production.
Antibiotics: If a bacterial infection is present.
Mitomycin C: Applied topically during surgery to prevent scar tissue formation.
None: Mild cases may require no medication.
In severe cases: Epinephrine nebulized and supplemental oxygen, along with intubation or tracheostomy may be needed.
Is Communicable
No, glottic stenosis is not a communicable disease. It is not caused by a pathogen that can be transmitted from person to person.
Precautions
Minimize intubation time: If intubation is necessary, healthcare providers should strive to use the smallest possible endotracheal tube and minimize the duration of intubation.
Proper intubation technique: Using proper technique during intubation can reduce trauma to the larynx.
Treat LPR: If you experience chronic heartburn or reflux symptoms, seek medical treatment to prevent irritation of the larynx.
Avoid smoking: Smoking can irritate the larynx and increase the risk of stenosis.
Protective gear: Wear appropriate protective gear when participating in activities that may cause trauma to the neck.
How long does an outbreak last?
Glottic stenosis isn't an "outbreak" situation. It's a chronic condition that develops over time. The symptoms may fluctuate in severity, but the stenosis itself is a persistent problem.
How is it diagnosed?
Medical history and physical examination: The doctor will ask about symptoms, medical history, and risk factors.
Laryngoscopy: The most common diagnostic tool. A flexible or rigid laryngoscope is inserted through the nose or mouth to visualize the larynx and vocal cords.
Flexible Endoscopic Evaluation of Swallowing (FEES): Assesses swallowing function and can also visualize the larynx.
Microlaryngoscopy: A surgical procedure where the larynx is examined under a microscope, allowing for more detailed visualization and potential biopsy.
Bronchoscopy: In some cases, a bronchoscope is used to examine the trachea and lower airways.
Imaging studies: CT scans or MRI scans can help to assess the extent of the stenosis and rule out other causes.
Pulmonary function tests (PFTs): Assess lung function and airflow, which can indicate the severity of the airway obstruction.
Timeline of Symptoms
The timeline of symptoms varies greatly depending on the cause and severity of the stenosis.
Congenital: Symptoms are usually present at birth or shortly after.
Acquired (post-intubation): Symptoms may appear days to weeks after extubation.
Gradual onset: In some cases, the stenosis develops slowly over months or years, with symptoms gradually worsening.
Sudden onset: In cases of trauma or infection, symptoms may appear suddenly.
Important Considerations
Early diagnosis and treatment are essential to prevent complications such as severe airway obstruction.
Treatment options vary depending on the severity and cause of the stenosis.
Surgical intervention may be necessary in severe cases.
Voice therapy may be helpful to improve voice quality after treatment.
Multiple surgeries may be required to achieve optimal results.
Long-term follow-up is important to monitor for recurrence of stenosis.
Pediatric glottic stenosis management differs significantly from adult management, often requiring specialized pediatric otolaryngologists.
The psychological impact of voice and breathing difficulties should not be overlooked, and counseling or support groups may be beneficial.