Summary about Disease
Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords (in the subglottic region). This narrowing obstructs airflow, leading to difficulty breathing. It can be congenital (present at birth) or acquired (developed later in life). The severity can range from mild, causing only exertional dyspnea, to severe, causing life-threatening airway obstruction.
Symptoms
Noisy breathing (stridor)
Difficulty breathing (dyspnea), especially with exertion
Recurrent croup
Chronic cough
Hoarseness or voice changes
Frequent upper respiratory infections
Cyanosis (bluish discoloration of the skin due to lack of oxygen) in severe cases
Causes
Acquired:
Prolonged endotracheal intubation (most common cause, especially in infants)
Tracheostomy
Trauma to the larynx
Autoimmune diseases (e.g., granulomatosis with polyangiitis (GPA), sarcoidosis)
Infections
Gastroesophageal reflux (GERD)
Burns
Congenital:
Abnormal cartilage formation in the larynx
Medicine Used
Medical management focuses on managing symptoms and reducing inflammation. Medications may include:
Corticosteroids: To reduce inflammation. Oral or injected.
Antibiotics: If there is a secondary bacterial infection.
Proton pump inhibitors (PPIs): If GERD is contributing to the stenosis.
Inhaled bronchodilators: To relax airway muscles.
Mucolytics: To thin mucus. Note: There is no medicine which will cure subglottic stenosis. Medication is used to treat related issues or secondary infections. Surgical interventions are often necessary for definitive treatment.
Is Communicable
No, subglottic stenosis is not a communicable disease. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Avoid smoke and irritants: Exposure to cigarette smoke, air pollution, and other irritants can worsen symptoms.
Manage GERD: If GERD is a contributing factor, follow dietary and medical recommendations to control it.
Avoid unnecessary intubation: Prolonged intubation is a major risk factor. Minimize intubation time whenever possible.
Prompt treatment of respiratory infections: Address any respiratory infections quickly to prevent further airway inflammation.
How long does an outbreak last?
Since subglottic stenosis is not communicable, the concept of an "outbreak" doesn't apply. The condition itself is chronic unless treated. Symptoms can fluctuate in severity depending on factors like infections or irritant exposure.
How is it diagnosed?
Laryngoscopy: A visual examination of the larynx using a flexible or rigid scope. This is the primary diagnostic tool.
Bronchoscopy: Similar to laryngoscopy but allows visualization of the trachea and bronchi.
Imaging studies:
X-rays of the neck: Can show narrowing of the airway.
CT scan of the neck: Provides more detailed images of the larynx and trachea.
MRI of the neck: Used in some cases to assess the soft tissues around the larynx.
Pulmonary function tests (PFTs): To assess lung function and airflow.
History and Physical Exam: Patient's history of intubation, trauma, autoimmune disease and assessing for stridor and respiratory distress.
Timeline of Symptoms
The onset and progression of symptoms vary depending on the cause and severity of the stenosis:
Congenital: Symptoms may be present from birth or develop in early infancy.
Acquired (post-intubation): Symptoms may appear weeks to months after extubation.
Gradual Onset: In some cases, the stenosis develops slowly over time, with symptoms worsening gradually.
Acute Exacerbation: An upper respiratory infection can cause a sudden worsening of symptoms.
Important Considerations
Severity Grading: Subglottic stenosis is typically graded based on the degree of airway obstruction, using the Myer-Cotton grading system.
Surgical Treatment: Surgical options include:
Endoscopic dilation: Balloon dilation or laser surgery to widen the airway.
Laryngotracheal reconstruction (LTR): Open surgical procedure to reconstruct the larynx and trachea using cartilage grafts.
Tracheostomy: In severe cases, a tracheostomy may be necessary to bypass the obstruction.
Multidisciplinary Approach: Management often involves a team of specialists, including otolaryngologists (ENT doctors), pulmonologists, and speech therapists.
Early Diagnosis and Treatment: Early diagnosis and intervention are crucial to prevent long-term complications.