Subglottic stenosis is a narrowing of the airway below the vocal cords. Subglottic stenosis can present with troublesome symptoms like shortness of breath and noisy breathing. Diagnosis can be made with CT scan or using laryngoscopy whereby a camera is passed into the airway to look for narrowing.
What is subglottic stenosis?
Subglottic stenosis is a narrowing of the airway below the vocal cords. There is often inflammation and breakdown of cartilage. Healing of the injury results in scarring and narrowing of the airway.
What causes subglottic stenosis?
Subglottic stenosis can be something you’re born with or acquire later in life.
Babies can be born with subglottic stenosis when their airway is smaller than usual.
The most common cause of subglottic stenosis is prolonged intubation or having a breathing tube in.
Trauma, burns and other irritants can also cause subglottic stenosis.
The condition can be idiopathic. This means we do not know what causes the subglottic stenosis.
Vasculitis which restricts the blood flow to the Subglottic trachea can cause narrowing.
Sarcoidosis can cause narrowing of the airway as one manifestation of the disease. Sarcoidosis is the growth of inflammatory cells throughout the body.
Acid reflux from the stomach can cause injury to the airway and subsequent subglottic stenosis.
Infections and systemic inflammatory conditions are some other causes.
Symptoms of subglottic stenosis
Subglottic stenosis is often diagnosed when there are breathing difficulties which do not respond to treatments for common conditions like asthma.
Idiopathic subglottic stenosis
This is a rare slowly progressive narrowing of the airway of unknown cause. It is most common in women.
What does subglottic stenosis look like on imaging?
Imaging can diagnose subglottic stenosis by seeing a narrowed airway below the vocal cords.
Subglottic stenosis on CT scan
CT scans of the neck can show the narrowed airway below the vocal cords. The airway can be evaluated in axial, coronal and sagittal planes.
Subglottic stenosis on MRI
MRI of the neck can show the narrowed airway below the vocal cords. MRI also allows evaluation of the airway in multiple planes.
How is subglottic stenosis diagnosed?
The best way to diagnose subglottic stenosis is to directly visualize the airway with laryngoscopy or bronchoscopy. CT or MRI imaging can also visualize the airway and show narrowing below the vocal cords.
Is subglottic stenosis dangerous?
Subglottic stenosis can sometimes develop quickly and cause severe airway narrowing which can be life threatening.
Is subglottic stenosis reversible?
Some mild cases have the potential to be reversible. The airway returns to normal size.
Is subglottic stenosis progressive?
Some cases are progressive or get worse over time. Treating the underlying cause of the stenosis can slow progression.
Subglottic stenosis treatment
Mild cases may be observed by a specialist.
Treatment involves both medical and surgical approaches. Medical treatment involves therapy with steroids to reduce inflammation. Antacid therapy is prescribed when gastric reflux is thought to be the cause.
Endoscopic therapy may involve resection of scar tissue and dilation to make the airway wider. Recurrence of the narrowing can occur.
Surgical therapy may involve laryngotracheal reconstruction where the airway is widened by inserting cartilage.
Subglottic stenosis: summary
Subglottic stenosis is a narrowing of the airway below the vocal cords. There are multiple causes with intubation being the most common. Diagnosis is made with imaging or direct visualization. Treatment can involve observation, medical or surgical approaches.