Subglottic stenosis is a scar-like narrowing of the windpipe below the vocal cords (subglottis) and above the trachea. It can both be congenital or acquired. When occurring in adults, subglottic stenosis can result in high-pitched sounds made while breathing in or out which is sometimes misdiagnosed as asthma. The subglottic space at the cricoid level, the narrowest part of the airway, extends from the inferior margin of the vocal cords to the lower border of the cricoid cartilage. Subglottic stenosis is commonly benign and may be due to a variety of diseases, whereas post intubation (PI) injury is definitely the most frequent cause. Surgery is necessary to remove the scar and increase the area of the windpipe to a normal size.
Signs and Symptoms
Noisy breathing or stridor is a common indication related with subglottic stenosis. It may also cause shortness of breath with exertion, such as long exercises or walking up the stairs. Some people with the condition may also experience difficulty catching their breath even for mild or moderate activities. Some symptoms may also include persistent hoarseness, sensation of mucus found within the throat, and difficulty breathing at rest.
Diagnosing Subglottic Stenosis
Diagnosis is often delayed since most patients with the condition are incorrectly treated for asthma or bronchitis instead. When treatments for those respiratory conditions are found not deliver results, further diagnostic testing is usually needed to confirm subglottic stenosis. During pulmonary function tests, a patient breathes in and out of a machine to test their respiratory competences, may help achieve a more accurate diagnosis of subglottic stenosis.
Examination of the trachea or windpipe is often administered with the application of a topical numbing medication rather than use of a general anesthesia. A camera is then passed through the nose to capture and record a clear view of the affected area to diagnose subglottic stenosis. For further accuracy, a CT scan of the neck can also be used to affirm the condition.
Subglottic Stenosis Treatment
There are different treatment options available for patients with subglottic stenosis. During an endoscopic surgery, performed through the mouth in a minimally invasive fashion is implemented as an outpatient procedure. A balloon is inflated to dilate the airway then a laser is used to resect the scar. Steroids and other medications are then applied to prevent stenosis from recurring. Anti-reflux drugs may also help manage the condition.
Remember, a stenotic disease involving the subglottic region presents increased technical problems when performing surgical treatment, mainly because of the need to extend the resection to the cricoid cartilage which is next to the vocal cords.
Tracheal resection may be performed if necessary. During this surgery, the narrowed portion of the airway is removed through a cut on the neck. In this way, the remaining portions of the trachea are connected to one another.
The cause for subglottic stenosis may be related to an underlying autoimmune or inflammatory disease, and the reasons for subglottic stenosis may differ. For other health concerns, it can also result from intubation through a breathing tube.
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