Subglottic and Tracheal Stenosis

 

Subglottic stenosis is scar tissue that builds up in the airway just below the level of the vocal cords.  This causes difficulty breathing with stridor, a high pitched noisy breathing that occurs with breathing in and breathing out.  It can develop subtlely over the course of a few years, or rapidly within just a few weeks.  It is often misdiagnosed for years as asthma, but it does not respond to bronchodilator inhalers (because it is not asthma!).  It can occur secondary to being intubated in the ICU because the tube rubs against the subglottis and creates a raw ulcer, which then leads to scar formation.  Most frequently, however, there is no identifying cause of subglottic stenosis.

 

Treatment consists of division of the stenosis in the operating room with a laser beam followed by stretching of the stenosis with an inflatable balloon.  This is done endoscopically through the mouth (no incision in the neck).  This usually does not permanently fix the problem, and often repeat procedures are needed every 1-2 years.  The permanent fix of the subglottic or tracheal stenosis is an open procedure through the neck to remove the scarred portion of airway and reconnect the two ends of healthy (unscarred) airway.