Subglottic stenosis is a narrowing of the airway just below the vocal cords. This narrowing can cause serious breathing difficulties.
Subglottic stenosis can occur in children and adults. It is often discovered after a patient's breathing difficulties do not respond to treatments for unrelated conditions, such as asthma or bronchitis.
If you or your child have been diagnosed with subglottic stenosis or are having breathing problems and don't know why, pediatric ENT specialists and experts at the Voice, Airway and Swallowing Program at Rush can help.
Causes of subglottic stenosis
- Subglottic stenosis can be congenital (something you are born with) or acquired (usually due to scar tissue).
- It is often less severe if it is congenital, improving as the larynx grows.
- Frequent or long-term intubation (having a breathing tube) is the most common cause of acquired subglottic stenosis in children and adults.
- Other causes include trauma and irritants to this area of the airway.
- Subglottic stenosis can also be seen in rare inflammatory conditions such as granulomatosis with polyangititis (a rare form of vasculitis that restricts blood flow), sarcoidosis and relapsing polychondritis.
Symptoms of subglottic stenosis
Most people with mild subglottic stenosis have no symptoms. Others with more serious subglottic stenosis may have one or more of the following symptoms:
- Difficulty breathing (dyspnea), especially after exertion
- Recurrent croup
- A high-pitched noise (called stridor) when breathing in and/or out is the primary symptom of subglottic stenosis. It is often mistaken for wheezing, a symptom of asthma.
How can I get help for subglottic stenosis?
Your doctor may refer you to an ear, nose and throat specialist (ENT) for diagnosis and treatment.
Care for subglottic stenosis at Rush
If you or your child has problems breathing, pediatric ENTs and doctors at Rush's Voice, Airway and Swallowing Program have the expertise and advanced capabilities needed to diagnose and treat many conditions, including subglottic stenosis.
To see if you or your child has subglottic stenosis, one or more of the following tests may be needed:
- Pulmonary function test. Children can receive this testing in Rush's Pediatric Pulmonary Function Lab, one of the few laboratories in Chicago to offer to offer testing for children ages 3 to 18 with lung disorders.
- Chest X-ray
- CT scan
Bronchoscopy to examine the stenosis directly.
- Children are sedated during the bronchoscopy, which is performed in the operating room. In many cases, the child is able to be discharged home the same day.
- For most adults, the subglottis can be evaluated during an office visit. If sedation is required, the procedure can be done as same-day surgery.
There are different treatment options depending on the patient's age, location and size of the subglottic stenosis, as well as the patient's overall medical condition. Your doctor will discuss your options with you.
If your child has been diagnosed with subglottic stenosis, we're here to help both of you throughout the treatment process.
- Anti-reflux medications may help reduce irritation to the affected area.
- Serial steroid injections to the subglottis may be an option for some patients with mild cases of subglottic stenosis.
Endoscopic dilation is a minimally invasive procedure performed through the mouth to expand the airway.
- During the procedure, doctors use a balloon and/or laser to create a larger opening.
- Since the stenosis is most often made of scar tissue, repeat procedures may be needed as the scar tissue grows back.
- Depending on the severity of the stenosis, the doctor may place a stent in the airway to keep the airway open.
- Open surgery through the neck is sometimes necessary when the subglottic stenosis is more severe, to remove the narrow segment and expand the airway.
- Tracheostomy (a tube inserted in the neck to help you breathe) may be needed in certain cases to open the airway below the narrowing.
- Observation is often recommended for mild cases of subglottic stenosis. As your child gets older, the airway grows larger, helping to alleviate breathing problems.
- Endoscopic dilation involves using a balloon and/or laser to create a larger opening.
- Tracheostomy is sometimes needed for severe cases of subglottic stenosis.
- Laryngotracheal reconstruction may help your child breathe without needing a breathing tube. With this procedure, a surgeon uses a small piece of rib cartilage to expand the narrowed area of your child's windpipe.
Why choose Rush for care of subglottic stenosis
- Experts you can trust: The experts at Rush's Voice, Airway and Swallowing Program work together to help you breathe easier with advanced treatment capabilities for subglottic stenosis as well as tracheal stenosis and other conditions affecting the airway.
- Specialized care for children: Pediatric ENTs at Rush collaborate with other pediatric specialists, such as pediatric gastroenterologists and pediatric pulmonologists, to provide coordinated, advanced care for your child.
- Family-focused approach: At Rush University Children's Hospital, a regional referral center with more than 30 pediatric specialties, you will be involved in every aspect of your child's care.