About
Subglottic stenosis is a narrowing just below the vocal cords in an area called the subglottis inside the cricoid cartilage and at the top end of the windpipe. The narrowed airway causes breathing problems.
Symptoms
Patients with a subglottic stenosis suffer noisy breathing and shortness of breath. Most adult cases are misdiagnosed as asthma.
Causes
There are four major causes;
- Injury to the windpipe from insertion of a breathing tube (intubation injury)
- Unknown origin (idiopathic)
- Inflammatory or autoimmune disease
- Malignancy, usually cancer or sarcoma
Diagnosis
Diagnosing this disease is complex because of the multiple possible causes. I start by listening to patients describe their symptoms, also referred to as taking a history. I want to find out when they first noticed symptoms and what other treatments they have tried. Patients will need a physical examination and also blood tests, respiratory function tests, CT scan, and examination under anaesthetic with microlaryngoscopy and biopsy. Some patients are aware of the injury and how it happened. Some patients don’t know they have an injured airway. Patients with idiopathic subglottic stenosis typically do not develop symptoms until they are adults. A lot of literature about this disease claims it only affects women. This is not my experience. For more information about idiopathic subglottic stenosis you can read my blog entry.
Treatment
I provide a range of treatments for subglottic stenosis. They vary depending upon the patient and the stenosis. Some of the treatments are short to medium term and some are longer term. The short to medium term solutions include microlaryngoscopy. Microlaryngoscopy can be performed alone, with laser, with dilation, or with both laser and dilation. The longer term solution is open surgery called a cricotracheal resection.
Microlaryngoscopy
This is usually a day procedure. The patient is anaesthetised and the voice box (larynx) is examined through a metal tube under magnification with a telescope. If there is an abnormality detected then this can either be biopsied, gradually removed with a laser, or temporarily widened using a small balloon.
Many patients with subglottic stenosis have the same microlaryngoscopy procedure once or twice a year to enlarge the opening. Other patients have a stenosis that is so narrow that they live with a permanent tracheotomy. If you are a patient like this you may be suitable for surgery which provides a longer term solution called a cricotracheal resection.
Cricotracheal Resection
Cricotracheal resection removes scar tissue within the cricoid cartilage just below the vocal cords. It also removes part of the upper trachea. The voicebox and the windpipe are then sewn back together.
This is complex surgery which requires not just an experienced surgeon but also an experienced anaesthetic and postoperative team. During the operation the anaesthetist and I work closely together to maintain the airway. After surgery I continue to work closely with an experienced intensive care unit (ICU) and also experienced nurses on the ward.
I am only one of a handful of surgeons in Australia who performs this procedure on adults. You can find out more by reading my blog articles (link) and watching a video presentation describing my results.