Subglottic Stenosis

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 your 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 our voice, airway and swallowing experts 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 polyangiitis (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:

• Hoarseness
• 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?

Call your primary care physician or your child's pediatrician if you or your child are experiencing problems breathing or having symptoms of subglottic stenosis.

Your doctor may refer you to an ear, nose and throat specialist (ENT) for diagnosis and treatment.

• Children may need to see a pediatric ENT, who has the experience and specialized expertise to address this condition in younger patients.
• Adults may be referred to a voice, aiwary and swallowing specialist at Rush.

Subglottic Stenosis Treatment at Rush

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.

For adults:

• 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.

For children:

• 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.

Rush Excellence in Subglottic Stenosis Care

• 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.