From the Guidelines
For patients with subglottic stenosis, dilation should be considered as a primary intervention, with consideration of local therapy like mitomycin C on recurrence and close collaboration with thoracic surgery or otolaryngology. This approach is based on the most recent and highest quality study available, which suggests that dilation can be an effective treatment for subglottic stenosis, especially in cases of benign, simple, and subglottic tracheal stenosis 1.
Diagnosis and Treatment Considerations
When diagnosing and treating subglottic stenosis, it is essential to consider the severity and cause of the stenosis. The condition can be congenital or acquired, with acquired cases often resulting from prolonged intubation, trauma, inflammatory conditions, or radiation therapy. Understanding the underlying cause is crucial for effective management and preventing recurrence.
Treatment Options
Treatment options for subglottic stenosis include:
- Dilation as a primary intervention, which can be performed alone or in combination with other therapeutic modalities 1
- Local therapy like mitomycin C on recurrence
- Close collaboration with thoracic surgery or otolaryngology
- Surgical approaches like laryngotracheal reconstruction or cricotracheal resection for more severe or recurrent cases
- Endoscopic procedures such as laser resection, balloon dilation, or placement of stents for temporary relief
Management and Follow-up
In cases related to inflammation, inhaled corticosteroids such as budesonide (0.5-1mg twice daily via nebulizer) may help reduce inflammation. Systemic steroids like prednisone (starting at 40-60mg daily with gradual taper) might be used for acute exacerbations. Antibiotics are indicated if infection is present. Post-treatment, regular follow-up with an otolaryngologist is essential to monitor for recurrence.
Research and Evidence
The current evidence suggests that a multimodality approach utilizing dilation, ablative resection, and medical treatment is more likely to achieve optimal outcomes 1. However, robust evidence is needed to understand the role of dilation, either alone or as an adjunct, to other bronchoscopic therapies.
From the Research
Diagnosis of Subglottic Stenosis
- Subglottic stenosis is a rare congenital or acquired disorder of airway patency that can lead to respiratory insufficiency 2
- The condition can be caused by iatrogenic damage to the larynx and trachea during invasive airway management, such as intubation or tracheotomy 2
- Diagnosis is typically made through retrospective analysis of patient medical histories and monitoring of patients for at least two years after completion of treatment 2
Treatment Options for Subglottic Stenosis
- Treatment options for subglottic stenosis include surgery and endoscopic techniques, such as dilation and laser resection 3, 4
- Endoscopic laser resection may be more effective than dilation in preventing recurrence of subglottic stenosis 3
- A single-staged laryngotracheal resection and reconstruction is now the preferred definitive treatment for idiopathic subglottic stenosis 5
- Endoscopic treatment by radial laser incision and dilation can also be effective in treating subglottic and tracheal stenosis 6
Outcomes and Complications
- Outcomes and treatment options depend on the benign or complex nature of the stenosis 3
- Complications of treatment can include anastomotic postoperative stenosis, infection, and wound infection 4, 5
- Careful selection of patients and preservation of tracheal epithelium with minimal heat and mechanical trauma are essential for good results 6
- Overall, treatment of subglottic stenosis can be effective in improving patient outcomes and reducing the risk of recurrence 2, 3, 4, 5