Diagnosis
Subglottic stenosis
Narrowing of the upper airway between the vocal folds and the inferior border of the cricoid cartilage.
Also known as: Benign tracheal stenosis, Idiopathic tracheal stenosis, Laryngotracheal stenosis
Etiology
Cause
Congenital subglottic stenosis: [ozo][iys][bvk]
Absence of prior intubation, observed in syndromes (trisomy 21, CHARGE, 22q11 deletion syndrome), congenital abnormalities (hemangioma/cyst, cartilage deformity, closed first ring, membranous web)
Acquired subglottic stenosis: [zqb][yvv][iys][bvk]
Intubation trauma (scar tissue), inhalation burns, gastroesophageal reflux, radiation, surgery, autoimmune diseases (granulomatosis with polyangitis, sarcoidosis, amyloidosis, systemic lupus erythematosus, rheumatoid arthritis, relapsing polychondritis, polyarteritis, scleroderma), and infectious processes (tracheitis, tuberculosis, histoplasmosis, diphtheria, papillomatosis)
Pathophysiology [zqb][bvk]
Congenital subglottic stenosis: Failure of recanalisation in the laryngeal lumen during embryogenesis
Acquired subglottic stenosis:
Trauma/inflammation --> proliferation of granulation tissue --> fibrosis --> stenosis
Prolonged intubation --> inflation of tracheal tube ballon --> vascular compromise --> tissue necrosis --> fibrosis --> stenosis
Complications [bvk]
Airway obstruction
Complications following tracheostomy: accidental decannulation, false tract, tracheoinnominate fistula
Epidemiology
Incidence per 100.000 [1ez][ety][bqf][zqb][6bg][iys]
Symptoms & findings
Symptoms
Cough, Dysphonia, Dyspnea, Stridor, Wheezing
Clinical findings
None listed.
Anamneses
None listed.
Approach
Laryngoscopy
Lateral soft tissue films
CT collum
The Cotton-Myer grading system
Grade 1 stenosis: Lumen obstruction between 0% and 50%
Grade 2 stenosis: Lumen obstruction between 51% and 70%
Grade 3 stenosis: Lumen obstruction between 71% and 99%
Grade 4 stenosis: Complete lumen obstruction
Treatment
Mild symptoms: Observation with spirometry
Serial intralesional steroid injection [bvk]
Endoscopic dilatation of the tracheal stenosis [zqb][yvv][kcw][ozo][iys]
Endoscopic resection of the stenosis
Surgery:
Tracheostomy [bvk]
Laryngotracheal reconstruction: Resection and end-to-end anastomosis [yvv]
Differential diagnoses
Acute laryngitis, Benign vocal cord lesion, Croup, Epiglottitis, Laryngeal cancer, Laryngopharyngeal reflux disease, Lymphoma, Reinkes edema
References
[1] Marston AP, White DR. Subglottic Stenosis. Clin Perinatol. 2018 Dec;45(4):787-804.
[2] Aravena C, Almeida FA, Mukhopadhyay S, Ghosh S, Lorenz RR, Murthy SC, Mehta AC. Idiopathic subglottic stenosis: a review. J Thorac Dis. 2020 Mar;12(3):1100-1111.
[3] Jagpal N, Sommerfeldt J, Shabbir N. Subglottic Stenosis. Updated 2023 Oct 30: https://www.ncbi.nlm.nih.gov/books/NBK563265/
[4] Nagaroor, A., Höller, S. & Franzen, D.P. An immunohistological analysis of 13 idiopathic subglottic stenosis (iSGS) excisions: a single centre study. Sci Rep 15, 10210 (2025).
[5] Donahoe L, Keshavjee S. Contemporary Management of Idiopathic Laryngotracheal Stenosis. Thorac Surg Clin. 2018 May;28(2):167-175.
[6] Maldonado F, Loiselle A, Depew ZS, Edell ES, Ekbom DC, Malinchoc M, Hagen CE, Alon E, Kasperbauer JL. Idiopathic subglottic stenosis: an evolving therapeutic algorithm. Laryngoscope. 2014 Feb;124(2):498-503.
[7] Chan RK, Ahrens B, MacEachern P, Bosch JD, Randall DR. Prevalence and incidence of idiopathic subglottic stenosis in southern and central Alberta: a retrospective cohort study. J Otolaryngol Head Neck Surg. 2021 Nov 12;50(1):64.
[8] Aarnæs MT, Sandvik L, Brøndbo K. Idiopathic subglottic stenosis: an epidemiological single-center study. Eur Arch Otorhinolaryngol. 2017 May;274(5):2225-2228.
[9] Pearson FG. Idiopathic laryngotracheal stenosis. J Thorac Cardiovasc Surg. 2004 Jan;127(1):10-1.
[10] Rosow DE, Barbarite E. Review of adult laryngotracheal stenosis: pathogenesis, management, and outcomes. Curr Opin Otolaryngol Head Neck Surg. 2016 Dec;24(6):489-493.
[11] http://emedicine.medscape.com/article/865437 (2014-01-02); [Medscape]
[12] http://emedicine.medscape.com/article/864208 (2014-01-02); [Medscape]
[13] Thomas RE, Rao SC, Minutillo C, Vijayasekaran S, Nathan EA. Severe acquired subglottic stenosis in neonatal intensive care graduates: a case-control study. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F349-F354.