Subglottic stenosis is the narrowing of the airway (larynx) just below the vocal folds.

The larynx has an upper region (supraglottis), middle region (glottis) and lower region (subglottis).

Symptoms

Symptoms of subglottic stenosis include:

• Shortness of breath during exercise and sometimes at rest
• Noisy breathing (stridor)
• Cough
• Recurrent croup
• Voice changes such as hoarseness
• Feeling of mucus in the airway

Causes of Subglottic Stenosis

Subglottic stenosis may be caused by trauma or infection (acquired) or may be present at birth (congenital).

Congenital subglottic stenosis occurs when the airway cartilage does not develop as it should before birth and leads to a narrowing of the airway.

Acquired subglottic stenosis is often caused by having a breathing tube in for a long time. Scarring from the pressure of the tube on the inside of the airway can cause the stenosis. Other causes can include:

• Rare diseases causing inflammation of the airway
• Trauma, such as an injury from inhaling a chemical or substance causing burns
• Idiopathic (unknown)

Diagnosis of Subglottic Stenosis

The subglottis is hard to see and check in a clinic. We use microlaryngoscopy and bronchoscopy to diagnose subglottic stenosis in children. For these tests, your child goes to sleep in the operating room and a special telescope is passed into your child’s airway. This is used to to look for narrowing.

We may also use X-rays or a CT scan to:

• Check the size of your child’s airway
• Check the degree of narrowing
• Look for any other structures that may be pressing on the airway

Treatment for Subglottic Stenosis

Treatment for subglottic stenosis depends on how severe child’s symptoms are.

• Mild subglottic stenosis — The child may not need any intervention. They will need to see the doctor on a routine basis, though.
• Moderate or severe subglottic stenosis — The child may need surgery to make the size of the airway larger. This will help them breathe easier. In some cases, your doctor may want to do a tracheotomy below the level of airway narrowing. This will give your child a safe airway and make it easier to breathe.

When your child is ready, your doctor may start procedures for airway reconstructive surgery. This may include:

Endoscopic Surgery

This type of surgery is used for children with mild to moderate subglottic stenosis. Using a camera, narrow parts are divided and / or widened using special balloons.

Open Surgery

If your child has moderate to severe narrowing, a more complex treatment may be needed. This surgery is done to enlarge the part with narrowing or stenosis. There are two main ways open surgery can be done.

Laryngotracheal Reconstruction (LTR) or Laryngotracheoplasty (LTP)

In LTR, the narrowed part of the windpipe right below the voice box is widened. This is done by putting a graft or piece of cartilage into the airway. Most grafts are made of cartilage from the rib, but cartilage from the ear or thyroid are also used. The surgery is done in a single stage or in steps, based on your child's condition.

Single stage (SSLTR): If your child has a tracheostomy tube, it will be removed at the time of surgery. Your child will have a breathing tube placed through their nose after surgery. The breathing tube holds open the airway and supports the repair site while the graft heals and gets stronger. While the breathing tube is in, your child may need to be sedated and ventilated by a respirator. In many cases, the repair site is checked in the operating room before taking out the breathing tube.

Double stage (DSLTR): There are two options with this surgery. Your child may have a stent (hollow tube-like device) placed in the airway above their tracheotomy tube (trach). The ENT doctor may decide to use a T-tube instead of using a trach and stent. A T-tube is like a trach and stent, but it is all-in-one. The stent or T-tube holds your child’s airway open while the graft heals. Your doctor will decide how long the T-tube or stent stays in place.

Cricotracheal Resection (CTR) or Cervical Slide Tracheoplasty

In a CTR and cervical slide tracheoplasty, the narrow part of the trachea is removed. Then the healthy ends of the trachea are reattached. This surgery may be done in a single stage or in steps.

Call Your Child’s Doctor If Your Child:

• Has problems keeping food down and spits it up all the time
• Is losing weight or is not gaining weight
• Begins to feed less and tires easily in the middle of feeding
• Begins to choke on food
• Struggles between eating and breathing

Take Your Child to the Hospital if Your Child:

• Stops breathing for longer than 10 seconds
• Has dusky or blue color around their lips with noisy breathing
• Has chest or neck retractions that do not stop with change in position or waking your child up