Subglottic Stenosis

1. Definitions
   1. Subglottic Stenosis
      1. Congenital or acquired narrowing of the airway immediately below the level of the Larynx (cricoid cartilage level)
2. Pathophysiology
   1. Subglottic airway is the narrowest portion of the upper airway
   2. Most common cause is prior Premature Infants with history of prolonged intubation (scar forms in subglottis)
3. Epidemiology
   1. Rare aside from Premature Infants who underwent prolonged intubation
4. Causes
   1. Congenital Anomaly
   2. Acquired
      1. Airway Trauma
         1. Prolonged neonatal intubation (postintubation stenosis)
         2. Gastroesophageal Reflux disease
      2. Infectious
         1. Syphilis
         2. Tuberculosis
         3. Typhoid Fever
         4. Diphtheria
5. Symptoms
   1. Infants and young children
      1. Persistent or recurrent Stridor
   2. Older children and adults
      1. Dyspnea on exertion
6. Diagnostics
   1. Pulmonary Function Tests
      1. Typically demonstrates a fixed upper airway obstruction
7. Management
   1. Non-Emergent Presentation
      1. Otolaryngology Consultation in all suspected cases
      2. Endoscopic dilation or surgical repair
   2. Emergency Airway Management (respiratory distress)
      1. Early emergent Consultation with ENT for surgical Tracheostomy
      2. Temporize airway
         1. Albuterol Nebulizer (with or without Ipratropium Bromide in Duoneb)
         2. Nebulized racemic epinephrine
      3. Calm Patient
         1. Sub-dissociative dose Ketamine
         2. Consider full-dissociative dose Ketamine
      4. Other measures
         1. Tracheal Jet Ventilation
         2. Heliox
      5. References
         1. Guest and Friedman in Herbert (2020) EM Rap 20(12): 1-2
8. References
   1. Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10