Subglottic Stenosis

Subglottic stenosis (SGS) is a narrowing of the airway just below the vocal cords (the subglottic space, part of the larynx). It can partially or completely obstruct airflow, causing breathing difficulties.

📍 Anatomical Location:

Located below the vocal cords (glottis) and above the trachea
The subglottis is the narrowest part of the upper airway in infants and young children

🧬 Causes:

🔹 Congenital (present at birth):

Abnormal development of the airway cartilage
Often diagnosed in infancy or early childhood

🔹 Acquired (most common):

Prolonged intubation (tube in the airway)
Trauma to the airway (surgery, tracheostomy)
Infections (rarely, e.g. tuberculosis, diphtheria)
Autoimmune diseases:
- Granulomatosis with polyangiitis (Wegener’s)
- Relapsing polychondritis
- Sarcoidosis
Idiopathic (unknown cause, especially in adult women)

🩺 Symptoms:

Noisy breathing (stridor, especially during inhalation)
Shortness of breath, especially with exertion
Voice changes (hoarseness)
Chronic cough
Recurrent croup-like episodes in children
Difficulty swallowing (in severe cases)

🔍 Diagnosis:

Laryngoscopy or bronchoscopy: Direct visualization of narrowing
CT scan or MRI: To assess extent of stenosis
Pulmonary function tests: May show upper airway obstruction

📏 Severity Classification:

Cotton-Myer grading system (based on percentage of airway obstruction):

Grade I: <50% narrowing
Grade II: 51–70%
Grade III: 71–99%
Grade IV: No detectable airway

💊 Treatment:

🔧 Non-surgical/Minimally invasive:

Endoscopic dilation (balloon or rigid dilators)
Laser surgery or microdebridement
Topical or injected steroids (reduce inflammation and scarring)
Mitomycin C application (to reduce scar tissue formation)

🏥 Surgical:

Laryngotracheal reconstruction (LTR) – Widening the airway with cartilage grafts
Cricotracheal resection (CTR) – Removal of the narrowed section and rejoining the airway
Tracheostomy – May be used temporarily or long-term in severe cases