Subglottic stenosis is a narrowing of the airway in the part of the voice box below the vocal cords (glottis). The diameter of a normal newborn subglottis is 4 mm. If the subglottis is less than 3.5 mm, it is considered narrow.
Two types of subglottic stenosis:
Tracheomalacia can be suspected based on history and physical exam. It can sometimes be seen with certain types of X-rays, including CT scan of the chest or airway fluoroscopy. Diagnosis is confirmedwith direct laryngoscopy/ bronchoscopy.
In addition to making a diagnosis, a laryngoscopy and bronchoscopy allows doctors to grade how severe the narrowing of the airway is. In many cases, significant symptoms do not develop until the airway is more than 50 to 60 percent smaller than normal size.
Treatment depends upon the severity of narrowing and the associated symptoms. In some cases, only supportive care and monitoring is needed. Sometimes the airway can be dilated (widened) with a balloon.
For more severe problems, a surgical procedure to expand the airway, either through telescopes or through an incision in the neck, is recommended. Often expanding the airway involves taking a piece of cartilage from another location and using it to expand the size of the airway. In rare instances, the narrowing is so severe that a tracheotomy needs to be placed to bypass the obstruction before a reconstructive surgery can take place.
Pediatric otolaryngologists at Nationwide Children’s have undergone additional training in pediatric airway management, and will discuss all surgical and nonsurgical options prior to making a recommendation for treatment.
It can be difficult for a parent or family member to discern the severity of a breathing problem when a child has subglottic stenosis. If you are concerned, we urge you to seek medical evaluation immediately. If your child is showing signs of illness, consider consulting your physician for additional treatment recommendations, as this may result in severe symptoms.
In particular, signs that indicate more severe conditions include: irritability, poor feeding, pulling in of the skin at the collar bone, between the ribs, or under the ribs, flaring of the nose, increasing effort to breathe and poor weight gain or weight loss, especially in infants.
Symptoms that should trigger emergency evaluation include: pauses in the breathing, color change of the skin (particularly if the lips, face or hands are turning blue), appearing lethargic or tired, or any other sudden change from a child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.
Request an Appointment