Glottic and Subglottic Stenosis and Related Voice Disorders

Glottic and Subglottic Injury and Development of Pediatric Airway Stenosis

“…Since the 1970s, rates of subglottic stenosis in neonates have decreased from 3.8% to 8.3% down to 1% to 2% in present day 22 . This steady reduction of cases is likely due to streamlining of preventative measures and optimized treatment options in the critical care setting 20 . In the modern intensive care unit, conditions that decrease the integrity of airway mucosa, such as upper airway infection, poor nutritional status, anemia, and GERD, can be preemptively managed to avoid exacerbation of ETT‐induced trauma 13,20,23 .…”

“…Symptoms of subglottic stenosis depend on degree of obstruction, but mild to moderate disease (grades I‐II) may be asymptomatic or present sporadically as compared with moderate to severe stenosis (grades III‐IV). Therefore, in the immediate postextubation period, it can be difficult to tell when subglottic stenosis has developed 20 . Subacute presentation may lead to delayed diagnosis and can manifest as significant airway obstruction weeks to months after discharge 22,24,25 .…”

“…Therefore, in the immediate postextubation period, it can be difficult to tell when subglottic stenosis has developed. 20 Subacute presentation may lead to delayed diagnosis and can manifest as significant airway obstruction weeks to months after discharge. 22,24,25 For pediatric patients with tracheostomies, the official recommendation of the American Thoracic Society is to perform routine bronchoscopy every 6 to 12 months, but the decision to perform additional surveillance endoscopies is often left to the discretion of the physician, which may be heavily biased by available knowledge of predisposing conditions (congenital airway anomalies, Down syndrome) or by classic symptoms of upper airway obstruction.…”

“…[17][18][19] In premature infants, acquired airway stenosis is most commonly caused by prolonged intubation. 20,21 Since the 1970s, rates of subglottic stenosis in neonates have decreased from 3.8% to 8.3% down to 1% to 2% in present day. 22 This steady reduction of cases is likely due to streamlining of preventative measures and optimized treatment options in the critical care setting.…”

“…13,20,23 Current preventative measures consist of close monitoring for signs of infection, systemic corticosteroids, aerosolized racemic epinephrine and steroid therapy, and proton pump inhibitors. 20,23 In the present study, 30% of children with glottic or subglottic injury vs 12% of children without airway injury on initial DL went on to develop airway stenosis. Given that 86% of all participants had at least 1 major comorbidity (Down syndrome, GERD, congenital cardiovascular syndrome, neonatal syndrome), our rates coincide with those reported in previous literature.…”