Many patients with subglottic stenosis have the same microlaryngoscopy procedure once or twice a year to enlarge the opening. Other patients have a stenosis that is so narrow that they live with a permanent tracheotomy. If you are a patient like this you may be suitable for surgery which provides a longer term solution called a cricotracheal resection. Cricotracheal resection removes scar tissue within the cricoid cartilage just below the vocal cords.
It also removes part of the upper trachea. The voicebox and the windpipe are then sewn back together. This is complex surgery which requires not just an experienced surgeon but also an experienced anaesthetic and postoperative team. During the operation the anaesthetist and I work closely together to maintain the airway. After surgery I continue to work closely with an experienced intensive care unit ICU and also experienced nurses on the ward. I am only one of a handful of surgeons in Australia who performs this procedure on adults.
You can find out more by reading my blog articles link and watching a video presentation describing my results. Adult Subglottic Stenosis. About Subglottic stenosis is a narrowing just below the vocal cords in an area called the subglottis inside the cricoid cartilage and at the top end of the windpipe. People who have idiopathic subglottic stenosis iSGS have a narrowing called stenosis in the part of the trachea windpipe known as the subglottis; this is the narrowest part of the airway, just below the vocal cords.
Most people with iSGS have scar tissue fibrosis and inflammation in the affected area. Other possible causes include collagen vascular disease, trauma from coughing, and gastroesophageal reflux disease GERD. Symptoms of iSGS, which develop as the subglottis becomes narrowed, may include shortness of breath upon exertion dyspnea , hoarseness, and a high-pitched wheezing sound when breathing in or out stridor.
Stridor from iSGS is often mistaken for wheezing caused by asthma, so people with iSGS are frequently misdiagnosed, delaying a correct diagnosis. Over time, in those with iSGS, stridor and shortness of breath can progressively worsen until they are gasping for breath after simple activities or even at rest. Symptoms may also include changes to the voice, increased mucous production, and a persistent cough.
Doctors diagnose iSGS by ruling out other potential causes of subglottic scarring, and may use the following tests to arrive at a diagnosis:. Surgery to open up the area of stenosis is the most effective treatment for iSGS. There are several surgical approaches including:. For more information, visit our contact us page.
Department of Otolaryngology Head and Neck Surgery. The diagnostic test is typically a tissue or blood test. Lebovics notes. Lebovics employs a multidisciplinary approach when treating each patient. This means he collaborates with other experts, including rheumatologists, pulmonologists, immunologists, allergists, oncologists, radiation oncologists, thoracic surgeons, laryngologists and speech language pathologists.
Together, they bridge their expertise to ensure the best monitoring and treatment path for each patient. Autoimmune and inflammatory diseases are indicators that the immune system is overactive hyper-immunity. This includes a misfiring of the immune system, which can cause dysregulated T-lymphocytes to transform other immune cells B cells into scavengers that attack healthy tissue.
The following are examples of these disorders:. Sometimes tracheal stenosis can transpire as a result of a viral infection or treatment for cancer, such as radiation or extended use of a breathing tube. In these instances, this effect is hypo-immunity, meaning the immune system is underactive. Cancer treatment and diseases such as tuberculosis or glanders can cause throat swelling and block the space in your trachea.
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