Idiopathic Subglottic Stenosis

People who have idiopathic subglottic stenosis (iSGS) have a narrowing (called stenosis) in the part of the windpipe just below the vocal cords (called the subglottis). Most people with iSGS have scar tissue (fibrosis) and inflammation in the area, as well.

Symptoms of Idiopathic Subglottic Stenosis

Symptoms of iSGS may include the following:

• Shortness of breath upon exertion (dyspnea)
• Hoarseness
• High-pitched wheezing sound when breathing in or out (stridor)
• Changes to the voice
• Increased mucous production
• Persistent cough

Stridor from iSGS is often mistaken for wheezing caused by asthma, so people with iSGS are frequently misdiagnosed. Over time, in those with iSGS, stridor and shortness of breath can worsen until the person is gasping for breath.

Causes of Idiopathic Subglottic Stenosis

There is no known cause for iSGS (this is the meaning of the term “idiopathic”). This condition occurs almost exclusively in women between the ages of 30 and 50 but has also been reported in younger women and older adults. Because most cases of iSGS occur in women around the time of menopause, the condition may be linked to hormonal changes. Other possible causes include collagen vascular disease, trauma from coughing, and gastroesophageal reflux disease (GERD). 

Diagnosing Idiopathic Subglottic Stenosis

Your doctor may diagnose iSGS by ruling out other potential causes of subglottic scarring. They may use several tests to make a diagnosis, including the following:

• Pulmonary function testing: A patient breathes into a machine called a spirometer, which measures how much air they can breathe out or take in.
• CT scan: Computed tomography (CT) can provide a clear and detailed view of the neck and reveal a narrowed (stenotic) region.
• Endoscopy: A doctor uses an endoscope (a small flexible tube equipped with a camera) to see the subglottic area of the windpipe. After numbing the airway, the doctor passes the endoscope through the nose and throat to the subglottic area. The rest of the trachea is also checked to make sure there are no other abnormalities. 
• Blood tests: Doctors may perform blood tests to look for antibodies that indicate autoimmune disorders known to cause subglottic stenosis. 

Treatment for Idiopathic Subglottic Stenosis

There are several effective treatments for iSGS, including:

• Steroid injection: Your doctor may inject the stenosis with steroids to help shrink it and decrease the risk of recurrence. Steroids may be given in the office as a series of three to four injections, each two weeks apart.
• Endoscopic incision and dilation: In this minimally invasive procedure, doctors use a laser to cut the stenosis then inflate a balloon to open the narrowed area of the trachea. In many cases, this provides only temporary relief, and the stenosis comes back requiring further treatment. Steroid injections may also be given as part of a dilation procedure.
• Open surgery: In patients with severe narrowing who haven’t responded to other treatments, doctors may perform open airway surgery through the front of the neck. In a procedure called a cricotracheal resection, surgeons remove a portion of cartilage from the trachea along with scar tissue and reconstruct the affected areas. Some doctors believe that these open surgical approaches provide greater long-term results than balloon dilations or laser therapy.

Why Choose Columbia

At Columbia Otolaryngology, our physicians have specialized expertise in diagnosing and treating the sensitive area of the throat affected by iSGS. Treatment for this condition has evolved over the last decade, and surgery is no longer the first option. Our specialists have vast experience with in-office transcutaneous steroid injections, which reduce the inflammatory process that creates stenosis leading to difficulty breathing. Patients are treated in the office the same day and usually notice fewer symptoms within a week of the first treatment.