Symptoms of subglottic stenosis include:

• Shortness of breath during exercise and sometimes at rest
• Noisy breathing (stridor)
• Cough
• Recurrent croup
• Voice changes such as hoarseness
• Feeling of mucus in the airway

Subglottic stenosis may be caused by trauma or infection (acquired) or may be present at birth (congenital).

Congenital subglottic stenosis occurs when the airway cartilage does not develop normally before birth and results in a narrowing of the airway.

Acquired subglottic stenosis is often related to having a breathing tube in for a long period of time. Scarring from pressure of the tube on the inside of the airway can cause the stenosis. Other causes of acquired subglottic stenosis include:

• Rare diseases causing inflammation of the airway
• Trauma, such as a burn injury from inhaling a chemical or substance causing burns
• Idiopathic (unknown)

The subglottis is hard to see and examine in a clinic. Children are often unsuccessfully treated for more common disorders, such as asthma, before the diagnosis of subglottic stenosis is made.

We use microlaryngoscopy and bronchoscopy to diagnose subglottic stenosis in children. For these procedures, your child goes to sleep in the operating room and a special telescope is passed into your child’s airway to look for narrowing.

We may also use X-rays or a CT scan to check the size of your child’s airway and degree of narrowing, and to look for any other structures that may be pressing on the airway.

Treatment for subglottic stenosis depends on the severity of your child’s symptoms. For mild subglottic stenosis, a child may not need any intervention but will need to see the doctor on a regular basis. For moderate or severe subglottic stenosis, your child may need surgery to make the size of the airway larger. This will help your child to breathe more easily. In some cases, your doctor may want to do a tracheotomy below the level of airway narrowing to provide your child with a safe airway and to make it easier for him/her to breathe.

When your child is ready, your doctor may begin procedures for airway reconstructive surgery that may include:

Endoscopic Surgery
This type of surgery is used for children with mild to moderate subglottic stenosis. Using a camera, narrow areas are divided and/or widened using special balloons designed to stretch the airway.

Open Surgery
If your child has moderate to severe narrowing a more complex treatment may be needed. This surgery is done to enlarge the area of narrowing or stenosis. There are two main types of open surgery procedures: Laryngotracheal Reconstruction (LTR) or Cricotracheal Resection (CTR)

Your child:

• Has difficulty keeping food down and constantly spits it up
• Is losing weight or is not gaining weight
• Begins to feed less and tires easily in the middle of feeding
• Begins to choke on food
• Struggles between eating and breathing

Take your child to the hospital if he/she:

• Stops breathing for longer than 10 seconds
• Has dusky or blue color around lips associated with noisy breathing
• Has chest or neck retractions that do not stop with repositioning your child or waking your child up