Subglottic stenosis

Subglottic stenosis is a narrowing of the trachea below the vocal cords, often resulting in difficulty breathing. This condition can be either congenital or acquired, and is most common in children, although its manifestations can also be observed in adults. Subglottic stenosis can vary in severity: from a minor narrowing that does not require treatment to complete obstruction of the trachea with dangerously low oxygen levels in the body. Symptoms of this condition include wheezing, stridor, coughing, difficulty breathing, and in more severe cases, respiratory failure. Successful therapy depends on timely diagnosis and adequate treatment.

History of the disease and interesting historical facts

The history of studying subglottic stenosis began in the 16th century, when the first attempts to describe diseases of the respiratory system began. However, serious research began only in the 20th century. One of the important moments in history was the introduction of respiratory tract imaging methods, which allowed for a better understanding of the causes and mechanism of stenosis development. It is noteworthy that in 1922, Harald Hestal was the first to describe diseases associated with traumatic stenosis of the trachea caused by foreign bodies and mechanical damage. It was noted that stenosis can occur as a result of various pathological processes: from infectious to degenerative. In recent decades, the attention of doctors has been drawn to the influence of smoking and other environmental factors on the development of male subglottic stenosis.

Epidemiology

The epidemiology of subglottic stenosis demonstrates a growing interest in this pathology among both pediatricians and otolaryngologists. Statistics show that congenital subglottic stenosis occurs in one in 2,500 newborns and is more often observed in boys. Acquired forms of stenosis are most often observed in adults, mainly in people over 40 years old, and are associated with smoking, chronic obstructive pulmonary diseases and other respiratory pathologies. According to the latest study, up to 6% patients with long-term tracheostomies can acquire subglottic stenosis, which convinces doctors of the importance of regular monitoring of such patients.

Genetic predisposition to this disease

Genetic predisposition to subglottic stenosis is observed in the case of its congenital forms. To date, several genes have been identified that may be involved in the pathogenesis of this pathology. For example, mutations in genes responsible for small cell analysis can lead to disruption of the formation of cartilaginous structures of the trachea and, accordingly, to its narrowing. One of these genes is the SOX9 gene, which plays an important role in chondrogenesis. Studies show that in children with congenital subglottic stenosis, in a significant proportion of cases, sequences associated with disruption of this gene are detected. It is also known that background mutations of BRCA1 and BRCA2 can increase the risk of developing anomalies that can contribute to the occurrence of subglottic stenosis.

Risk factors for the development of this disease

Risk factors for subglottic stenosis can be divided into physical and chemical. Physical factors include:

• neck and trachea injuries;
• consequences of tracheostomy;
• chronic inflammatory diseases of the upper respiratory tract;

Chemical risk factors include:

• exposure to tobacco smoke;
• alcohol;
• exposure to harmful gases and chemicals in the workplace.

It is also worth noting that there is a link between a lack of vitamin and mineral intake among different population groups, which may serve as an indirect risk factor for the development of this disease.

Diagnosis of this disease

Diagnosis of subglottic stenosis requires a comprehensive approach and includes several key stages, such as determining clinical symptoms, laboratory tests and radiological examinations. The main symptoms of stenosis that should alert the doctor include:

• stridor;
• wheezing;
• difficulty breathing;
• cough;

Laboratory tests may include a complete blood count and biochemistry to rule out infectious processes, possible allergies, or other respiratory diseases. Radiological examinations include chest X-rays and CT scans of the neck. Direct visualization of the trachea and bronchoscopy may also be used. Differential diagnosis should include conditions such as tracheal cancer, allergic edema, and benign tumors to ensure accurate treatment.

Treatment

Treatment of subglottic stenosis can be either conservative or surgical. Conservative methods include pharmacological treatment, especially in cases where the stenosis is minor. Drugs that help expand the airways and facilitate breathing, such as beta-adrenergic agonists and glucocorticosteroids, are used. In more severe cases, surgery is indicated, which may include:

• parallel expansion of the stenotic area;
• tracheoplasty;
• tracheostomy, if necessary to ensure breathing.

Other treatments may include physical therapy and the use of inhalers to relieve symptoms. If an infection is detected, antibiotic therapy is prescribed.

List of medications used to treat this disease

Medications used to treat subglottic stenosis include:

• Glucocorticosteroids (eg, prednisolone, dexamethasone);
• Bronchodilators (eg, salbutamol);
• Antibiotics if infections are present (eg, amoxicillin);
• Antihistamines (eg, loratadine);

The dosage and choice of therapy are always determined by the doctor, based on the individual indicators of the patient.

Disease monitoring

Monitoring of subglottic stenosis plays a key role in assessing the dynamics and effectiveness of treatment. Regular monitoring activities include:

• Assessment of respiratory function;
• X-ray examinations to assess changes in the trachea;
• Regular examinations by an otolaryngologist.

The prognosis for patients with subglottic stenosis depends on its causes and severity. In most cases, with timely treatment, positive dynamics are observed, but complications such as repeated stenosis or chronic respiratory diseases are possible.

Age-related features of the disease

Subglottic stenosis may manifest itself differently depending on the age of the patient. In newborns and young children, it is more often congenital, which is associated with insufficient development of the tracheal structure. In adults, the main cause of stenosis is usually acquired factors, such as chronic inflammation or temporary stenosis that occurs after injuries. In older people, attention should be paid to comorbid conditions, such as chronic obstructive pulmonary disease, which can aggravate the course of stenosis.

Questions and Answers

• What are the main causes of subglottic stenosis? Subglottic stenosis can be caused by congenital anomalies, mechanical trauma, chronic inflammatory processes and exposure to chemicals.
• How to diagnose subglottic stenosis? The disease can be diagnosed using radiography, bronchoscopy, general clinical assessment and laboratory tests.
• What medications are used to treat the disease? Treatment may include glucocorticosteroids, bronchodilators, and antibiotics in case of infectious processes.
• What are the risk factors for subglottic stenosis? Major risk factors include chronic lung disease, tracheal injury, and exposure to toxic substances.
• What is the prognosis for this pathology? The prognosis is favorable with timely diagnosis and treatment, but relapses and complications are possible.