Subglottic Stenosis in Children!

Subglottis is the part of the voice box from just beneath the vocal cords down to the top of the trachea or windpipe. The narrowing of the subglottis is called subglottic stenosis. Subglottic stenosis also involves narrowing of the cricoid cartilage. In some children there can be involvement of the vocal cords as well. Children with subglottic stenosis, the degree of obstruction can be variable. Depending on the severity of obstruction, subglottic stenosis is divided from grade one to grade 4 (cotton myer classification), with grade one being the least narrowed and grade four being the most narrowed. In this article we shall discuss the causes, symptoms, diagnosis and treatment of subglottic stenosis in children.

Subglottic Stenosis in Children!

What are the most common causes of subglottic stenosis in children?
Subglottic stenosis could be either congenital or acquired. Babies with congenital subglottic stenosis are born with this problem. This happens as the child’s airway did not form normally before birth. The second type of subglottic stenosis in children is acquired (not present at birth, but develops later). The main cause of acquired subglottic stenosis is related to intubation (a breathing tube inserted into a child's airway). The other causes of acquired subglottic stenosis in children are infections and trauma. These diseases cause damage and scarring in the airway leading to airway narrowing.

What are the symptoms of subglottic stenosis?
The symptoms of subglottic stenosis depend upon whether it is a congenital type or an acquired type. In addition, the degree of obstruction, depending on the grade of stenosis, also decides the symptoms of the child. In children with congenital subglottic stenosis, symptoms usually start after they are born. Symptoms include noisy breathing or stridor, difficulty in breathing and retractions in the suprasternal, intercostal, and diaphragmatic regions. In case of involvement of the vocal cords children can have a weak cry, aphonia, or hoarseness. The symptoms of acquired subglottic stenosis are similar to congenital subglottic stenosis, but they usually begin after the event which has led to stenosis of the child’s airway.

How is subglottic stenosis treated?
The treatment of subglottic stenosis in children depends upon whether it is congenital or acquired and Cotton Mayer grade of subglottic stenosis. Children with congenital subglottic stenosis, especially if you have stenosis of grade 3 or grade 4, usually require a surgical repair of the stenosis. This procedure is known as laryngotracheoplasty. In this surgery the narrowed diameter of the subglottis is enlarged by inserting a piece of cartilage. Children who have acquired subglottic stenosis specially of grade 1-2 can be managed by balloon dilatation of the airways alone. Acquired subglottic stenosis, which is advanced into stage 3 or stage 4 also requires opening up of the stenosed segment using an electrosurgery knife or laser combined with repeated balloon dilatation.

In case your baby is having noisy breathing/stridor or is diagnosed to have subglottic stenosis, you need to get in touch with the child pulmonologist specialist for proper diagnosis and treatment.

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