Case Of Subglottic Stenosis Research Articles

Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea.

To present a patient with the first case of NTM (nontuberculous mycobacteria) infection of the larynx extending to cervical trachea, and the first case of subglottic stenosis associated with an NTM infection. Case report and review of the literature. A 68-year-old female with history of prior smoking, gastroesophageal reflux disease, asthma, bronchiectasis, and tracheobronchomalacia presented with a 3-month history of shortness of breath, exertional inspiratory stridor, and hoarseness. Flexible laryngoscopy demonstrated ulceration of medial aspect of right vocal fold and subglottic tissue abnormality with crusting and ulceration extending through the upper trachea. Microdirect laryngoscopy with tissue biopsies and carbon dioxide (CO2) laser ablation of disease completed, and intraoperative culture revealed positive Aspergillus and acid-fast bacilli with Mycobacterium abscessus (type of NTM). Patient began antimicrobial treatment of cefoxitin, imipenem, amikacin, azithromycin, clofazimine, and itraconazole. Fourteen months after initial presentation, patient developed subglottic stenosis with limited extension into the proximal trachea prompting CO2 laser incision, balloon dilation, and steroid injection of the subglottic stenosis. Patient remains disease free without further subglottic stenosis. Laryngeal NTM infections are exceedingly rare. Failure to consider NTM infection in the differential diagnosis when presented with an ulcerative, exophytic mass in patients with increased risk factors (structural lung disease, Pseudomonas colonization, chronic steroid use, prior NTM positivity) may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.

Cuffed Endotracheal Tubes in Neonates

AbstractCuffed endotracheal tubes (ETTs) are becoming increasingly used in neonates; nevertheless, current data in the literature mostly include infants over 3,000 g in weight. The aim of this study was to compare the use of cuffed and uncuffed ETTs in neonates in the neonatal intensive care unit of a tertiary children's hospital, assessing the presence of airway complications. We performed a single-center retrospective cohort study. Our study included all term neonates receiving cuffed ETTs over the period from January 2019 to December 2021. The controls were all neonates receiving an uncuffed ETT over the same period. Twenty-five patients were intubated with cuffed ETTs in the study period. The group receiving cuffed ETTs was compared with 53 patients receiving uncuffed ETTs. All cuffed ETTs were inserted in the operating room by anesthesiologists. Comparing the outcomes of the cuffed ETT group with controls, there were no significant differences in the number of unplanned extubations, reintubation episodes, ventilator-associated pneumonia, episodes of atelectasis, the use of dexamethasone, or vocal cord paresis. No unplanned extubation was observed in the cuffed ETT group, and no cases of subglottic stenosis were observed in either of the groups. This retrospective study with a small sample size suggests that the use of cuffed ETTs in surgical patients >2,000 g in weight is not associated with an increase in airway complications. Well-designed randomized controlled trials are needed to compare cuffed ETTs with uncuffed ETTs.

COVID-19肺炎に対する気管挿管・気管切開後に認めた声門下狭窄の2症例

COVID-19肺炎に対する気管挿管・気管切開後に認めた声門下狭窄の2症例

A Case of Subglottic Stenosis Treated with Resection of the Cricoid Cartilage and Circumcision of a Tracheal Ring

A Case of Subglottic Stenosis Treated with Resection of the Cricoid Cartilage and Circumcision of a Tracheal Ring

A case of subglottic stenosis developing on postoperative day two

A case of subglottic stenosis developing on postoperative day two

A 10-year-old Child with Severe Subglottic Stenosis Following Intubation: A Case Report

Background: Subglottic stenosis is among the most common airway problems in children, i.e., acquired or congenital. More than 90% of acquired cases are secondary to endotracheal intubation and occur iatrogenically. Subglottic stenosis is an unexpected problem that requires timely diagnosis and intervention. Most cases of subglottic stenosis in children are mild to moderate. Case Presentation: The presented patient was a 10-year-old child who, after long intubation due to head trauma following early discharge from the surgical center, was referred to the Children’s Hospital on the same day with a complaint of high fever and shortness of breath. With the development of respiratory distress and cyanosis, the patient was transferred to the intensive care unit. Due to the impossibility of passing the tracheal tube with the appropriate age for the patient, the initial diagnosis of subglottic stenosis was established and a tracheostomy was performed. Diagnostic bronchoscopy confirmed severe subglottic stenosis, and the child was referred to a specialized Ear, Nose, Throat (ENT) center for the repair of the tracheal stenosis. Conclusion: One of the most common causes of stridor in children is subglottic stenosis following prolonged intubation. Recognizing the predisposing factors, prevention, strong clinical suspicion, timely diagnosis, and treatment can prevent further adverse complications or consequences in children.

Follow-Up Investigation of 41 Children After Metallic Airway Stent Implantation: An 8-Year Experience.

Objective: To present 8-year follow-up outcomes, treatment of complications, and prognosis in children with congenital tracheal stenosis after metallic airway stent implantation.Methods: Retrospective analysis was performed on the clinical records of children who had airway stents placed between May 20, 2011 and May 31, 2016, and on their follow-up records collected on November 31, 2019.Results: During the 8 years follow-up, 41 children underwent airway stenting under flexible bronchoscopy and participated in the follow-up investigation. There were 26 cases with left main bronchus (LMB) stenosis (63.4%), 16 cases with congenital tracheal stenosis (CTS, 39.0%), 12 cases with right main bronchus (RMB) stenosis (29.3%), and 1 case of subglottic stenosis (2.4%). A total of 76 stents were implanted, and 21 patients died after implantation. There were 34 children (82.9%) with congenital heart disease (CHD), while other diseases accounted for <5%. Among children with CHD and those with other conditions, the number of death cases was 19 and 2, respectively; no significant differences were observed between the two groups (P>0.05). The most frequent complications were increased airway secretion (75.8%), stent deformation (66.7%), and granulation tissue hyperplasia (60.6%). The airway stenosis (45.5%) and stent migration (12.1%) occurred at a moderate rate. The less common complications were airway softening (6.1%), and stent breakage (6.1%).Conclusions: The placement and removal of the metallic stent are convenient and quick procedures that can relieve the symptoms of dyspnea caused by airway stenosis in the case of an emergency. After stent implantation, the primary disease should be actively treated, and the stent should be removed as soon as possible after the cause of airway stenosis is successfully removed. Larger stents are more likely to cause complications; thus, a good follow-up system should be established to timely address all the complications.

Assessing the Breadth of Laryngology Training in Otolaryngology Residency Programs

Laryngology is an expanding field with incorporation in resident training nationwide. However, the breadth of training in laryngology reported by residents has not been previously evaluated. This project assesses the variability in laryngology training among otolaryngology residents. A cross sectional, multi-institutional study was performed with an anonymous survey sent to residents and laryngology fellows nationally to assess different laryngology training practices. There were 151 responses to the survey with 9.6% response rate. 49 (32.9%) did not have a designated laryngology rotation. 134 (89.3%) had a fellowship-trained laryngologist as part of their institution. The greatest percentage of respondents intended to pursue general ENT (31; 20.7%). PGY5 responses were analyzed for total residency exposure showing, 66.7% of PGY5s received training to identify different types of dysphonic voices through auditory findings alone. 61.9% could interpret a videoflouroscopic swallow study. Regarding surgical cases, 52.4% had been involved in open cricopharyngeal myotomies, 76.2% in endoscopic cricopharyngeal myotomies, and 100% in subglottic stenosis cases. Residents pursuing a career in laryngology and those with a designated laryngology rotation had more exposure to laryngeal surgeries and office-based procedures than their peers. Laryngology training and exposure varies across the country. Residents are more familiar with airway than voice and swallowing related pathology. Residents with a designated laryngology rotation and those pursing laryngology fellowships were more likely to have exposure to laryngeal surgery and office-based procedures. Programs with a laryngologist likely had higher response rates so the true laryngology exposure may be more limited than our data suggests.

A case of subglottic stenosis 130 days after extubation

A case of subglottic stenosis 130 days after extubation

Airway Management of Severe Subglottic Stenosis with a Novel Airway Device

S ubglottic stenosis (SS) is the leading cause of stridor in pediatric age group. It involves narrowing of subglottic lumen due to incomplete recanalization during embryogenesis (congenital) or after trauma (post intubation). Stridor is the important symptom of SS and usually present in both phases of respiration. Airway management becomes a challenging task to the anesthesiologist in SS due to difficulty in maneuvering endotracheal tube (ETT) through the noncompliant stricture. Location and extent of stricture also pose difficulty in securing front of neck access [1]. After taking consent of the child’s parent for possible publication in a medical journal, we present a case of subglottic stenosis posted for emergency tracheostomy and ventilated with a novel airway device prepared by simple equipments present in operation theatre. Case Report A one-year-old baby of 11 kg presented to the emergency with chief complaint of noisy breathing developed after upper respiratory tract infection (URTI), fever and cough since 2 days. Child’s stridor started since birth that was progressive in severity and frequency, aggravated by recurrent URTI. At the time of admission, child was in severe respiratory distress with intercostals and suprasternal retraction. Nasal flaring was present with weak cry. Bilateral air entry was decreased with harsh bronchial sounds on auscultation. Hemodynamically child was unstable with heart rate 200 per minute, blood pressure 60/36 mmHg, respiratory rate 44 per minute, axillary temperature 38.5 degree Celsius and SpO2 62% at room air and 88% with Oxygen given by facemask and reservoir at 10 liters per minute. ABG showed pH 7.32, PO2 52 mm Hg, PCO2 68 mm Hg, HCO3 20.2 meq/l and Hb 10.6 mg/dl. Emergency CECT was done which showed the subglottic stenosis of 2.6 mm in length and 2.0 mm of patent airway in diameter at the narrowest point [Figure 1]. Securing the airway was planned with endotracheal intubation followed by surgical tracheostomy and definite correction. Tracheostomy could be done under sedation in a spontaneously breathing child with the aid of facemask or supraglottic airway device. However, an unsuccessful attempt in tracheostomy could completely obstruct the airway and patient may suffer hypoxia. ETT of 2.0 mm ID was not available that day so we decided to make a novel device in place of ETT. We developed a novel airway device by using 6F suction catheter (SC), 18 G intravenous needle catheter, 3.5 mm ID Endotracheal tube connector and guide wire of 10 F Foleys catheter. We cut the connecting end of SC to resize it equivalent to the length of 2.5mm ID ETT and marking the SC with marker at 6 to 10 cm, 1 cm apart. Foleys guide wire was inserted in the SC and whole

Lyell’s syndrome as a factor which escalates the risk of laryngotracheal stenosis and atresia after intubation

Toxic epidermal necrolysis (TEN) also known as Lyell’s Syndrome is a rare, acute hypersensitivity reaction characterized by cutaneous and mucosal necrosis. Lyell’s syndrome is self limited, but potentially recurrent disease. The mortality for toxic epidermal necrolysis is approaching to 30%.[1] Subglottic stenosis is the most common anomaly of larynx and trachea requiring tracheostomy in pediatric population. Subglottic part of larynx is the narrowest section of laryngotracheal area of airways in childhood.[5] It is estimated that most of subglottic stenosis cases is acquired and developed as a result of injury caused by long-term use of endotracheal tube. A 2-year-old patient admitted to our Clinic of Children’s Otolaryngology after long treatment for TEN because of problems with breathing without tracheostomy tube. Because of the results of bronchofiberoscopy patient has been sent to our Clinic of Children’s Otolaryngology. We performed laryngotracheoscopy which showed transglottic, subglottic and proximal part of tracheal stenosis and complete atresia of trachea above tracheostomy tube. Result of MRI examination was described as complete atresia of trachea which was 4 mm long and located above tracheostomy tube. Our patient was classified for open surgery intervention- partial cricotracheal resection with reconstruction (CTR). Latest improvements about construction of endotracheal tube and rules of procedures reduced frequency of subglottic stenosis to less than 1%.[11] There are no statistics or medical reports about tracheal atresia caused by intubation or Lyell’s syndrome. This situation forced us to recognise Lyell’s syndrome and endotracheal intubation overlapping on each other as a cause of medical state of our patient.

Dyspnea-Think outside of the box, a case of subglottic stenosis.

Dyspnea is a common presentation in upper and lower airway obstructive causes. However, biphasic stridor and hoarseness should prompt evaluation of the upper airway. Nasendoscopy carried out by the otolaryngology team is a quick and an effective way of evaluating the upper airway.

Associated airway anomalies and their impact in patients with laryngomalacia: A retrospective review

Introduction: Laryngomalacia is the most common cause of stridor in newborn constituting 50%–75% of all airway anomalies. It is graded as mild, moderate, and severe on the basis of presenting features. It has been shown that 12%–64% of laryngomalacia present with other associated airway anomalies. Here, we have tried to find out the incidence of associated anomalies with laryngomalacia and their impact on the patient's management and prognosis. Materials and Methods: We reviewed patients with laryngomalacia visiting laryngology clinic from January 2014 to January 2019. The incidence and type of associated anomalies; their impact on management protocol and hospital stay; and their association with mild, moderate, and severe grades of laryngomalacia were evaluated. Results: A total of 63 patients were included in the study. Most of the patients presented with severe laryngomalacia (34/63 [53.9%]). Out of them, associated anomalies were present in 23/63 (36%) patients, more common in severe laryngomalacia (16/34 [47.05%]). Tracheomalacia was the most common anomaly (9/63 [14.28%]). The management protocol was changed on the basis of the associated anomalies. The six out of nine patients with tracheomalacia underwent tracheostomy and watchful waiting was done for the other three. The bilateral vocal cords palsy patients underwent partial arytenoidectomy, direct laryngoscopic dilatation was done for all cases of subglottic stenosis, the vallecular cyst patient underwent excision of the cyst and for the patient with laryngeal cleft repairing of the cleft was done after freshening the margins of the cleft. Patients with associated anomalies had statistically significant increased duration of hospital stay (11.35 days) as compared to patients without these anomalies (7.5 days). Conclusion: It can be concluded that associated anomalies are present in a significant number of patients with laryngomalacia and can result in the modification of management protocol and increase in the duration of hospital stay.

A case of subglottic stenosis developed after intubation of double-lumen tube

A case of subglottic stenosis developed after intubation of double-lumen tube

A clinical threat in patients with granulomatosis polyangiitis in remission: Subglottic stenosis

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatous disease that involves small- and medium-sized arteries and affects the main respiratory tracts and kidneys. Upper respiratory tract involvement usually occurs in 90% of patients, who most frequently present with symptoms of chronic sinusitis. Subglottic stenosis (SS) is a rare and severe complication that is usually observed in approximately 15% of patients. Here we present a case of SS in a patient with limited form of GPA during remission.

A Case of Subglottic Stenosis that Developed after Intubation with a Double-lumen Endotracheal Tube

A Case of Subglottic Stenosis that Developed after Intubation with a Double-lumen Endotracheal Tube

The use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in 17 cases of subglottic stenosis.

Shared airway management in patients with subglottic stenosis (SGS) is challenging for both the anaesthetist and surgeon. Various methods of airway management have been described but currently no gold standard exists. Jet ventilation has been described as the preferred technique despite a UK National Survey highlighting potential complications including pneumothorax, pneumomediastinum, surgical emphysema, hypoxia and death. This article is protected by copyright. All rights reserved.

Technique for improved safety in the endoscopic management of subglottic stenosis

ObjectiveTo identify a safe approach to airway management during the endoscopic balloon dilation of subglottic stenosis BackgroundSubglottic stenosis is an abnormal narrowing of the upper airway commonly managed by endoscopic technique performed on an unsecured airway. MethodsReview of surgical treatment of subglottic stenosis cases by the senior author. TechniqueFollowing steroid injection and radial cuts performed either under jet anesthesia or mask ventilation with brief periods of apnea, a small endotracheal tube may be passed beyond the narrowing to permit adjacent balloon dilation with the airway secured. ConclusionsWe introduce an endoscopic subglottic balloon dilation technique done with a secured airway.

Airway Management in Patients with Subglottic Stenosis

We describe a pilot study investigating the airway techniques used in the anesthetic management of subglottic stenosis. We searched the electronic clinical information database of the University of Michigan Health System for cases of subglottic stenosis in patients undergoing surgery. Demographics, airway techniques, incidence of hypoxemia, and technique failure were extracted from 159 records. A lower incidence of hypoxemia was found between the 4 most commonly used techniques and the less common techniques. We detected no difference in outcome between individual techniques. This study suggests a larger prospective multicenter study is required to further investigate these outcomes in patients with subglottic stenosis.

Subglottic stenosis and socio-economic deprivation: A 6-year review of the Scottish National Service for Paediatric Complex Airway Reconstruction

ObjectiveSubglottic stenosis is the third most common cause of stridor in children, and severe cases may need surgical reconstruction. Babies born to parents in high-deprivation areas are at increased risk of prematurity and low birth weight. This may require intensive care admission with prolonged intubation, hence, putting them at increased risk of subglottic stenosis. We aimed to review cases of subglottic stenosis requiring surgical intervention in the Scottish population and its association with socio-economic deprivation. MethodsWe collected retrospective data on all children who underwent open reconstructive surgery for subglottic stenosis between January 2005 and January 2011 at the Royal Hospital for Sick Children, Yorkhill, which provides the national complex airway reconstruction service for Scotland. The Scottish Index of Multiple Deprivation (SIMD) was used to categorise deprivation based on the child's home postal code. Incidence figures were calculated based on the total number of births in each deprivation category over the time period. ResultsThere were a total of 53 cases of subglottic stenosis undergoing surgery in Scotland over the last 6 years, of which 31 were acquired and 22 were congenital. The most common procedure performed was laryngotracheal reconstruction with cartilage grafts (46 cases). No association was found between deprivation and the incidence of acquired or congenital subglottic stenosis. ConclusionOur data is the first attempt to review the incidence of subglottic stenosis in the Scottish population and its association with deprivation. Perhaps surprisingly, we found no association.