Beyond Asthma: Could Subglottic Stenosis Cause My Noisy Breathing?

Matthew C. Mori, MD

Frustrated by a year of increasingly difficult breathing, a 39-year-old female patient sought relief in the office of Matthew C. Mori, MD, a laryngologist at the Grabscheid Voice and Swallowing Center of Mount Sinai. Despite aggressive asthma treatment, nothing had helped. When he asked the patient to take a deep breath, Dr. Mori could hear noisy “stridor”—a high-pitched breath sound caused by upper airway obstruction—from across the room. Stridor is subtly distinct from the expiratory wheezes of an asthmatic. On further examination, Dr. Mori discovered the source of her breathing difficulty: subglottic stenosis.

What Is Subglottic or Tracheal Stenosis?
Subglottic or tracheal stenosis is a narrowing of a portion of the subglottis or trachea. The trachea is our “windpipe,” which connects our throats with our bronchi and lungs. Just above the trachea is the larynx, or “voice box,” which contains our vocal cords. The airway opening between the vocal cords is called the “glottis.” Just below the glottis, and above the trachea, is the subglottic airway. The narrowing of this portion typically involves a very short segment of the airway.

What Causes Subglottic or Tracheal Stenosis in Adults?
Among adults, subglottic or tracheal stenosis can result from trauma, tumors, or a history of tracheostomy and prolonged intubation (for example, having a breathing tube in during a long stay in the intensive care unit). It can also be caused by systemic diseases such as amyloidosis, autoimmune diseases such as Wegener granulomatosis, history of radiation therapy to the neck, and infection. With such a wide variety of causes, anyone can be at risk. The patient who contacted Dr. Mori was diagnosed with idiopathic subglottic stenosis (iSGS). Idiopathic means the cause is unknown. Interestingly, iSGS is found primarily in Caucasian women. Dr. Mori, an Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai, works within the Division of Laryngology, part of the North American Airway Collaboration (NOAAC), which has ongoing research to find the underlying cause of and best treatments for iSGS.

How to Distinguish Between Asthma and Subglottic or Tracheal Stenosis
According to Dr. Mori, if a patient comes for an evaluation, tracheal or subglottic stenosis can be diagnosed by the end of the appointment. During an evaluation, Dr. Mori performs a detailed history and physical exam which involves examining the throat and the windpipe with a flexible laryngoscope. Direct visualization shows whether there is narrowing. A patient can have both asthma and stenosis. It is important for patients to see a pulmonologist to undergo evaluation for asthma.

What Are the Treatment Options?
Patients with mild cases of  subglottic or tracheal stenosis may not require treatment. It is important to examine these patients at regular intervals to assess for progression of disease. For those undergoing treatment, options depend on severity and can include medications, surgery, or both. Medical treatments include anti-inflammatory medications such as corticosteroids, antibiotics, and anti-reflux medication that treats gastroesophageal reflux (GERD). Anti-reflux therapy is usually combined with diet and lifestyle changes to reduce stomach acid production and reflux. Every patient is different, so specific medication regimens are tailored to the underlying causes. In-office or surgical procedures include steroid injection, endoscopic dilation with balloon or metal dilators, endoscopic resection of the stenosis with laser therapy or microinstruments, and external approaches through the neck. The most common type of open surgery is cricotracheal or tracheal resection and involves resection of the narrow scarred segment.

To make an appointment with Dr. Matthew Mori, call 212-241-9425.