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Glottic Stenosis Workup

  • Author: Gauri Mankekar, MBBS, MS, DNB, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Sep 27, 2015
 

Laboratory Studies

See the list below:

  • Few diagnostic laboratory findings are associated with glottic stenosis, although performing a serological workup is necessary if a granulomatous disease (eg, sarcoidosis, tuberculosis, syphilis, Wegener granulomatosis) or a systemic disease (eg, rheumatoid arthritis, amyloidosis) is suspected as the cause.
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Imaging Studies

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  • Routine plain upper airway and chest radiographs are of limited value in the diagnosis and treatment of glottic stenosis but may provide an initial assessment of laryngotracheal air column and coexisting pulmonary disease.
  • A CT scan allows for evaluation of the length and thickness of the glottic stenotic segment in subglottic stenosis. A CT scan also allows for evaluation of the laryngeal framework in order to determine the presence of a fracture or other significant injury.
  • Spiral computed tomography with 3-dimensional reconstruction is advisable for better surgical planning and outcome, and it is complementary to rigid endoscopy in the management of these conditions. [16]
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Other Tests

See the list below:

  • Pulmonary function tests (ie, maximum inspiration and expiration flow rates, flow volume loops, pressure flow loops) show characteristic changes in upper airway stenosis and may be used to compare preoperative and postoperative results.
  • Electromyography (EMG) can help to differentiate posterior glottic stenosis from bilateral vocal cord paralysis. It may also be used to evaluate the function of the intrinsic muscles of the larynx.
  • Twenty four-hour pH studies help to evaluate coexistent gastroesophageal reflux.
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Diagnostic Procedures

First, the conscious patient's vocal cord mobility is assessed using either indirect laryngoscopy or fiberoptic laryngoscopy. Currently many clinicians are advocating early evaluation of the larynx (ie, within the first few hours after extubation) to diagnose and commence treatment of lesions caused by prolonged endotracheal intubation.

Subsequently, under anesthesia, direct laryngoscopy and bronchoscopy in the operating room allow for careful evaluation of the laryngeal and distal airways and provide a means of assessing the cricoarytenoid joints.

Microlaryngoscopic assessment helps to identify the extent and character of the stenosis and the degree of arytenoid mobility and to determine if cricoarytenoid joint fixation is present. Posterior glottis stenosis or interarytenoid adhesion has sometimes been misdiagnosed as cord paralysis. Laryngoscopy and laryngeal electromyography studies are the two diagnostic aids in this condition.[17]

Other important aspects of the evaluation include assessment of inflammatory changes in the larynx, the size of the airway, and evidence of gastroesophageal reflux (eg, interarytenoid edema, erythema).

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Histologic Findings

In rare cases of glottic stenosis caused by a granulomatous or systemic infection or disease, biopsy is necessary to make the diagnosis. The presence or absence of caseous necrosis or vasculitis differentiates tuberculosis, sarcoidosis, and Wegener granulomatosis. Identification of causative organisms can also be accomplished using the biopsy specimen.

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Staging

Cohen’s classification is as follows:[18]

  • Type I : This is the mildest form of the web. It involves less than 35% of the glottis. It is usually thin and uniform in thickness with no subglottic extension. The true vocal cords are usually well seen through the web. The patient usually has an adequate airway and only slight voice change.
  • Type II: The web involves 35-50% of the glottis and can be thin or thick, but the vocal cords can usually be seen within the web. These may be associated with some subglottic extension of stenosis. Patients usually don't have too much airway obstruction or airway symptoms.
  • Type III: This type involves 50-75% of the glottis. The web is usually very thick anteriorly and may thin out as it extends posteriorly. The true vocal cords may or may not be visible within the web; these almost always have a subglottic component to them. Patients have marked vocal dysfunction and have moderate-to-severe airway symptoms.
  • Type IV: This is the most severe form. The web involves 75-90% or more of the glottis and is uniformly thick both anteriorly and posteriorly. The true vocal cords are not identifiable within the web and may be one continuous, thick band. The patient is usually aphonic. Severe airway obstruction is usually present and almost always requires an emergency tracheotomy.
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Contributor Information and Disclosures
Author

Gauri Mankekar, MBBS, MS, DNB, PhD Consultant Otorhinolaryngologist, Department of Otolaryngology, PD Hinduja National Hospital, India

Gauri Mankekar, MBBS, MS, DNB, PhD is a member of the following medical societies: Association of Otolaryngologists of India, Cochlear Implant Group of India, Association of Medical Consultants of Mumbai

Disclosure: Nothing to disclose.

Coauthor(s)

Alan D Murray, MD Pediatric Otolaryngologist, ENT for Children; Full-Time Staff, Medical City Dallas Children's Hospital; Consulting Staff, Department of Otolaryngology, Children's Medical Center at Dallas, Cook Children's Medical Center; Full-Time Staff, Texas Pediatric Surgery Center, Cook Children's Pediatric Surgery Center Plano

Alan D Murray, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, American Academy of Pediatrics, American College of Surgeons, Texas Medical Association

Disclosure: Nothing to disclose.

Debbie A Eaton, MD Private Practice

Debbie A Eaton, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

John Schweinfurth, MD Professor, Department of Otolaryngology, University of Mississippi Medical Center

John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Laryngological Association, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

References
  1. Sittel C. Pathologies of the larynx and trachea in childhood. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014. 13:Doc09. [Medline].

  2. Mackenzie, M. The Use of the Laryngoscope in Diseases of the Throat. 1st ed. 1865.

  3. Von Schroetter L. Lectures Regarding Diseases of the Larynx (in German). Leipzig: Braumuller & Wein; 1892. 239.

  4. Haslinger F. A case of membrane formation in the larynx: a new method of safer recovery (in German). Monatsschr Ohrenheilkd Laryngorhinol. 1924. 22:174-76.

  5. Iglauer S. New procedure for the treatment of web in the larynx. Arch Otolaryngol. 1935. 22:597 -602.

  6. McNaught RC. Surgical correction of anterior web of the larynx. Laryngoscope. 1950. 60:264-72.

  7. Dedo HH, Sooy CD. Endoscopic laser repair of posterior glottic, subglottic and tracheal stenosis by division or micro-trapdoor flap. Laryngoscope. 1984 Apr. 94(4):445-50. [Medline].

  8. Lichtenberger G, Toohill RJ. New keel fixing technique for endoscopic repair of anterior commissure webs. Laryngoscope. 1994 Jun. 104(6 Pt 1):771-4. [Medline].

  9. Montgomery WW. Posterior and complete laryngeal (glottic) stenosis. Arch Otolaryngol. 1973 Sep. 98(3):170-5. [Medline].

  10. Zalzal GH. Posterior glottic fixation in children. Ann Otol Rhinol Laryngol. 1993 Sep. 102(9):680-6. [Medline].

  11. Biavati MJ, Wood WE, Kearns DB, Smith RJ. One-stage repair of congenital laryngeal webs. Otolaryngol Head Neck Surg. 1995 Mar. 112(3):447-52. [Medline].

  12. Cheng AT, Beckenham EJ. Congenital anterior glottic webs with subglottic stenosis: surgery using perichondrial keels. Int J Pediatr Otorhinolaryngol. 2009 Jul. 73(7):945-9. [Medline].

  13. Crowe S, Westbrook A, Bourke M, Lyons B, Russell J. Impossible laryngeal intubation in an infant with Fraser syndrome. Paediatr Anaesth. 2004 Mar. 14(3):276-8. [Medline].

  14. Howard NS, Shiba TL, Pesce JE, Chhetri DK. Photodocumentation of the development of type I posterior glottic stenosis after intubation injury. Case Rep Surg. 2015. 2015:504791. [Medline].

  15. Wolf M, Primov-Fever A, Talmi YP, Kronenberg J. Posterior glottic stenosis in adults. Isr Med Assoc J. 2007 Aug. 9(8):597-9. [Medline].

  16. Parida PK, Gupta AK. Role of spiral computed tomography with 3-dimensional reconstruction in cases with laryngeal stenosis--a radioclinical correlation. Am J Otolaryngol. 2008 Sep-Oct. 29(5):305-11. [Medline].

  17. Boemo RL, Navarrete ML, Genestar EI, Gonzalez M, Fuentes JF, Fortuny P. Interarytenoid osseous bridge after prolonged endotracheal intubation. Acta Otorrinolaringol Esp. 2011 Jun 14. [Medline].

  18. Cohen SR. Congenital glottic webs in children. A retrospective review of 51 patients. Ann Otol Rhinol Laryngol Suppl. 1985 Nov-Dec. 121:2-16. [Medline].

  19. Sharouny H, Omar RB. Iatrogenic aspiration of custom-made keel: a case report. Iran Red Crescent Med J. 2014 Dec. 16 (12):e17066. [Medline].

  20. Bogdasarian RS, Olson NR. Posterior glottic laryngeal stenosis. Otolaryngol Head Neck Surg. 1980 Nov-Dec. 88(6):765-72. [Medline].

  21. Lahav Y, Shoffel-Havakuk H, Halperin D. Acquired Glottic Stenosis-The Ongoing Challenge: A Review of Etiology, Pathogenesis, and Surgical Management. J Voice. 2015 Sep. 29 (5):646.e1-646.e10. [Medline].

  22. Yılmaz T, Suslu N, Gunaydın RO, Kuscu O, Sozen T, Atay G, et al. Microtrapdoor Flap Technique for Treatment of Glottic Laryngeal Stenosis: Experience With 34 Cases. J Voice. 2015 Aug 28. [Medline].

  23. Beswick DM, Clark AK, Bergeron J, Sung CK. Endoscopic suture retriever for endolaryngeal keel placement in treatment of anterior glottic webs. Ann Otol Rhinol Laryngol. 2015 Mar. 124 (3):240-3. [Medline].

  24. Chitose S, Umeno H, Nakashima T. Endoscopic surgical treatment of posterior glottic stenosis. J Laryngol Otol. 2009 May. 123 Suppl 31:68-71. [Medline].

  25. Rovo L, Venczel K, Torkos A, Majoros V, Sztano B, Jori J. Endoscopic arytenoid lateropexy for isolated posterior glottic stenosis. Laryngoscope. 2008 Sep. 118(9):1550-5. [Medline].

  26. Schaefer SD, Close LG, Brown OE. Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure. Laryngoscope. 1986 Jun. 96(6):656-9. [Medline].

  27. Krimsky WS, Rodrigues MP, Malayaman N, Sarkar S. Spray cryotherapy for the treatment of glottic and subglottic stenosis. Laryngoscope. 2010 Mar. 120(3):473-7. [Medline].

  28. Pullens B, Pijnenburg MW, Hoeve HJ, et al. Long-term functional airway assessment after open airway surgery for laryngotracheal stenosis. Laryngoscope. 2015 Jun 24. [Medline].

  29. Sztanó B, Szakács L, Madani S, Tóth F, Bere Z, Castellanos PF, et al. Comparison of endoscopic techniques designed for posterior glottic stenosis-A cadaver morphometric study. Laryngoscope. 2013 Jun 22. [Medline].

  30. Roh JL, Lee YW, Park CI. Can mitomycin C really prevent airway stenosis?. Laryngoscope. 2006 Mar. 116(3):440-5. [Medline].

  31. Hsieh MJ, Liu YH, Yueh YS, Ko PJ. Use of microdebrider in glottic stenosis following airway stenting. Eur J Cardiothorac Surg. 2006 Aug. 30(2):388-90. [Medline].

  32. Hueman EM, Simpson CB. Airway complications from topical mitomycin C. Otolaryngol Head Neck Surg. 2005 Dec. 133(6):831-5. [Medline].

  33. Inglis AF Jr, Perkins JA, Manning SC, Mouzakes J. Endoscopic posterior cricoid split and rib grafting in 10 children. Laryngoscope. 2003 Nov. 113(11):2004-9. [Medline].

  34. Liyanage SH, Khemani S, Lloyd S, Farrell R. Simple keel fixation technique for endoscopic repair of anterior glottic stenosis. J Laryngol Otol. 2006 Apr. 120(4):322-4. [Medline].

  35. Roh JL, Yoon YH. Prevention of anterior glottic stenosis after bilateral vocal fold stripping with mitomycin C. Arch Otolaryngol Head Neck Surg. 2005 Aug. 131(8):690-5. [Medline].

  36. Rutter MJ, Cotton RT. The use of posterior cricoid grafting in managing isolated posterior glottic stenosis in children. Arch Otolaryngol Head Neck Surg. 2004 Jun. 130(6):737-9. [Medline].

  37. Smith MM, Kuhl G, Carvalho PR, Marostica PJ. Flexible fiber-optic laryngoscopy in the first hours after extubation for the evaluation of laryngeal lesions due to intubation in the pediatric intensive care unit. Int J Pediatr Otorhinolaryngol. 2007 Sep. 71(9):1423-8. [Medline].

 
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Anatomical regions of the larynx.
 
 
 
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