Subglottic Stenosis in Adults Workup

Updated: Sep 17, 2020
  • Author: James D Garnett, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Laboratory Studies

In the absence of a history of prior trauma or when suggested by other findings, evaluate for inflammatory or infectious causes, including the following:

  • Wegener granulomatosis
  • Relapsing polychondritis
  • Syphilis
  • Tuberculosis
  • Sarcoidosis
  • Leprosy
  • Diphtheria
  • Scleroma
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Imaging Studies

Radiography

Standard chest radiographs can often provide a great deal of information regarding the tracheal air column.

Anteroposterior filtered tracheal views and lateral soft tissue views of the neck provide specific information regarding the glottic/subglottic air column.

MRI

Magnetic resonance imaging (MRI) is useful in evaluating length and width of the stenotic region by means of coronal and sagittal views.

CT scanning

Computed tomography (CT) scanning is not as helpful as MRI because its views are generally only in the axial plane.

Thin cuts (1 mm) with sagittal and/or coronal reconstructions may be helpful, however. This is the preferred initial imaging study of the author.

New software allows virtual bronchoscopy, which may be helpful in assessing the airway and surgical planning prior to actually performing a procedure.

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Other Tests

Flow-volume loops do not offer more specific information regarding stenosis than what is gained from imaging. However, flow-volume loops may be helpful in monitoring for restenosis after intervention.

The use of pH probe testing has been helpful in identifying reflux as a contributing factor to the cause and recurrence of subglottic stenosis.  As previously mentioned, a retrospective study by Fang et al found that among 41 patients with idiopathic subglottic stenosis who underwent esophageal pH impedance testing, 19 (46.3%) had gastroesophageal reflux disease, including 15 (36.6%) who had a predominantly upright reflux condition. [2]   

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Diagnostic Procedures

Videostrobolaryngoscopy is extremely helpful in evaluating the glottic and supraglottic larynx for possible concomitant injury.

Visualization of the larynx by flexible fiberoptic or rigid telescopic (90- or 70-degree scopes) in the clinic is crucial to the evaluation of airway lesions.

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