Difficulty breathing and wheezing (Subglottic Stenosis): Let's talk about this!

Does your little one sometimes make a whistling sound when they breathe? Or do you sometimes find yourself having difficulty breathing for no apparent reason, feeling like your chest is constricted? While many people think this is normal, sometimes it can be a sign of something to be concerned about. Today we are going to talk about one such rare but very important condition. It is called Subglottic Stenosis. Although the name may sound a bit scary, let's keep it simple.

What is Subglottic Stenosis?

Simply put, Subglottic Stenosis is a narrowing of the upper part of our windpipe (trachea), which is the bronchi . This is located just below our vocal cords. As the name suggests, "Subglottic" means below the vocal cords. "Stenosis" means narrowing.

The best way to understand this is with the example of a drinking straw. Imagine you are drinking water from a drinking straw. When the straw is wide open, you can easily take a sip of water. But what happens if you tighten the straw a little and make it narrower? The amount of water that comes out decreases. If you tighten it even more, the amount of water that comes out decreases significantly, and sometimes the little water that comes out starts to come out with a noise. That's what happens in this situation too. When the airway narrows, the amount of air that goes into the lungs decreases. This can cause difficulty breathing and a whistling sound.

Is this situation common?

No. This is actually a very rare condition . It affects about one in four hundred thousand (400,000) people. So many people may not have heard of it. But if you or your child has these symptoms, it is important to be aware of it.

What are the symptoms?

These symptoms can be mild, moderate, or severe, depending on how narrowed the airway is. Let's look at how these symptoms differ in young children and adults.

Why is this happening? What are the reasons?

There can be several causes of subglottic stenosis. Sometimes, no cause can be found.

• Congenital Subglottic Stenosis: Some babies are born with a narrowed airway. This often shows symptoms shortly after birth.

• Acquired Subglottic Stenosis: This is the most common condition . It means that the airway becomes narrowed after birth for some reason. This can be caused by:
• Being on a ventilator for a long time: A very sick person is intubated and connected to a ventilator to help them breathe. If they have to stay on a ventilator for more than two weeks, the tube can damage the delicate lining of the airways, causing scar tissue to form and narrow the airways as they heal.
• Injury to the respiratory tract: A severe injury to the neck or chest can damage the respiratory tract.
• Certain medical conditions: Very rare autoimmune disorders or conditions like vasculitis can cause swelling and scar tissue in the airways, narrowing them.

• Idiopathic Subglottic Stenosis: Sometimes, especially in adults, no clear cause can be found for this condition. It is especially common in women between the ages of 30 and 60 .

How does a doctor diagnose this condition?

When you tell your doctor about these symptoms, he or she will perform a physical exam. He or she will ask you about your medical history and symptoms. If subglottic stenosis is suspected, he or she will likely refer you to an ear, nose, and throat specialist (ENT specialist or otolaryngologist) . The specialist may perform several tests to confirm the condition.

What are the treatments?

Because this is a rare condition, there is no one-size-fits-all treatment. Treatment depends on factors such as the patient's age, the severity of the condition, and the cause.

For mild conditions

If the condition is not too severe, meaning that the airway is only slightly narrowed, your doctor may not treat you right away, but may put you on continuous monitoring . This means checking you at regular intervals to see if your condition is getting worse.

More advanced treatments

• Steroid Injections: This can be used as a first-line treatment. Here, the neck and airway are numbed with local anesthesia, and a steroid injection is injected through the neck into the narrowed airway. This can help reduce swelling and scar tissue. This series of injections is usually given every 4-6 weeks.

• Surgery: If the condition is severe or other treatments are not successful, surgery may be necessary. There are various surgical procedures.
• Endoscopic Dilation: In this, a small balloon is inserted into the narrowed area using an endoscope and inflated to widen the area. However, this is not a permanent solution in most cases. The narrowing can return over time, so the procedure may need to be repeated.
• Cricotracheal Resection: This is a more complex surgery. In this, the narrowed part below the vocal cords is completely cut out and removed, and the remaining two healthy parts are reconnected. This can often result in a permanent cure.
• Endoscopic Laryngotracheoplasty: In this surgery, pieces of cartilage taken from another part of the patient's body (e.g., a rib) are transplanted into the narrowed area to widen the airway. This is also called Laryngotracheal Reconstruction.

What happens after treatment?

In most cases, with prompt and proper treatment, this condition can be well controlled, and sometimes even cured. However, the most important thing to remember is that sometimes this condition can recur . If this happens, it is very important to seek treatment again before the symptoms worsen.

When should I see the doctor?

If you or your child has been treated for Subglottic Stenosis and you notice that symptoms such as difficulty breathing and wheezing (stridor) are occurring again, do not delay and see your doctor immediately. Early detection can help control the condition before it gets worse. Also, if you first notice these symptoms, it is important to seek medical advice rather than ignoring them as normal.

Subglottic Stenosis, Difficulty breathing, stridor, Narrowing of the airway, Pediatrics, ENT, Respiratory diseases