Laryngeal stenosis constitutes an acquired or congenital pathology of the larynx, that involves glottic, supraglottic, and/or subglottic restriction, caused by various underlying conditions and events.
Various factors can have an effect on the clinical presentation of a patient affected by laryngeal stenosis. It is known that medical history, age, length of the stenosed segment, and general physical condition all influence the final symptomatology.
The most frequent manifestation associated with laryngeal stenosis is stridor, a high-pitched, wheezing sound heard during inhalation or inhalation/ exhalation (biphasic stridor) . The former stridor type is mostly linked to a stenosed glottic or supraglottic region.Stridor is heard when the stenosis has reached approximately 50% of the laryngeal diameter, at which time dyspnea also complicates the clinical picture  . Milder narrowing could be marked by a progressively worsening cough. Patients suffering from laryngeal stenosis at the glottic level may also display a hoarse voice, aphonia, dysphagia, hypoxia, cyanosis, and anxiety.
In pediatric patients, laryngeal stenosis may cause no respiratory symptoms at an early stage, but poor appetite and delayed growth may be reported. Recurrent croup is a common finding amongst children affected by laryngeal stenosis of the subglottic area. Congenital laryngeal narrowing tends to present with less alarming symptoms than an acquired stenosis. In addition, children who present with laryngeal stenosis may also have a history of tracheotomy or laryngotracheal reconstruction.
In some cases, the presenting manifestation of laryngeal restriction is severe dyspnea associated with an individual who reports an aggravation of the symptoms following a decannulation/extubation .
Laryngeal stenosis implies a narrowing of the larynx, whether at the supraglottic, glottic, or subglottic level, which may lead to obstructed breathing, dyspnea, and hoarseness. [voiceindy.com]
TABLE 90.1 SIGNS AND SYMPTOMS OF LARYNGEAL STENOSIS Laryngeal Region Signs and Symptoms Subglottis Hoarse or normal voice, biphasic stridor, normal feeding (except with severe obstruction), barking cough Glottis Hoarse voice or aphonia, inspiratory (early [entokey.com]
The cardiovascular cause of the hoarseness might be of much higher consequence for the patient as the hoarseness itself, as in the presented case. [hindawi.com]
Patients suffering from laryngeal stenosis at the glottic level may also display a hoarse voice, aphonia, dysphagia, hypoxia, cyanosis, and anxiety. [symptoma.com]
Eventually, frequent vocal abuse and misuse can cause changes in vocal function and result in hoarseness. (Hoarseness that lasts longer than 2-4 weeks without explanation should be evaluated by an otolaryngologist.) [my.clevelandclinic.org]
- Laryngeal Disease
Diseases Otorhinolaryngologic Diseases Respiratory System Abnormalities Congenital Abnormalities Mitomycins Mitomycin Antibiotics, Antineoplastic Antineoplastic Agents Alkylating Agents Molecular Mechanisms of Pharmacological Action Nucleic Acid Synthesis [clinicaltrials.gov]
Manifestations that indicate difficulty in breathing and subsequent oxygenation, such as stridor, cyanosis, and cough should always raise suspicion of laryngeal stenosis. A medical history of intubation or tracheostomy also suggests the possibility of this specific pathology and should be investigated.
With reference to laboratory tests, laryngeal stenosis is normally not diagnosed via blood tests. However, underlying conditions that may predispose the patient to this type of the disorder can be evaluated, such as Wegener's granulomatosis, sarcoidosis, or rheumatoid arthritis. Blood gas analysis can reveal hypoxia in severe cases.
The diagnosis of laryngeal stenosis can be achieved through a multitude of imaging modalities. Plain lateral and anteroposterior neck radiographs can illustrate airway diameter and the extent of the narrowed segment, as well as possible contributing or causing disorders, such as epiglottitis and a retropharyngeal abscess. Thoracic X-ray helps to depict concurrent pathologies of the thorax. The larynx can be evaluated, without the need for general anesthesia, down to the glottic level via flexible fiberoptic endoscopy. Nevertheless, bronchoscopy and direct laryngoscopy constitute the gold standard for the diagnosis .
A computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan are usually not the first-line tools of assessment but can be utilized in the detailed evaluation. The MRI scan precisely illustrates regional vascular anatomy .
Laryngeal electromyography and pulmonary function tests can also be employed in the workup procedure .
- Bluestone C, Stool S, Kenna M. Pediatric Otolaryngology. 3rd ed. Philadelphia, PA: WB Saunders Co; 1995. 1275-1286.
- Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med. 2003;24(3):457–471.
- Nair S, Mohan S, Mandal G, Nilakantan A. Tracheal Stenosis: Our Experience at a Tertiary Care Centre in India with Special Regard to Cause and Management. Indian J Otolaryngol Head Neck Surg. 2014; 66(1): 51–56.
- Brichet A, Verkindre C, Dupont J, et al. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J. 1999;13(4):888–893.
- Antón-Pacheco JL, Cano I, García A, et al. Patterns of management of congenital tracheal stenosis. J Pediatr Surg 2003;38:1452-1458.
- Schweiger C, Cohen AP, Rutter MJ. Tracheal and bronchial stenoses and other obstructive conditions. J Thorac Dis. 2016; 8(11): 3369–3378.
- Boemo RL, Navarrete ML, Genestar EI, Gonzalez M, Fuentes JF, Fortuny P. Interarytenoid osseous bridge after prolonged endotracheal intubation. Acta Otorrinolaringol Esp. 2012;63(6):480-481.