Acquired Laryngeal Stenosis

Glottic and Supraglottic Stenosis

• Causes: blunt trauma, endotracheal tube trauma, infection, caustic ingestion, infection, foreign body

• SSx: inspiratory or biphasic stridor, dyspnea, cough

• Dx: flexible nasopharyngoscopy, endoscopy, or videostroboscopy, CT of neck

• Rx: endoscopic excision (laser) or dilation for thin webs; thicker webs require external approaches

Subglottic Stenosis

• typically more severe and more common than congenital

1. Endotracheal Intubation: pressure necrosis results in ulceration and cartilage exposure, healing occurs by secondary intention causing fibrosis

2. Postoperative: pressure necrosis from a high tracheotomy or from a cricothyroidotomy

3. Granulomatous Disease: tuberculosis (most common granulomatous disease of larynx), sarcoidosis, rhinoscleroma (Klebsiella), Wegener's granulomatosis

4. Infectious: leprosy (epiglottic and vocal fold ulceration), syphilis, blastomycosis, coccidiomycosis, histoplasmosis

5. Idiopathic: amyloidosis

6. Trauma: foreign body, caustic ingestion, blunt trauma, hematoma, thermal injury

7. Systemic: connective tissue disorders, GERD, radiation effects

8. Neoplasia: chondroma, fibroma, malignancy

• SSx: dyspnea, biphasic stridor, cough, dysphagia

• Rx: similar to Congenital Subglottic Stenosis

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