San Francisco Voice and Swallowing

Airway Conditions We Treat

Airway Stenosis

Laryngotracheal stenosis (LTS) is congenital or acquired restriction of the airway affecting the larynx and/or trachea. Subglottic stenosis (SGS) is also a term that is used to describe LTS that involves only the segment of trachea just below the vocal folds. Obstruction of the upper airway caused by LTS or SGS results in difficulty breathing that may even be life-threatening. Despite appropriate treatment, patients often experience recurrence of the stenosis as a result of the abnormal wound-healing process that is the initial cause of the disorder.

Medical treatment includes oral systemic steroids or a series of in-office steroid injections into the airway. Surgical treatment typically entails minimally invasive surgery to dilate the narrowed airway. Unfortunately, the stenosis often recurs, necessitating additional procedures. In rare cases, the patient may not respond to endoscopic dilation and may require an open surgery (cricotracheal or tracheal resection).

Airway stenosis can also result from immobility of the vocal folds, whether from nerve injury (bilateral vocal fold paralysis) or mechanical injury or scarring (posterior glottic stenosis). Treatment options for narrowing at the vocal fold level include tracheotomy or airway expanding surgeries.

Irritable Larynx Syndrome

Irritable Larynx Syndrome (ILS) refers to a continuum of disorders that include chronic throat clearing, chronic coughing, paradoxical vocal fold movement (PFVM) - also called vocal cord dysfunction (VCD), and laryngospasm. Patients with ILS have laryngeal and neurologic hypersensitivity, which may lead to episodes of unnecessary and counterproductive vocal fold closure (PVFM & laryngospasm).

Common triggers include environmental irritants (e.g., strong odors, dust, smoke or chemical exposure), weather changes, physical exertion, stress, or voice use.

The first line of treatment for ILS is typically behavioral intervention. Therapy will focus on respiratory restraining techniques, desensitizing the throat/larynx, and retraining the body’s response to triggers. Neuromodulating medications or reflux medications may also be helpful for refractory cases.

Airway Anatomy
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