Latest Treatments for Subglottic Stenosis

Laryngologist and airway surgeon Alexander Hillel describes the condition known as laryngotracheal stenosis, or scarring that develops at the level of the vocal cords and areas below it, which can result in difficulty breathing. He describes the three main causes of laryngotracheal stenosis: breathing tubes and/or tracheostomy tubes (iatrogenic laryngotracheal stenosis), autoimmune disease (granulomatosis with polyangiitis, formerly Wegener granulomatosis) and idiopathic subglottic stenosis, a rare disease that exclusively affects women and develops spontaneously when women are in their 40s or 50s. Idiopathic subglottic stenosis develops slowly, and the average time to diagnosis is over two years. Traditionally, idiopathic subglottic stenosis has been treated surgically either through endoscopic incision and dilation or cricotracheal resection. Since 2015, three new treatments have emerged: serial intralesional steroid injections (an in-office procedure), the Maddern endoscopic laryngotracheoplasty, and endoscopic laser wedge resection. Johns Hopkins has a multidisciplinary complex airway team that focuses on providing the best possible care for patients with laryngotracheal stenosis. Dr. Hillel’s NIH-funded lab is testing new treatments for idiopathic subglottic stenosis, including the use of everolimus, and developing a drug-eluting stent.