In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan talk to Dr. Stephen Schoeff, laryngologist at Kaiser Permanente (Tacoma, WA) about subglottic stenosis in adults.

Dr. Schoeff introduces subglottic stenosis (SS) as a rare condition affecting adult women of all ages. Patients complain of progressive dyspnea, declining exercise tolerance, and mucus sensation. Sometimes confused for asthma, globus sensation, LPR, or paradoxical vocal fold motion, SS is diagnosed when airway scarring and narrowing is visible on laryngoscopy. After describing workup, Dr. Schoeff reviews etiologies of SS, including iatrogenic, idiopathic, and autoimmune. Treatment options for SS include cricotracheal resection, endoscopic dilation, and airway steroid injections. Dr. Schoeff concludes the episode by sharing his success using periodic airway steroid injections for treatment of SS.

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SHOW NOTES

00:00 - Introduction

01:21 - Dr. Schoeff’s Journey & Practice

08:28 - Symptoms & Differential Diagnosis

12:31 - Physical Examination & Diagnosis

27:23 - Introduction to Endoscopic Dilation

28:57 - Steroid Injections as a Management Option

31:24 - The Three Big Categories of Treatment

33:05 - How Steroids Address Disease Pathophysiology

38:58 - Technique for Airway Dilation

49:06 - Deciding on Cricotracheal Resection

51:14 - How Insurance Affects Treatment Options

55:05 - Final Thoughts & Pearls