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Glottic Stenosis: What You Need to Know

What is Glottic Stenosis?

Glottic stenosis is a narrowing (stenosis) of the glottis – the part of the larynx (voice box) that contains the vocal cords. When the opening between the vocal cords becomes reduced, airflow into the trachea is limited. This can cause voice changes, breathing difficulty, and, in severe cases, life‑threatening airway obstruction.

The condition may be congenital (present at birth) or acquired after injury, infection, or inflammation. The degree of stenosis is usually graded from mild (­< 25 % narrowing) to severe (> 75 % narrowing), and treatment is tailored to the severity and underlying cause.

Common Causes

Glottic stenosis rarely occurs without an inciting factor. The most frequent causes include:

• Prolonged endotracheal intubation – pressure from the tube cuff can damage the mucosa and cause scar tissue.
• Tracheostomy or laryngeal surgery – postoperative scarring is a well‑recognized risk.
• Severe or repeated respiratory infections (e.g., diphtheria, bacterial laryngitis).
• Inhalation injury from smoke, chemical fumes, or thermal burns.
• Autoimmune diseases such as granulomatosis with polyangiitis (Wegener’s) that inflame the airway.
• Radiation therapy to the head and neck – fibrosis can develop months to years later.
• Vocal cord nodules/polyps that undergo repeated trauma and scar formation.
• Congenital anomalies – subglottic or glottic webs seen in certain birth defects.
• Neoplastic processes – benign or malignant tumors that encroach on the glottic opening.
• Systemic diseases such as sarcoidosis or amyloidosis that deposit abnormal tissue in the larynx.

Associated Symptoms

Because the glottis controls both voice production and airway patency, stenosis often presents with a combination of respiratory and phonatory complaints:

• Hoarseness or breathy voice
• Stridor (high‑pitched, noisy breathing that worsens on inspiration)
• Difficulty breathing, especially during exertion or when lying flat
• Frequent coughing or the sensation of a “lump” in the throat (globus)
• Worsening symptoms at night or with upper‑respiratory infections
• Reduced exercise tolerance
• Voice fatigue after prolonged speaking
• In severe cases, cyanosis (bluish skin) or loss of consciousness due to hypoxia

When to See a Doctor

Prompt evaluation is essential whenever the following occur:

• Persistent hoarseness lasting longer than two weeks without an obvious cause (e.g., a cold).
• New‑onset stridor or noisy breathing, especially if it worsens when you exert yourself or lie down.
• Difficulty swallowing liquids or a sensation of choking.
• Any breathing trouble after recent intubation, surgery, or a severe respiratory infection.
• Recurrent throat infections that do not improve with usual treatment.

Diagnosis

Evaluation typically involves a stepwise approach:

1. Clinical History & Physical Examination

The clinician will ask about prior intubation, surgeries, infections, exposure to irritants, and systemic illnesses. A neck exam may reveal tenderness, masses, or abnormal vibrations.

2. Laryngoscopy

Direct or flexible laryngoscopy lets a physician visualize the vocal cords and glottic opening. This is the gold‑standard for identifying stenosis, its length, and the presence of scar tissue.

3. Imaging Studies

• CT scan of the neck – provides cross‑sectional images of the airway.
• MRI – useful for soft‑tissue characterization when a tumor is suspected.
• Ultrasound – increasingly used for bedside assessment of vocal‑cord movement.

4. Functional Tests

• Pulmonary function tests (PFTs) – especially flow‑volume loops that show characteristic “flattening” with upper‑airway obstruction.
• Voice analysis – objective measurement of hoarseness and pitch range.

5. Biopsy (if indicated)

If a mass or suspicious lesion is seen, a small tissue sample may be taken to rule out cancer or granulomatous disease.

Treatment Options

Management is individualized based on severity, cause, and patient health. Options fall into three categories: medical, procedural, and supportive/home‑care measures.

Medical Management

• Corticosteroids – short courses can reduce acute inflammation and swelling.
• Antibiotics or antifungals – indicated only when an active infection is present.
• Proton‑pump inhibitors (PPIs) – for patients with gastro‑esophageal reflux disease (GERD) that may irritate the larynx.
• Anti‑reflux diet and lifestyle changes – to minimize ongoing mucosal irritation.

Procedural & Surgical Treatments

• Dilation (balloon or rigid) – gently stretches the narrowed segment; often repeated.
• Laser excision – CO₂ laser removes scar tissue with minimal bleeding.
• Microlaryngoscopic resection – precise removal of webs or granulation tissue.
• Stent placement – temporary silicone or metal tubes keep the airway open while it heals.
• Open reconstructive surgery – for severe, long‑standing stenosis (e.g., laryngotracheal reconstruction, cricotracheal resection).
• Voice therapy – working with a speech‑language pathologist to improve vocal technique and reduce strain.

Home & Supportive Care

• Stay well‑hydrated; humidified air can soothe irritated mucosa.
• Avoid smoking, vaping, and exposure to chemical fumes.
• Use a cool‑mist humidifier, especially in dry climates.
• Practice gentle vocal warm‑ups as recommended by a speech therapist.
• Elevate the head of the bed if reflux symptoms are prominent.

Prevention Tips

While not all cases are preventable, many risk factors are modifiable:

• Limit unnecessary intubation – use the smallest appropriate tube and monitor cuff pressure (<30 cm H₂O).
• Promptly treat upper‑respiratory infections and follow prescribed antimicrobial courses.
• Protect the airway from inhalation injuries – wear appropriate respiratory protection when exposed to smoke or chemicals.
• Manage GERD aggressively with medications and diet changes.
• Avoid excessive voice strain – take vocal breaks, stay hydrated, and consider voice training if you use your voice professionally.
• Regular follow‑up after laryngeal surgery – early detection of scar formation can allow minimally invasive correction.
• Maintain good overall health – balanced diet, regular exercise, and smoking cessation support airway resilience.

Emergency Warning Signs

Key Take‑aways

Glottic stenosis is a potentially serious condition that interferes with breathing and voice production. Early recognition, thorough evaluation, and appropriate treatment can prevent progression to life‑threatening airway obstruction. If you experience persistent hoarseness, stridor, or any breathing difficulty—especially after intubation, surgery, or infection—contact a healthcare professional promptly.

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References:

• Mayo Clinic. “Laryngeal stenosis.” Mayo Clinic Proceedings, 2022.
• American College of Surgeons. “Management of Subglottic and Glottic Stenosis.” 2023.
• National Institute on Deafness and Other Communication Disorders (NIDCD). “Voice Disorders.” 2021.
• Cleveland Clinic. “Airway Stenosis – Symptoms and Treatment.” 2023.
• World Health Organization. “Guidelines for Safe Airway Management in Critical Care.” 2022.

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