HF 8010

Steroid Injections for Subglottic Stenosis

Subglottic stenosis is when the breathing passage below the vocal folds narrows. This causes shortness of breath during activity. It can cause noisy breathing.

Causes

  • Scarring from an endotracheal tube

  • Inflamed blood vessels

  • An autoimmune or inflammatory disease

  • Trauma to the front of the neck

  • Unknown cause, most common in females aged 25-50

Symptoms

  • Shortness of breath during activity and sometimes at rest

  • Noisy breathing, also known as stridor

  • Cough

  • Voice changes

  • Feeling of phlegm "stuck" within the airway

Treatment

Steroid injections are used to treat this condition. We inject steroids into the inflamed area. Steroids are medicines that reduce inflammation. This should improve your airway over time.
You will have the injection in the ENT clinic room without sedation. Patients can drive themselves home and wear normal clothing.

Your visit will take about 30 minutes. We will explain the process, the risks and benefits. Most people do very well with no problems.

When Breathing Will Return to Normal

The steroids take time to help. Your breathing will likely feel limited for 24-72 hours after the injection. It may take weeks for your breathing to improve. Some patients do not feel a difference until they have had multiple injections.

Getting Ready

Do not eat or drink anything for 3 hours before the injections. This includes water, coffee and juices.

Tell us if you are taking blood-thinners such as warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), aspirin (even a baby aspirin), or clopidogrel (Plavix). Ask your primary care provider if you can stop these medicines 3 days before the treatment.

Do not take ibuprofen (Advil) or naproxen (Aleve) for 3 days before or 2 days after the injections. These medicines can make bleeding more likely. You may use acetaminophen (Tylenol).

If you are diabetic, you may need to adjust your insulin. Talk to your primary care provider about the best way to do this.

Do not take pills to lower blood sugar the morning of your treatment. Bring your blood sugar monitor with you so that you can check your blood sugar before the treatment.

Monitor your blood sugar closely after the injections. The steroids may increase your blood sugar for a few days. Talk to your primary care provider if you have questions.

Day of the Procedure

The staff will review your recent health history and go over your allergies, medicines and pregnancy status. You will fill out forms about your symptoms. Your doctor will go over the consent form and the procedure.

Staff will tell you how to focus on breathing to relax your muscles to help you have a smooth procedure.

You will have medicine applied to your nose. You will breathe lidocaine through a nebulizer to help to numb your throat. This takes about 4 minutes.

A camera will be passed through your nose to look at your vocal cords. Small amounts of lidocaine will be applied while you say “ee.” This will make you cough, but it will go away. Your throat will feel strange, this is normal. This may last 45 minutes to an hour.

During the Procedure

A very thin tube with a tiny needle is passed through the camera. The doctor will see the area to be treated on a monitor. They will give injections thru the tube directly to the area. The doctor will tell you how much time is left and repeat the tips for a smooth procedure. We will ask you about pain before, during and after the procedure.

After the Procedure

You will go to the front desk to schedule follow up visits. You will get printed instructions for home care.

Pain Relief

You may have throat pain after the numbing medicine wears off. Most patients take acetaminophen (Tylenol) for pain. Sucking on ice chips or drinking ice water can also help.

Activity

Avoid strenuous activity for 1-2 days.

Diet

  • Resume your normal diet after the numbing medicine wears off.

  • Drink plenty of fluids.

  • Avoid spicy foods for 2-3 days.

Getting Rid of Thick Mucus

  • Drink plenty of water throughout the day.

  • Try guaifenesin (Mucinex). You can buy it over the counter if your insurance does not cover it. Take one 600 mg tablet twice daily.

  • Taking N-Acetylcysteine (NAC) can thin thick mucus and reduce cough. You can find NAC in certain pharmacies in the supplement section. If you can’t find it, ask your pharmacist. Take one 600 mg tablet once per day.

When to Call

  • Pain that doesn’t go away with acetaminophen (Tylenol) and the suggestions above.

  • You cough up bright red blood or clots.

If you have trouble breathing, go to the nearest emergency room or call 911.

Who to Call

ENT (Otolaryngology) Clinic

Monday to Friday, 8 am to 5 pm

(608) 263-6190

After hours, the paging operator will answer. Ask for the ENT doctor on call. Give your name, date of birth and phone number with area code. The doctor will call you back.

The toll-free number is 1-800-323-8942.