Question:
Our 32 year old daughter has recently been diagnosed
with subglottic stenosis(4mm airway). She is a
childhood cancer survivor having had surgery,
radiation, and chemo.
Is this going to get worse as time goes on? What
options does she have? Should something be done
immediately, or should she take a wait and see
approach? We understand this is a rare condition.
Any information or medical advice will be greatly
appreciated.

Answer:
Hey Gene, how are you doing?

If you decide to obtain a second opinion, you can find a laryngologist near you by contacting the American Laryngological Association. Arguably, the best doctor to treat this problem is a laryngologist.

Partial or complete narrowing of the subglottic area may be congenital or acquired. Speedy intervention prior to cartilage damage or scar contracture is preferred when the diagnosis is made early.

Stenosis is said to be congenital in the absence of a history of intubation or other acquired causes. Trauma (acquired) is the most common cause of stenosis in both children and adults.

The first step in any medical evaluation is for your doctor to gather information about symptoms, risk factors, and family history and medical conditions. In particular, your doctor will look for any signs that the cancer has spread, such as enlarged lymph nodes in your neck.

If your doctor suspects a cancer of the larynx or hypopharynx, you will be referred to see an otolaryngologist (ear, nose, and throat specialist) for a complete evaluation. Because the larynx and hypopharynx are deep inside the neck and not easily seen, special mirrors and fiber-optic laryngoscopes (flexible, lighted, narrow tubes inserted through the mouth or nose) are used to examine these areas.

Examination of the neck is essential, with palpation for adenopathy, mobility of the laryngotracheal complex, and direct tumor extension. Laryngeal cancer affects men 4 times more frequently than women in the United States, however.

Hoarseness is the commonest symptom of disorders of the larynx, regardless of etiology. Both inflammatory and noninflammatory diseases of this organ as well as functional disturbances (hysterical aphonia) may be causative factors.

The common denominator of the numerous causes of this symptom is interference with normal phonatory function of the larynx. Although hoarseness is usually of short duration with acute self-limited processes such as infections, it may persist for long periods.

Cough is common with any type of laryngeal disease. Pain occurs occasionally, while stridor and dyspnea are common manifestations of laryngeal involvement.

However, when present, the latter are ominous because they indicate the development of airway obstruction which may rapidly become complete. Obstruction to breathing is not only associated with intralaryngeal lesions of those which exert pressure directly on this organ, but may occur as a result of neurologic disorders in which paralysis of both vocal cords develops.

The exact cause of laryngeal obstruction can be detected only by direct or indirect examination of the larynx. This is usually necessary when manifestation have persisted for longer than 2 or 3 weeks.

However, if serious obstruction of the airway develops rapidly in acute disorders of the larynx, laryngoscopic examination should be carried out promptly and tracheostomy performed if necessary. When it is clear that the airway is seriously threatened, tracheostomy, in addition to chemotherapy, is urgently indicated.

REFERENCES
Douglas Hoffman, MD, PhD.,: Breathing Trouble With "Web" Over Trachea
iVillage/iVillage Health & Well-Being

American Cancer Society,: How are Laryngael and Hypopharyngeal Cancer Diagnosed?

Mary C Snyder, MD,: Glottic Cancer
Resident Physician, Division of Plastic Surgery,
University of of Wisconsin Medical School, Madison

James D Garnett, MD,: Subglottic Stenosis In Adults
Director of Voice and Swallowing Center, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center

Louis Weinstein,: Disease Of The upper Respiratory Tract
Harrison's Principles of Internal Medicine, ed.8, sec.4 Alterations in circulatory and
respiratory function, chap.28, p159

Best wishes,

The Prison Hospital

Prisoner: Look here, doctor! You've already removed my spleen, tonsils, adenoids, and one of my kidneys. I only came to see if you could get me out of this place!

Doctor: I am, bit by bit.