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Propranolol for the treatment of subglottic hemangiomas
Nikhila Raol1, Denise Metry, Joseph Edmonds
1Department of Otolaryngology, Texas Children's Hospital, Houston, TX, United States. pinnapur@bcm.edu
Insights
Infantile subglottic hemangiomas are rare airway obstructions. While propranolol shows promise, its effectiveness for these specific hemangiomas is inconsistent, requiring careful monitoring and potential adjuvant therapies.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Surgery
Background:
- Infantile subglottic hemangiomas (ISH) are rare causes of pediatric airway obstruction.
- They typically present with biphasic stridor and can lead to respiratory distress.
- Diagnosis relies on direct visualization via laryngoscopy and bronchoscopy.
Purpose of the Study:
- To review the diagnosis, management, and outcomes of infantile subglottic hemangiomas.
- To evaluate the effectiveness of various treatment modalities, including oral propranolol.
Main Methods:
- Retrospective chart review of nine patients with ISH over a 5-year period (2005-2010).
- Analysis of patient characteristics, clinical presentation, diagnostic workup, and treatment strategies.
- Case presentation illustrating diagnostic and management challenges.
Main Results:
- Six of nine patients underwent laser excision for localized ISH.
- Three of four patients initiated on propranolol in 2009 showed varied responses; two improved, one required tracheotomy.
- One patient with bearded hemangioma and ISH necessitated tracheotomy.
Conclusions:
- ISH are critical considerations in the differential diagnosis of biphasic stridor.
- Oral propranolol's efficacy for ISH may not be as consistent as for other hemangioma types.
- Close patient monitoring and consideration of adjuvant therapies are crucial due to the potential for life-threatening airway compromise.
Introduction:
Infantile subglottic hemangiomas are rare causes of airway obstruction. They begin to proliferate at 1-2 months of age and can cause biphasic stridor with or without respiratory distress. Diagnosis requires direct visualization by direct laryngoscopy and bronchoscopy. Various therapeutic options have been utilized for treatment, including tracheotomy, open surgical excision, laser ablation, intralesional steroid injection, systemic steroids, and now oral propranolol.
Methods:
We present a retrospective chart review of infantile subglottic hemangiomas over a 5-year span (January 2005-2010) at a tertiary care pediatric hospital. IRB approval was obtained, and charts were reviewed to find patients with subglottic hemangiomas, including patient characteristics, presentation, workup, medical and surgical management, and outcomes. A case presentation demonstrates diagnostic, management, and treatment strategies and dilemmas encountered.
Results:
Nine patients were found to have infantile subglottic hemangiomas. Six of nine patients were treated with laser excision, with five of the six having localized subglottic hemangiomas. In 2009, three of four patients were initiated on propranolol as first-line treatment; the fourth had comorbidities which precluded this. Of the three, two showed improvement, while a third, who also had bearded hemangioma, required tracheotomy.
Discussion:
Infantile subglottic hemangiomas are rare but essential in the differential diagnosis of biphasic stridor. Although propranolol has been effective in treating cutaneous and airway hemangiomas, our experience suggests that this is not consistent for subglottic hemangiomas. In an area where airway compromise can be lethal, we must extend caution and monitor these patients closely as they may require adjuvant therapy.
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