Benign subglottic stenosis from a rheumatologist' perspective: a narrative review

Area of Science:

• Pulmonology
• Rheumatology
• Otolaryngology

Background:

• Subglottic stenosis (SGS) is a rare, life-threatening narrowing of the proximal airway below the glottis.
• SGS can result from iatrogenic injury, idiopathic causes (iSGS), or autoimmune diseases like Granulomatosis with Polyangiitis (GPA) and Relapsing Polychondritis (RP).
• The condition significantly impacts quality of life due to dyspnea, reduced exercise tolerance, and voice impairment, often leading to delayed diagnosis.

Purpose of the Study:

• To provide rheumatologists with updated insights into the etiology, pathophysiology, diagnosis, and treatment of subglottic stenosis.
• To highlight recent advances in understanding and managing SGS, particularly idiopathic SGS.

Main Methods:

• Review of current diagnostic tools including pulmonary function testing, flexible endoscopy, CT scans, laboratory tests, and pathology.
• Analysis of treatment strategies, distinguishing between autoimmune-associated SGS and idiopathic SGS.
• Exploration of emerging therapeutic approaches, including adjuvant therapies for iSGS.

Main Results:

• Diagnostic evaluation for SGS utilizes a multimodal approach.
• Treatment is etiology-dependent, often involving endoscopic dilation, with surgery (cricotracheal resection) reserved for specific cases.
• Efficacy of immunosuppressants in iSGS is not well-established, prompting investigation into adjuvant therapies.

Conclusions:

• Subglottic stenosis requires a comprehensive diagnostic and management strategy tailored to the underlying cause.
• Further research into novel treatments, especially for idiopathic SGS, is essential to improve patient outcomes and reduce the need for repeated interventions.
• Collaboration between specialties like rheumatology and pulmonology is key for optimal patient care.