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Acquired laryngeal stenosis — Clinical Guidelines

Overview

Acquired laryngeal stenosis involves narrowing of the laryngeal airway, often secondary to trauma, inflammation, or previous surgical interventions, leading to respiratory compromise and voice dysfunction 5.

Diagnosis

Clinical Presentation: Dyspnea, stridor, hoarseness, and respiratory distress 5.

Diagnostic Tests: Flexible nasolaryngoscopy for visualization 1, flexible fiberoptic laryngoscopy with biometric feedback monitoring (HR changes) for assessment 1.

Grading: Various grading systems exist (e.g., Cotton-Myer classification for subglottic stenosis) 5.

Management

First-Line Treatments:

- Surgical Interventions: Cricotracheal resection, coblation techniques (e.g., cold-plasma posterior arytenoid cordotomy) 2 5. - Tracheostomy: Temporary airway management in severe cases 5.

Adjunctive Treatments:

- Silastic Prosthesis: For dilatable strictures, anchored to a tracheostomy tube 6. - Orthophonic Training: Long-term speech therapy to compensate for vocal function 2.

Special Populations

Pediatrics: Hidden obstructions must be ruled out preoperatively, especially in syndromic cases 5.

Comorbidities: Preoperative assessment is crucial to identify additional airway issues 5.

Key Recommendations

Comprehensive Preoperative Assessment: Include thorough airway evaluation to identify hidden obstructions, particularly in pediatric and syndromic patients (Evidence: Moderate 5).

Consider Coblation Techniques: For surgical management of laryngeal stenosis due to minimal tissue trauma and effective resection (Evidence: Moderate 2).

Post-Surgical Speech Therapy: Implement long-term orthophonic training to aid in vocal function recovery (Evidence: Expert opinion 2).

References

1 Fernández-Penny FE, Clements AC, Meyer TK, Le H, Bindschadler M, Friedman SD et al.. Feedback Enhances Training and Elicits Biometric Responses in Novel Flexible Nasolaryngoscopy Model. The Laryngoscope 2025. link 2 Svistushkin VM, Starostina SV, Toldanov AV. Possibilities of coblation in otorhinolaryngology: analytical review. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2022. link 3 Formeister EJ, Courey MS, Yung KC. Perceptions of the laryngology Match: A survey of program directors and recent trainees. The Laryngoscope 2017. link 4 Bohm LA, Nelson ME, Driver LE, Green GE. Babbling, vegetative function, and language development after cricotracheal resection in aphonic children. The Laryngoscope 2010. link 5 Hoeve LJ, van der Eerden PA. Pitfalls in preoperative management of acquired laryngeal stenosis. The problem of the hidden obstruction in the airway. International journal of pediatric otorhinolaryngology 2002. link00034-4) 6 Kotton B, Kalish P. A silastic prosthesis for laryngeal stenosis. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1976. link

Acquired laryngeal stenosis