Abstract
Recently, it has been recognized that gastroesophageal or laryngopharyngeal reflux can contribute to the pathophysiology of some recalcitrant laryngeal conditions. Subglottic stenosis also is considered to be in a relationship with laryngopharyngeal reflux. We report nine cases of subglottic stenosis and examined whether or not laryngopharyngeal reflux can contribute to the conditions of their subglottic stenosis, based on interviews for typical symptoms of gastroesophageal reflux disease and findings of laryngeal fiberscopy, lateral cervical X-ray and VTR esophagography. Previous histories included prolonged intubation (4 cases), high tracheotomy (2 cases) and cricothyrotomy (1 case), and 2 cases were idiopathic. There were only three cases with typical symptoms (regurgitation, belching and hiccups); however, there was found to be swelling of the arytenoid and inter-arytenoid mucosa in eight cases, abnormal X-ray findings (swelling of cervical esophagus) in 7 cases, and abnormal findings of VTR esophagography (abnormal peristalsis, hiatal hernia and reflux) in eight cases. The conditions of subglottic stenosis were found to be granulous or edematous changes for cases within two months after previous history and scar formation with inter-arytenoid bar for cases more than six months after previous history.
Therapies for subglottic stenosis combined with acid-suppression therapy using proton pump inhibitor were performed for all patients. In eight cases, anterior cricoid split and insertion of the T-tube were performed, and for one case, intravenous administration of steroid. The results were that all patients saw improvement in the conditions of their subglottic stenosis. Two cases saw recurrences due to terminated administrations of the proton pump inhibitor; they recovered with readministration of the inhibitor. From these results, we considered that laryngopharyngeal reflux can contribute to the condition of subglottic stenosis directly or as an aggravation factor, and combining therapies with acid-suppression therapy using a proton pump inhibitor is useful for treatment of subglottic stenosis.
