Serial injections for subglottic stenosis
For years, managing subglottic stenosis meant returning to the operating room — often about once a year, sometimes more. What changed that for me was Dr. Ramon Franco’s work on awake serial intralesional steroid injections.
It has let me manage far more patients with a quick office treatment, quite often eliminating any further return to the operating room.
How it goes in practice
A patient comes in as the breathing begins to tighten again — perhaps four, eight or twelve months after the last treatment. Another injection shrinks the stenosis enough to put them back to their regular activity.
This is management, not cure. But it is management that keeps people out of the operating room and living normally, which is a fair trade.
When to come back
Franco’s recommendation is to monitor rather than wait: a portable spirometer at home, a weekly check of inspiratory airflow, and a visit when the number drops. In principle that brings the patient back sooner than symptoms would.
I have suggested it to many patients. Nobody buys the spirometer, and nobody wants to keep the record. So in my practice the return is symptom-driven.
What is worth knowing is that the symptom is not the same for everyone. For one patient it is exertion — they notice when they can no longer ski. For another it is mucus beginning to collect. For another it is the noise; they hear themselves breathing. Each patient has a sentinel of their own, and it is worth asking at the end of a treatment which one is likely to be theirs, so they know what they are waiting for.
On inhaled steroids
I do not believe inhaled steroids land on the stenosis in sufficient concentration to do this work. The injection puts the drug into the scar; an inhaler passes over it.
Reference
Franco RA, et al. Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis. The Laryngoscope, 2018. doi:10.1002/lary.26874
See also: the surgical technique that these injections follow and often replace — and the case behind them, When symptoms of cough and hoarseness might be hidden.