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Ep. 161 Idiopathic Subglottic Stenosis Evaluation and Management with Dr. Stephen Schoeff
Description
In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan talk to Dr. Stephen Schoeff, laryngologist at Kaiser Permanente (Tacoma, WA) about subglottic stenosis in adults.
Dr. Schoeff introduces subglottic stenosis (SS) as a rare condition affecting adult women of all ages. Patients complain of progressive dyspnea, declining exercise tolerance, and mucus sensation. Sometimes confused for asthma, globus sensation, LPR, or paradoxical vocal fold motion, SS is diagnosed when airway scarring and narrowing is visible on laryngoscopy. After describing workup, Dr. Schoeff reviews etiologies of SS, including iatrogenic, idiopathic, and autoimmune. Treatment options for SS include cricotracheal resection, endoscopic dilation, and airway steroid injections. Dr. Schoeff concludes the episode by sharing his success using periodic airway steroid injections for treatment of SS.
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SHOW NOTES
00:00 - Introduction
01:21 - Dr. Schoeff’s Journey & Practice
08:28 - Symptoms & Differential Diagnosis
12:31 - Physical Examination & Diagnosis
27:23 - Introduction to Endoscopic Dilation
28:57 - Steroid Injections as a Management Option
31:24 - The Three Big Categories of Treatment
33:05 - How Steroids Address Disease Pathophysiology
38:58 - Technique for Airway Dilation
49:06 - Deciding on Cricotracheal Resection
51:14 - How Insurance Affects Treatment Options
55:05 - Final Thoughts & Pearls