Steroid Injections for Subglottic Stenosis
What is subglottic stenosis?
Subglottic stenosis is narrowing of the
breathing passage below the vocal folds.
Subglottic stenosis causes shortness of
breath during times of exertion. Subglottic
stenosis can causes noisy breathing during
What causes subglottic stenosis?
ξ Scar formed from an endotracheal
ξ Granulomatosis with polyangiitis is a
condition of inflamed blood vessel.
ξ Other autoimmune or inflammatory
diseases like relapsing polychondritis
ξ Trauma to the front of the neck
ξ Idiopathic is a diagnosis made if
there is no obvious cause. Patients
with idiopathic subglottic stenosis
are often young females aged 25-50.
This is the most common type.
What are symptoms of subglottic
ξ Shortness of breath during exertion
and sometimes at rest
ξ Noisy breathing, also known as
ξ Voice changes
ξ Feeling of phlegm "stuck" within the
What is a subglottic stenosis steroid
The procedure is done in the office without
sedation. Patients can drive themselves
home and wear standard clothing. It is done
in an ENT clinic room. A camera is passed
through your nose to look at your voice box
and the wind pipe (trachea). Steroids are
injected in to the area of inflammation.
Steroids are medicines that reduce
inflammation. The process is designed to
improve your airway over time by precisely
injecting anti-inflammatory medicine to the
problem areas of the airway narrowing.
How long does it take?
Your visit is usually 30 minutes but the
procedure takes only a few minutes. The rest
of the 30 minutes is spent on safety checks.
We will explain the process and the risks
and benefits. We will give you helpful tips
and suggestions so everything goes well.
Does it hurt?
Most people do very well and tolerate the
procedure without difficulty.
Will my breathing be better right after
No. The steroids work over time. Your
breathing will likely feel limited for 24-72
hours after the injection. It may take weeks to
notice a difference in your breathing effort.
Some patients do not feel a difference until
they have had multiple injections.
How do I get ready?
ξ You must not eat or drink anything
for 3 hours before the injections.
This includes water, coffee and
ξ It is important for you to tell us to
know you are taking blood-thinning
medicines such as Warfarin
(Coumadin), aspirin (even a baby
aspirin), or Plavix. You must discuss
with your primary care provider if
stopping these medicines for 3 days
before the treatment is OK.
ξ Do not take anti-inflammatory
medicines such as Advil for 3 days
before or 2 days after the injections.
These medicines can cause bleeding
which may complicate the treatment
outcome. You may use Tylenol.
ξ If you have diabetes, you may need
to adjust your insulin because you
will not eat right before the
treatment. Please talk to your
primary care provider about the best
way to do this. Do not take oral
hypoglycemic medicine the morning
of your treatment. Bring your blood
sugar monitor to the clinic with you
so that you can check your blood
sugar before the treatment. If you
have symptoms of low blood sugar
(feeling clammy, weak, faint) you
can drink orange juice or suck on a
o If you have diabetes, please
monitor your blood sugar
closely after the injections.
The steroids may increase
your blood sugar for a few
days. Please work with your
What happens right before the
Before the injection procedure, the nursing
staff will review your recent medical history
and go over your allergies, medicines and
pregnancy status. You will fill out forms
about your symptoms. The staff will all
introduce themselves so you know who is
helping you. There is usually a nurse, a
medical assistant, ENT residents, and
sometimes medical students or other doctors
who are learning from the doctor doing the
injection. All team members are important
and have a role. All are interested in your
good outcome. Your doctor will go over the
consent form and the procedure to be done.
What is the preparation like right before
Staff will give your time-tested tips and
suggestions on how to focus on breathing,
relax your muscles and help you have a
smooth procedure. Medicine will be applied to
your nose and you will breatxhe topical
lidocaine through a nebulizer to help to numb
your throat. This takes about 4 minutes. Then
a camera will be passed through your nose to
examine your vocal cords and apply small
amounts of additional lidocaine while you say
“ee”. This will make you cough a little, but the
cough will go away. Your throat will feel
strange at this point – this is normal and
anticipated. That strange feeling lasts 45
minutes to an hour and then will go back to
What happens during the procedure?
ξ The camera will stay in your nose
while a very thin tube with a tiny
needle is passed through the camera.
The doctor will see the area to be
treated on a monitor. They will give
injections thru the tube directly to the
areas of inflammation. The doctor will
tell you how much time is left and also
reiterate the tips and suggestions for a
smooth procedure. The care provider
if you have questions on managing
What happens after the procedure?
You will be asked questions about any pain
you experienced before, during and after the
procedure. You will then head to the front
desk to schedule follow up appointments
and will get printed instructions for home
What about pain relief?
You may have throat pain or discomfort
after the numbing medicine wears off. Most
patients take Tylenol for pain relief. You
may also get pain relief from sucking on ice
chips or drinking ice water.
What about activity?
Avoid strenuous activity or exercise for 1-2
days after the injection.
What about my diet?
You may resume your normal diet after the
numbing medication wears off.
Drink plenty of fluids. It may be better to
avoid spicy foods for 2-3 days.
What can I do about the thick mucus in
ξ Drink water throughout the day.
ξ You could try guaifenesin. You can
purchase this medicine over the
counter if your insurance does not
o Dosing: One 600 mg tablet
ξ Some of our patients with idiopathic
subglottic stenosis have found
benefit from taking N-Acetylcysteine
(NAC) to thin out the thick mucus
and reduce cough. NAC is a drug
that breaks down mucus, the
substance that lubricates many parts
of the body such as the mouth,
throat, and lungs. NAC can be found
in certain pharmacies in the
supplement section. If your
pharmacy does not carry it, talk with
your pharmacist to see if it can be
o Dosing: Take one 600 mg
tablet once per day.
When do I call the doctor?
ξ You have pain that doesn’t go away
with Tylenol and the suggestions
ξ You cough up bright red blood or
ξ You have trouble breathing: if you
have trouble breathing go to the
nearest Emergency Department or
ENT (Otolaryngology) Clinic, Monday to
Friday 8 am to 5 pm: (608) 263-6190.
After hours, you will be connected to the
paging operator. Ask for the ENT
(Otolaryngology) doctor on call. Give your
name, date of birth and phone number to the
paging operator. The doctor will call you
If you live out of the area, call:
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor.
This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because
each person’s health needs are different, you should talk with your doctor or others on your health care team
when using this information. If you have an emergency, please call 911. Copyright © 10/2017 University of
Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#8010