Ep. 161 Idiopathic Subglottic Stenosis Evaluation and Management with Dr. Stephen Schoeff

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. --- 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