Use of Steroid Injection to Alleviate Posterior Glottic Stenosis

Posterior glottis stenosis (PGS) represents an interesting dilemma to the airway surgeon. Diagnosis of this rare condition can be difficult, often mimicking bilateral vocal fold paralysis. Management can also be challenging, with several potential therapeutic options. After receiving IRB approval, pediatric Otolaryngology patient records at a single institution in Memphis, TN were reviewed from 1/1/2013 to 7/1/2014 and 4 patients were identified with PGS. Serendipitously, each these 4 patients represented a distinct grade, I-IV, of PGS. Our case series presents these pediatric patients, all with confirmed PGS on operative direct laryngoscopy that were treated with Triamcinolone 40 mg/ 1mL injectable solution a variable number of times, based on therapeutic response. All 4 patients showed improvement or resolution of synechiae causing the PGS on subsequent laryngoscopy. Triamcinolone injection has previously been shown to be a viable first-line therapeutic option for the treatment of low-grade (type I-II) PGS. Based on our limited series, a trial of steroid injection may represent a standalone therapeutic option worth trial for higher grade (type III-IV) PGS prior to more aggressive surgical treatment such as cartilage grafting, which is the standard practice at this time.