Subglottic stenosis is a narrowing of the airway just below the vocal cords — a condition that is frequently misdiagnosed as asthma for years before the correct diagnosis is made. If you have been struggling with breathing difficulties, a high-pitched wheeze (stridor), or exercise intolerance that hasn't responded to inhalers, subglottic stenosis may be the explanation. Beach Cities ENTS in Torrance provides evaluation and treatment for this condition for patients throughout the South Bay, including El Segundo.
Subglottic stenosis is not rare — it is under-recognized. The condition disproportionately affects women, and many spend years being treated for reactive airway disease before an ENT or pulmonologist orders a laryngoscopy that finally reveals the real problem.
What Is Subglottic Stenosis?
The subglottis is the segment of the airway directly below the vocal cords, above the trachea. When scar tissue, inflammation, or structural changes narrow this segment, air has to move through a smaller opening — making breathing harder, particularly with exertion. As the airway narrows further, a high-pitched stridor may be audible at rest.
Causes include scar tissue from prolonged or traumatic intubation (a known complication of extended mechanical ventilation), autoimmune conditions such as granulomatosis with polyangiitis (GPA) or relapsing polychondritis, prior radiation to the neck, and idiopathic subglottic stenosis — the most common type in otherwise healthy women in their 30s to 60s, where no identifiable cause is found despite thorough workup.
How Subglottic Stenosis Is Diagnosed
Diagnosis requires direct visualization of the airway. Flexible laryngoscopy in the office allows the physician to pass a camera through the nose and visualize the subglottis directly. For a more complete assessment — particularly for surgical planning — rigid bronchoscopy under sedation provides better visualization of the degree and length of narrowing. CT imaging of the neck and upper chest characterizes the extent and location of the stenosis.
Pulmonary function tests can also be revealing: a characteristic "flattening" of the inspiratory flow-volume loop suggests upper airway obstruction rather than small airway disease, which is a key distinguishing feature from asthma. If you have been told your PFTs are abnormal but inhalers have not helped, bringing those test results to Beach Cities ENTS is a useful starting point for evaluation.
Treatment Options at Beach Cities ENTS
The primary treatment options are endoscopic procedures — performed through the mouth under general anesthesia without external incisions — and, for more severe or recurrent cases, open airway reconstruction. Endoscopic approaches include balloon dilation (stretching the narrowed segment) and surgical resection using a laser or cold steel instruments to remove scar tissue and widen the airway. These are typically outpatient or short-stay procedures with a relatively quick recovery.
For idiopathic subglottic stenosis, endoscopic treatment is highly effective but often requires repeat procedures — this is a chronic, recurrent condition, not a one-time fix. Most patients manage it well with interval procedures as needed. For patients with autoimmune SGS, controlling the underlying inflammatory disease is essential alongside airway treatment. Open laryngotracheal reconstruction or cricotracheal resection is reserved for more severe stenosis or for patients in whom endoscopic management is no longer providing adequate results.
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Very knowledgeable and personable - She has been seeing our son since he was one year old for ongoing ENT-related issues. She has helped us navigate complicated issues and seems to favor lowest level of intervention medically required, which we prefer. She always seems genuinely happy to see her patients and she is good with him. We will continue to see her only as long as she is practicing.
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Dr. Levine was great. My Son had surgery and he made us feel comfortable and confident throughout the entire process. He even called on a Sunday to see how he was doing. He was professional, caring, and took the time to answer all of our questions. I am in healthcare and am really particular. The office staff was also friendly, welcoming, and efficient, making every visit a pleasant experience. I highly recommend Dr.Levine and his entire team.
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Frequently Asked Questions
How do I know if my breathing problems are from subglottic stenosis rather than asthma?
Several features distinguish subglottic stenosis from asthma. SGS typically produces a noisy inhale (inspiratory stridor), while asthma predominantly affects the exhale. SGS-related breathing difficulty does not respond to bronchodilators or inhaled corticosteroids. Pulmonary function tests in SGS show flattening of the inspiratory flow-volume loop, which is not characteristic of asthma. And laryngoscopy or bronchoscopy directly shows the narrowing. If you have been treated for asthma without meaningful improvement, an evaluation at Beach Cities ENTS is warranted.
Can subglottic stenosis be cured, or will it keep recurring?
For idiopathic subglottic stenosis, recurrence is the rule rather than the exception — most patients require repeat procedures at intervals ranging from months to years. The goal is not a permanent cure but effective long-term management that keeps the airway open and your breathing comfortable between procedures. For stenosis from a resolved cause (such as healed intubation injury with no ongoing inflammation), recurrence is less predictable. Understanding at the outset that SGS often requires ongoing management helps patients in Torrance and El Segundo plan accordingly.
What triggers idiopathic subglottic stenosis, and why does it disproportionately affect women?
The honest answer is that we do not fully understand the cause of idiopathic SGS. Research suggests a hormonal component — the condition appears to be influenced by estrogen, which may explain why premenopausal women are disproportionately affected and why some patients notice worsening around the menstrual cycle. There is also evidence of abnormal fibroblast behavior in the subglottis in these patients. Research is ongoing, and what we know has advanced considerably in the past decade. At Beach Cities ENTS, we stay current with the literature on idiopathic SGS and incorporate the most current evidence into care.
Is subglottic stenosis dangerous?
It can be. A significantly narrowed airway limits exercise tolerance and, if the narrowing is severe, can compromise breathing at rest. Most patients with managed SGS do not face an acute airway emergency, but worsening stenosis without treatment does carry that risk. One of the important aspects of ongoing follow-up at Beach Cities ENTS is monitoring the degree of stenosis over time so that a procedure is scheduled before the airway becomes critically narrow rather than as an emergency.
Do I need to be seen urgently, or can I schedule a routine appointment?
If you are having significant difficulty breathing — particularly at rest or with mild exertion — or if your symptoms are worsening rapidly, seek care urgently, as an acutely narrowed airway is a medical emergency. If your symptoms are stable and you are breathing comfortably with moderate exertion, a scheduled evaluation at Beach Cities ENTS is appropriate. When you call, describe your symptoms clearly so our team can triage the urgency of your appointment correctly.