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Awake Steroid Injection for Idiopathic Subglottic Stenosis

Contributor: Michael Johns III, MD

This video demonstrates a steroid injection in an awake patient for the treatment of idiopathic subglottic stenosis. The patient is first anesthetized with topical 2% lidocaine over the larynx and 1% lidocaine with epinephrine percutaneously over the cricoid cartilage. An endoscope is passed transnasally and positioned just below the vocal folds. A 23 gauge needle is then passed through the cricothyroid membrane, and Kenalog is circumferentially injected submucosally taking care not to reduce the caliber size of the airway.

DOI: http://dx.doi.org/10.17797/htvmbepobg

Awake Office-Based Corticosteroid Injection for Subglottic Stenosis
Subglottic Stenosis
Critically narrow airway
Topical laryngeal and tracheal anesthesia; Topical nasal anesthesia and decongestant, Transnasal flexible video endoscopy, Subcutaneous injection of lidocaine over the cricothyroid membrane
Diagnostic tracheoscopy/bronchoscopy
Cricothyroid membrane
Advantages: Awake/unsedated Disadvantages: Delayed effect of treatment
Small risk of airway narrowing
none
N/A
Franco RA, Paddle P, Hussain I, Reder L Serial Intra-Lesional Steroid Injections as a Treatment for Idiopathic Subglottic Stenosis. Presented at the 2016 American Laryngological Association Meeting, April 23rd 2015, Boston, MA http://www.alahns.org/i4a/pages/index.cfm?pageid=3550

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