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.
Awake Office-Based Corticosteroid Injection for 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
Disadvantages: Delayed effect of treatment
Small risk of airway narrowing
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