Going away to college is a rite of passage in a young adult’s life. John Steever, MD, director of special programs at Mount Sinai Adolescent Health Center and assistant professor of pediatrics at the Icahn School of Medicine at Mount Sinai, for some advice for students undergoing this exciting and sometimes turbulent time.
Matthew C. Mori, MD
Frustrated by a year of increasingly difficult breathing, a 39-year-old female patient sought relief in the office of Matthew C. Mori, MD, a laryngologist at the Grabscheid Voice and Swallowing Center of Mount Sinai. Despite aggressive asthma treatment, nothing had helped. When he asked the patient to take a deep breath, Dr. Mori could hear noisy “stridor”—a high-pitched breath sound caused by upper airway obstruction—from across the room. Stridor is subtly distinct from the expiratory wheezes of an asthmatic. On further examination, Dr. Mori discovered the source of her breathing difficulty: subglottic stenosis.
What Is Subglottic or Tracheal Stenosis?
Subglottic or tracheal stenosis is a narrowing of a portion of the subglottis or trachea. The trachea is our “windpipe,” which connects our throats with our bronchi and lungs. Just above the trachea is the larynx, or “voice box,” which contains our vocal cords. The airway opening between the vocal cords is called the “glottis.” Just below the glottis, and above the trachea, is the subglottic airway. The narrowing of this portion typically involves a very short segment of the airway.
What Causes Subglottic or Tracheal Stenosis in Adults?
Among adults, subglottic or tracheal stenosis can result from trauma, tumors, or a history of tracheostomy and prolonged intubation (for example, having a breathing tube in during a long stay in the intensive care unit). It can also be caused by systemic diseases such as amyloidosis, autoimmune diseases such as Wegener granulomatosis, history of radiation therapy to the neck, and infection. With such a wide variety of causes, anyone can be at risk. The patient who contacted Dr. Mori was diagnosed with idiopathic subglottic stenosis (iSGS). Idiopathic means the cause is unknown. Interestingly, iSGS is found primarily in Caucasian women. Dr. Mori, an Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai, works within the Division of Laryngology, part of the North American Airway Collaboration (NOAAC), which has ongoing research to find the underlying cause of and best treatments for iSGS.
How to Distinguish Between Asthma and Subglottic or Tracheal Stenosis
According to Dr. Mori, if a patient comes for an evaluation, tracheal or subglottic stenosis can be diagnosed by the end of the appointment. During an evaluation, Dr. Mori performs a detailed history and physical exam which involves examining the throat and the windpipe with a flexible laryngoscope. Direct visualization shows whether there is narrowing. A patient can have both asthma and stenosis. It is important for patients to see a pulmonologist to undergo evaluation for asthma.
What Are the Treatment Options?
Patients with mild cases of subglottic or tracheal stenosis may not require treatment. It is important to examine these patients at regular intervals to assess for progression of disease. For those undergoing treatment, options depend on severity and can include medications, surgery, or both. Medical treatments include anti-inflammatory medications such as corticosteroids, antibiotics, and anti-reflux medication that treats gastroesophageal reflux (GERD). Anti-reflux therapy is usually combined with diet and lifestyle changes to reduce stomach acid production and reflux. Every patient is different, so specific medication regimens are tailored to the underlying causes. In-office or surgical procedures include steroid injection, endoscopic dilation with balloon or metal dilators, endoscopic resection of the stenosis with laser therapy or microinstruments, and external approaches through the neck. The most common type of open surgery is cricotracheal or tracheal resection and involves resection of the narrow scarred segment.
To make an appointment with Dr. Matthew Mori, call 212-241-9425.
Signs and Symptoms of Subglottic or Tracheal Stenosis:
Doctors increasingly understand the hard science behind pregnancy, including which pregnancies are at higher risk than others, according to Elizabeth Howell MD, MPP, Professor of Population Health Science & Policy, Professor of Obstetrics, Gynecology, and Reproductive Science at Icahn School of Medicine at Mount Sinai, and Director, Women’s Health Research Institute.
While resilience is an essential skill for healthy childhood development, science shows that adults also can take steps to boost resilience in middle age, which is often the time we need it the most. Last year, Dennis S. Charney, MD, Dean of the Icahn School of Medicine at Mount Sinai and President of Academic Affairs for the Mount Sinai Health System, was leaving a deli when he was shot by a disgruntled former employee. Dr. Charney spent five days in intensive care and faced a challenging recovery. “After 25 years of studying resilience, I had to be resilient myself,” he explained, as he is the co-author of the book “Resilience: The Science of Mastering Life’s Greatest Challenges.” “It’s good to be prepared for it, but it’s not too late once you’ve been traumatized to build the capability to move forward in a resilient way.”
Paula Klein, MD, Associate Professor of Hematology and Medical Oncology at the Icahn School of Medicine at Mount Sinai, whose research of the device led to FDA approval, explains why the new scalp cooling system is so important for patients.
A cold spring and wet summer can produce a ragweed season that wreaks havoc for many New Yorkers, says Anthony Del Signore, MD, PharmD, Assistant Professor, Otolaryngology and Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square.
Ragweed grows best in wet conditions, producing enough pollen to affect allergy sufferers when the weather turns warm and dry. Typically, the ragweed season begins in August, peaks in September, and can last until November. As summer winds down, and global temperatures continue to increase, pollen counts rise. Warmer temperatures in the autumn, which often persist well into the winter, present a host of issues for allergy sufferers as these conditions contribute to a lengthier ragweed season. The ragweed pollen grain is fine and light, allowing for easy dissemination by wind. Given its low weight, pollen has been known to remain airborne for many days and travel hundreds of miles. Elevated pollen counts are most visible on warm, windy days, and daytime hours when plants are in full bloom. Cool, rainy, wet days can provide some respite with low pollen counts.
Ragweed Allergy Symptoms Not everyone is a sufferer, but approximately 20 percent of the population can be sensitive to ragweed pollen. Symptoms include:
Some people can also experience difficulty breathing, asthma exacerbation, sinus infection, and cough. Ragweed allergies can also cross-react and cause itching, burning, and swelling in the mouth with certain foods, including bananas, melons, beans, potatoes, celery, and cucumbers.
Treatment for Ragweed Allergies
Treatment for ragweed allergies often begins with prevention and avoidance. Frequent household cleaning, changing linens, and washing bedding and clothes can minimize daily exposures. Nasal saline washes are extremely important to decrease pollen levels within the nasal cavity. Medications become an important part of surviving the season. Over-the-counter medications are often the first line of defense. Antihistamines, decongestants, and nasal steroid sprays are the most popular options. Staying ahead of the pollen levels is extremely important, so pre-treatment with antihistamines and nasal sprays may help. For those with persistent symptoms, prescription-strength oral medications and nasal sprays may be needed to control symptoms and provide relief. For those with an allergy verified through skin or blood testing, allergy shots or drops can be used to slowly help patients become immune to yearly symptoms.
When Allergy Sufferers Should See a Physician
Allergy sufferers should seek the care of a physician if symptoms persist for more than three months or the sufferer experiences;
Allergists can arrange for a testing of allergens, with either blood tests or skin-prick testing; provide advice on avoidance; and administer allergy shots. ENT doctors can help with persistent nasal obstruction, congestion that is not improving, or worsening symptoms by providing oral and nasal medications. More importantly, an ENT can help rule out structural abnormalities within the nasal cavity that may exacerbate symptoms.
Commonly seen issues include;
Allergy sufferers should be clear to ask their doctor the following important questions:
During allergy season, sufferers should track pollen counts in their geographic area. Pollen.com, both a website and mobile app, tracks pollen counts year-round. In addition, it can alert sufferers as to which seasonal allergens are most important in certain geographic areas. For information regarding allergy symptoms and treatments, American Academy of Allergy Asthma and Immunology is an excellent resource.
Assistant Professor, Otolaryngology and Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square
Dr. Del Signore’s specific clinical interests include endoscopic minimally invasive management of chronic sinusitis, paranasal sinus and skull base tumors, cerebrospinal fluid leaks (CSF), and allergic disease. His current research is focused on health outcomes following skull base surgery and the implementation of sinus treatment protocols and surgical intervention.