Severe subglottid stenosis, well-tolerated for many years

A 45 year old man was admitted to our hospital due to dyspnoea. At the age of 1 yr, he had undergone orotracheal intubation for croup diphtheria resulting in dysphonia. He was in good health up to the age of 39 yrs when exertional dyspnoea arose. He had had irregular therapy by aerosol without improvement. At admittance, the flow-volume curve indicated an impairment at high flows (peak expiratory flow (PEF) and maximum expiratory flow at 75% (MEF75%)). Fibreoptic bronchoscopy revealed a thin and smooth diaphragm, with a small (7-8 mm) central orifice in the subglottid area. CO2 laser therapy improved symptoms by increasing the cross-sectional area of the diaphragm orifice.