What tests should my doctor be doing?

There are a range of blood tests that should be regularly run to check for potential autoimmune causes of your subglottic stenosis.

There is not a definitive list of tests, but the following blood tests would be a great start to rule out known causes of scarring in the airway. Make sure you know what your doctor is doing or has done.

ESR (Erythrocyte sedimentation rate) - used to detect and monitor the activity of inflammation as an aid in the diagnosis of the underlying cause.
CRP (C-reactive protein) - used to identify the presence of inflammation, to determine its severity, and to monitor response to treatment. A more sensitive form of the test, highsensitivity C-reactive protein (hs-CRP), is used to assess your risk of heart disease.
RF (Rheumatoid factor) - to help diagnose rheumatoid arthritis (RA) and Sjögren’s syndrome
ANA (Antinuclear antibody; fluorescent antinuclear antibody) - screen for certain autoimmune disorders, such as systemic lupus erythematosus (SLE), polymyositis, and a number of others

ACE (Angiotensin converting enzyme) – screens for sarcoidosis.
ANCA - looks for antineutrophil cytoplasmic antibodies (ANCAs) in your blood test for vasculitis related autoimmune diseases, such as Granulomatosis with polyangiitis (once called Wegener granulomatosis), Microscopic polyangiitis and Eosinophilic granulomatosis with polyangiitis (once called Churg-Strauss syndrome).

Your doctor should also take a biopsy of the tissue while under anaesthetic which will be tested for signs of granulomas (small areas of inflammation). Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate.

It is strongly recommended that the blood tests are repeated each time you have an airway review or treatment (at least annually) as results can change many years later. It is also recommended that your doctor take a biopsy every time a dilation is performed.

If your surgeon suspects laryngeal reflux (acid from your stomach reaching your airway) then ask your doctor to refer you for further investigation. A variety of diagnostic tests are available (e.g. esophageal pH probe testing, esophageal impedance testing, esophageal manometry, pharyngeal probe testing – called ResTech, pharyngeal pepsin assay, esophageal endoscopy, etc), depending on where you live. In the event you test positive, taking 20ml of liquid containing sodium alginate daily has minimal side effects. (In the UK, Australia, and USA, use Gaviscon reflux medicine, available at most pharmacies)