title: Propranolol for the treatment of subglottic hemangiomas.
abstract: BACKGROUND
  Infantile subglottic hemangiomas are rare causes of airway obstruction. They begin to proliferate at 1-2 months of age and can cause biphasic stridor with or without respiratory distress. Diagnosis requires direct visualization by direct laryngoscopy and bronchoscopy. Various therapeutic options have been utilized for treatment, including tracheotomy, open surgical excision, laser ablation, intralesional steroid injection, systemic steroids, and now oral propranolol.
  
  
  METHODS
  We present a retrospective chart review of infantile subglottic hemangiomas over a 5-year span (January 2005-2010) at a tertiary care pediatric hospital. IRB approval was obtained, and charts were reviewed to find patients with subglottic hemangiomas, including patient characteristics, presentation, workup, medical and surgical management, and outcomes. A case presentation demonstrates diagnostic, management, and treatment strategies and dilemmas encountered.
  
  
  RESULTS
  Nine patients were found to have infantile subglottic hemangiomas. Six of nine patients were treated with laser excision, with five of the six having localized subglottic hemangiomas. In 2009, three of four patients were initiated on propranolol as first-line treatment; the fourth had comorbidities which precluded this. Of the three, two showed improvement, while a third, who also had bearded hemangioma, required tracheotomy.
  
  
  CONCLUSIONS
  Infantile subglottic hemangiomas are rare but essential in the differential diagnosis of biphasic stridor. Although propranolol has been effective in treating cutaneous and airway hemangiomas, our experience suggests that this is not consistent for subglottic hemangiomas. In an area where airway compromise can be lethal, we must extend caution and monitor these patients closely as they may require adjuvant therapy.
authors.affiliation: Department of Otolaryngology, Texas Children's Hospital, Houston, TX, United States. pinnapur@bcm.edu
authors.forename: Nikhila
authors.initials: N
authors.lastname: Raol
authors.forename: Denise
authors.initials: D
authors.lastname: Metry
authors.forename: Joseph
authors.initials: J
authors.lastname: Edmonds
authors.forename: Binoy
authors.initials: B
authors.lastname: Chandy
authors.forename: Marcelle
authors.initials: M
authors.lastname: Sulek
authors.forename: Deidre
authors.initials: D
authors.lastname: Larrier
mesh_terms: D000284:Administration, Oral; D005260:Female; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007822:Laryngeal Neoplasms / Q000188:drug therapy*; D008297:Male; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D011433:Propranolol