The Journal of Laryngology & Otology

Main Articles

Great Ormond Street Hospital treatment guidelines for use of propranolol in infantile isolated subglottic haemangioma

Y Bajaja1 c1, K Kapoora1, S Ifeachoa1, C G Jephsona1, D M Alberta1, J I Harpera2 and B E Hartleya1

a1 Department of ENT, Great Ormond Street Hospital, London, UK

a2 Department of Dermatology, Great Ormond Street Hospital, London, UK


Objective: Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.

Methods: The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.

Results: The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.

Conclusion: Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation.

(Accepted May 01 2012)

(Online publication February 01 2013)

Key words

  • Hemangioma;
  • Larynx;
  • Propranolol;
  • Child


c1 Address for correspondence: Mr Yogesh Bajaj, 2 Tall Trees, Leeds LS17 7WA, UK Fax: +44 (0)113 266 3305 E-mail:


  Mr Y Bajaj takes responsibility for the integrity of the content of the paper

Competing interests: None declared