Effects of Balloon Dilation for Idiopathic Laryngotracheal Stenosis on Voice Production

Hoffman, Matthew R.; Brand, William T.; Dailey, Seth H.

doi:10.1177/0003489415595425

Cited by 15 publications

(25 citation statements)

References 19 publications

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“…Idiopathic subglottic stenosis is well suited to assessment with PROMs because the primary clinical manifestation of this disease is a perceptual and psychosocial symptom with an impact on many facets of QOL . Several groups have used PROMs to show that patients with airway stenosis tend to improve along many dimensions after surgery to widen the glottis and/or subglottic airway, including along the dimensions of voice and dyspnea symptoms . Our model agrees with the inclusion of both of these dimensions, as well as including questions about cough (which can be persistent in ISGS) and general overall health.…”

Section: Discussionsupporting

confidence: 67%

Quality‐of‐Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

Naunheim

Paddle

Husain³

et al. 2018

The Laryngoscope

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Section: Discussionsupporting

confidence: 67%

Quality‐of‐Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

Naunheim

Paddle

Husain³

et al. 2018

The Laryngoscope

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“…Regardless of these possible reasons for variability across studies, the results from the present investigation indicate that patients with SGS present with voice disorder severity ranging from mild to moderate based on auditory‐perceptual, aerodynamic, acoustic analyses, and patient‐reported measures. Presumably, the greater the severity of the stenosis, the more severe the voice disorder; however, this is yet to be proven because many patients seek out and receive surgical intervention in the form of balloon dilation prior to open laryngeal procedures …”

Section: Discussionmentioning

confidence: 97%

“…Smith et al also observed voice disorders in the mild‐to‐moderate range based on selected acoustic measures prior to surgical management of idiopathic SGS in a similar group of patients to those in the present study. Most recently, Hoffman, Brand, and Dailey performed a study of 10 patients with SGS who received balloon dilation as an alternative to the potentially more detrimental effects of open laryngeal surgeries such as CTR. The authors documented presurgical voice disorder severity in the very mild range based on the VHI and the severe range based on the auditory‐perceptual Grade, Roughness, Breathiness, Asthenia, Strain Scale .…”

Section: Discussionmentioning

confidence: 99%

Effects of voice‐sparing cricotracheal resection on phonation in women

et al. 2016

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Introduction Individuals with idiopathic subglottic stenosis (SGS) are at risk for voice disorders prior to and following surgical management. This study examined the nature and severity of voice disorders in patients with SGS before and after a revised cricotracheal resection procedure designed to minimize adverse effects on voice function. Method Eleven women with idiopathic SGS provided presurgical and postsurgical audio recordings. Voice Handicap Index (VHI) scores were also collected. Cepstral, signal-to-noise, periodicity, and fundamental frequency analyses were undertaken for connected speech and sustained vowel samples. Listeners made auditory-perceptual ratings of overall quality and monotonicity. Results Paired samples statistical analyses revealed that mean fundamental frequency decreased from 215 Hz (SD=40 Hz) to 201 Hz (SD=65 Hz) following surgery. In general, VHI scores decreased after surgery. Voice disorder severity based on the cepstral spectral index of dysphonia™ for sustained vowels decreased (improved) from 41 (SD=41) to 25 (SD=21) points; no change was observed for connected speech. Semitone standard deviation (2.2 semitones) did not change from pre- to post-treatment. Auditory-perceptual ratings demonstrated similar results. Conclusions These preliminary results indicate that this revised cricotracheal resection procedure is promising in minimizing adverse voice effects while offering a longer-term surgical outcome for SGS. Further research is needed to determine causal factors for pretreatment voice disorders, as well as to optimize treatments in this population.

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“…Perceptual voice quality evaluation using the CAPE-V assessment did not demonstrate improvement in our sample population, a result that is consistent with those of previous perceptual voice evaluation studies. 5,6 The lack of concordance between improvement in CAPE-V and V-RQOL scores may be because the patient’s self-rated V-RQOL improvement reflects that they no longer run out of breath or that they are less anxious and/or depressed about their airflow related to voice, rather than the quality of voice grade, roughness, breathiness, asthenia, or strain that perceptual raters assess. Acoustic and aerodynamic measures evaluated largely remained unchanged, although maximum phonation time and maximal high-pitch frequency improved after the airway intervention.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

Samad

Akst

Karataylı-Özgürsoy

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. OBJECTIVE To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. DESIGN, SETTING, AND PARTICIPANTS This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. MAIN OUTCOMES AND MEASURES The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. RESULTS Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95%CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, −20.3; 95%CI, −27.9 to −12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, −2.2; 95% CI, −3.4 to −0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95%CI, 0.3–1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, −27.5 cm H2O/L/s; 95%CI, −44.8 to −10.3 cm H2O/L/s) postoperatively. CONCLUSIONS AND RELEVANCE Patients demonstrate statistically clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons’ regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.

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Effects of Balloon Dilation for Idiopathic Laryngotracheal Stenosis on Voice Production

Cited by 15 publications

References 19 publications

Quality‐of‐Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

Quality‐of‐Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

Effects of voice‐sparing cricotracheal resection on phonation in women

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

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