Idiopathic Subglottic Stenosis: An Institutional Review of Outcomes With a Multimodality Surgical Approach

Abstract

Objectives This article reports on a unique cohort of patients with idiopathic subglottic stenosis spilt fairly equally between endoscopic and open surgical approaches. Patients’ sequence of operations and reinterventions over time are outlined, offering insight to improve surgical counseling and allow for informative, autonomous patient decision making. Study Design Retrospective cohort study. Setting Tertiary care academic center. Methods Cases of consecutive adults with idiopathic subglottic stenosis managed surgically over a 12-year period (January 2006–December 2017) were retrospectively reviewed. Surgical workflow, complications, and outcomes, including reinterventions and tracheotomy dependence, are reported. Results Seventy-two patients (71 women; mean age, 50.4 years) with idiopathic subglottic stenosis requiring surgical airway intervention were identified. Six patients underwent tracheotomy prior to attempt at airway stenosis surgery. Initial surgical approach thereafter included endoscopic (73.5%, n = 53) and open (26.4%, n = 19) procedures. Thirty-one patients underwent cricotracheal resection; the reintervention rate was 22.5%. Sixty patients underwent 147 endoscopic procedures; the reintervention rate was 75.5%, and the mean time between dilations was 83 weeks (range, 5-402). Two (2.8%) patients remain tracheotomy dependent. Adverse events were significantly higher in the cricotracheal group, especially with respect to dysphonia and temporary gastrostomy tube placement ( P < .01). Conclusions Endoscopic and open surgical airway intervention can be employed successfully to avoid tracheotomy dependence and maintain airway patency; however, multiple procedures are usually required, regardless of surgical approach. Cricotracheal reintervention rates are lower than endoscopic dilation but with increased morbidity. Quality-of-life outcomes should be clearly discussed with patients before deciding on a surgical management strategy.

Monitoring Adult Subglottic Stenosis With Spirometry and Dyspnea Index: A Novel Approach

“…Endoscopic procedures, such as dilatation or serial steroid injections under local anesthesia, are considered to be less invasive treatment modalities than open surgery, which maintain a patent airway without the need for tracheostomy but have a higher risk of relapse and recurring surgical treatment. 4 , 8 - 11 …”

“…Endoscopic procedures, such as dilatation or serial steroid injections under local anesthesia, are considered to be less invasive treatment modalities than open surgery, which maintain a patent airway without the need for tracheostomy but have a higher risk of relapse and recurring surgical treatment. 4,[8][9][10][11] Spirometry could simplify decision making about the timing of intervention during follow-up of adults with subglottic stenosis. The association of several spirometry values with laryngotracheal stenosis have been studied in recent decades, yet no consensus has been reached about the exact role of pulmonary function tests (PFTs) in preoperative evaluation and postoperative outcome monitoring.…”

“…The anatomic classification commonly used was first described by Myer et al 7 and is based on the cross‐sectional area of the stenotic part of the airway: grade I, up to 50% obstruction; grade II, from 51% to 70%; grade III, >70% to any detectable lumen; and grade IV, when there is a completely obliterated airway. Endoscopic procedures, such as dilatation or serial steroid injections under local anesthesia, are considered to be less invasive treatment modalities than open surgery, which maintain a patent airway without the need for tracheostomy but have a higher risk of relapse and recurring surgical treatment 4,8‐11 …”

Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era

“…Laryngotracheal stenosis, which involves progressive airway fibrosis and narrowing, confers significant morbidity 16,105 . The resulting obstruction often necessitates intervention, 106‐110 with variable long‐term outcomes 111,112 . Intravenous corticosteroids have known efficacy in the treatment of acute airway edema and in prevention of postextubation laryngeal edema 11,113,114 .…”

“…16,105 The resulting obstruction often necessitates intervention, [106][107][108][109][110] with variable long-term outcomes. 111,112 Intravenous corticosteroids have known efficacy in the treatment of acute airway edema and in prevention of postextubation laryngeal edema. 11,113,114 However, prolonged use of SCSs for laryngotracheal stenosis is seldom indicated.…”