Office‐based corticosteroid injections as adjuvant therapy for subglottic stenosis

Abstract

Objective Subglottic stenosis (SGS) is a serious, potentially life‐threatening disorder that is difficult to treat due to significant recurrence rates. While conventional treatment of SGS relies heavily on serial endoscopic dilation procedures, this study aims to characterize the efficacy of incorporating subglottic corticosteroid injections in increasing surgery‐free intervals (SFIs) for a cohort of patients at a university‐based medical system. Study Design Retrospective chart review. Methods All SGS patients who underwent endoscopic dilation and at least one adjuvant office‐based serial intralesional steroid injection (SILSI) were reviewed. Patients were excluded if they had synchronous airway lesions or stenosis outside of the subglottis. Charts were reviewed for demographic and treatment‐specific data. The SFI was calculated for patients both prior to the initiation of SILSI and after. Groups were compared via Mann–Whitney U test, with P < .05 as the threshold for significance. Results Thirteen patients met criteria, with mean age 50.1 ± 14.1 years and 7:6 female to male ratio. Eight of the thirteen (61.5%) had intubation‐related stenosis, while 4/13 were idiopathic and 1/13 was due to Wegener's granulomatosis. Mean follow‐up was 20.4 months. Patients underwent an average of 4.2 ± 2.2 postoperative injections, beginning 45.9 ± 19.0 days after surgery. The mean SFI prior to initiating SILSI was 288.6 ± 362.0 days; while after receiving SILSI, the mean interval was significantly longer (545.5 ± 152.7 days, P = .0041). Conclusions We demonstrate that office‐based corticosteroid injection for SGS was associated with a statistically significant improvement in the SFI and is a promising adjuvant approach. Future prospective studies should evaluate if the efficacy is reproducible on a large scale and if SILSI can and/or should be incorporated into the standard management paradigm for SGS treatment. Level of Evidence 4

An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

“…1). Pan and Rosow examined a retrospective cohort of SGS patients of various etiologies who underwent a mean of 4.2 injections following ED and demonstrated a significantly increased SFI following SILSI [85]. A study of 24 SGS patients of various etiologies who underwent a mean of 4.08 injections (88% had undergone ED prior to SILSI) showed that 71% of patients did not require further surgery after SILSI.…”

Differing Progression to Posterior Glottic Stenosis in Autoimmune and Idiopathic Subglottic Stenosis

“…[4][5][6][7] Treatment modalities have evolved over time from open surgical procedures to endoscopic dilations, laser surgery, and adjuvant intralesional steroid injections. [8][9][10][11][12] Generally, treatments are tailored to severity and recurrence of a patient's breathing, and possibly voice, dysfunction.…”

Serial Intralesional Steroid Injection for Subglottic Stenosis: Systemic Side Effects and Impact on Surgery‐Free Interval

“…Small retrospective studies have shown up to an 8- to 12-month increase in surgery-free interval (SFI). 12 , 13 This coincides with stable or even improved airway patency with SILSIs. 14 , 15 Patients indicate less dyspnea, decreased vocal handicap, and improved voice-related quality of life.…”

“…While there are several reports in the literature describing outcomes with SILSIs, extant literature is lacking regarding clinically identified systemic side effects. [12][13][14][15][16][17][18][19] Hoffman et al noted a similar rate of adverse effects (31%) but a different set of side effects incident to the injection procedure itself, including transient airway restriction, cough, nasal pain, and a single instance of possible hypercortisolism (weight gain, headaches, insomnia, restlessness). 16 Multiple patients in the present study indicated discomfort with injection or a vasovagal response, but these were not included in our analysis.…”

“…This study revealed a 32% incidence of systemic side effects in the medical record after SILSIs. While there are several reports in the literature describing outcomes with SILSIs, extant literature is lacking regarding clinically identified systemic side effects 12–19 . Hoffman et al noted a similar rate of adverse effects (31%) but a different set of side effects incident to the injection procedure itself, including transient airway restriction, cough, nasal pain, and a single instance of possible hypercortisolism (weight gain, headaches, insomnia, restlessness) 16 .…”