The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology

Abstract

Objective:To determine the long-term efficacy of submucosal corticosteroid injection plus dilatation for subglottic stenosis as a single modality treatment in granulomatosis with polyangiitis and relapsing polychondritis, as compared with idiopathic subglottic stenosis and traumatic subglottic stenosis.Method:Patients who underwent dilatation for autoimmune causes were identified. Corticosteroid injection into the submucosa of a stenotic segment was followed by serial dilatation. Definitive improvement was defined as good airway patency for more than 24 months with no further procedures needed. Clinical, demographic and procedural data were recorded.Results:Patients (n = 45) were divided into three subglottic stenosis groups: traumatic (n = 24), idiopathic (n = 9) and autoimmune (n = 12). Patients were treated with dilatations, with a median follow-up time of 76 months. Six patients were tracheostomy-dependent. There were no statistical differences in the number of final improvements between autoimmune, idiopathic and traumatic groups, with values of 75, 56 and 71 per cent, respectively. There was no statistical difference between granulomatosis with polyangiitis plus relapsing polychondritis and idiopathic subglottic stenosis in terms of decannulation rates.Conclusion:Granulomatosis with polyangiitis and relapsing polychondritis patients have better improvement rates than patients with other subglottic stenosis types.

Office‐based corticosteroid injections as adjuvant therapy for subglottic stenosis

“…Overall, 75% (3/4) of our idiopathic SGS patient were female compared to 50% (4/8) female in our intubation SGS group and a single male with Wegener's granulomatosis etiology, demonstrating a female predilection within the idiopathic cohort. The most common presenting symptom among SGS patients was dyspnea (100%), as described in prior studies …”

“…Investigation of corticosteroid injections in an office‐based setting is a growing topic of interest in SGS research, as it is well tolerated and provides presumed cost‐effective advantages of nonsedation techniques, shorter procedure times, and reduced need for operative intervention with no cited adverse effects . Given the body of literature demonstrating the efficacy of intralesional corticosteroid injections in the operating room setting, the ability to provide these same injections in an office setting can revolutionize the way in which we approach clinical management of SGS.…”

“…Subglottic stenosis (SGS) is a rare, but potentially life‐threatening disorder that is characterized by the narrowing of the airway below the vocal folds, causing dyspnea with potentially devastating consequences for patients. Other common symptomatic manifestations can include dysphonia, stridor, coughing, and fatigue . SGS can be idiopathic in nature or result from iatrogenic causes, including prolonged intubation, tracheostomy, or other tracheal surgeries, autoimmune disorders such as Wegener's granulomatosis, prior caustic exposure, trauma, or neoplasm .…”

“…Because SGS is a fibroinflammatory disease, the injection of corticosteroids into the sites of stenosis or scarring targets the pathophysiologic mediators of disease progression and serves as a theoretically sound approach in management. Intralesional corticosteroid injections under general anesthesia at the time of endoscopic dilation have been long been suggested to benefit SGS patients, but this newly trending concept of serial in‐office delivery of injections is noteworthy to explore because it can significantly reduce the surgical burden on SGS patients and revolutionize standard of care . As both aforementioned studies solely examined efficacy in patients with idiopathic SGS, there is a gap in current knowledge about how this approach could benefit patients with other etiologies of SGS.…”

Serial In-Office Intralesional Steroid Injections in Airway Stenosis

“…Since then, other studies have suggested that ISI at the time of dilation in the operating room may prolong the effects of dilation in patients with GPA-related SGS/PTS. [15][16][17] More recently, the concept that serial ISI may be more effective than a single ISI in the operating room was adopted from the treatment of keloids and hypertrophic scars. 18 Serial inoffice ISI in airway stenosis were first described by Franco et al 19 and have been shown to be effective as a sole treatment strategy or as an adjunct to surgery in patients with iSGS.…”