Voice Outcomes After Endoscopic Treatment of Laryngotracheal Stenosis

Hatcher, Jeanne L.; Dao, Ashley M.; Simpson, C. Blake

doi:10.1177/0003489414551980

Cited by 17 publications

(15 citation statements)

References 29 publications

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“…Additionally, patient‐reported voice‐related quality of life improved postdilation in patients with SGS versus other stenoses of the airway. Similar findings were observed by Hatcher et al Unfortunately, dilation procedures are not long‐lasting; many patients have to return within 1 to 2 years for repeated procedures. In some cases, multiple dilations result in a lengthier period of airway patency, but this result varies.…”

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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Section: Discussionmentioning

confidence: 99%

Effects of voice‐sparing cricotracheal resection on phonation in women

et al. 2016

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“…4–13 A few studies 4–6 have retrospectively demonstrated improved voice QOL after endoscopic balloon dilation in patients with LTS. None of the published studies evaluating voice outcomes in LTS have been prospective.…”

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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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“…Of note, no statistically significant difference was observed for FEV 1 /FVC, which is primarily utilized in the evaluation of lower as opposed to upper airway obstruction 23 . Patient reported outcomes, as measured by V‐RQOL, 24 VHI‐10, 25 CCQ, 26 have also been studied in the setting of endoscopic treatment for laryngotracheal stenosis. Using these measures, our iSGS cohort also shows significant postoperative improvement.…”

Section: Discussionmentioning

confidence: 99%

Laryngotracheal Mucosal Surface Expression of Candidate Biomarkers in Idiopathic Subglottic Stenosis

et al. 2020

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Objectives Idiopathic subglottic stenosis (iSGS) is an inflammatory process leading to fibrosis and narrowing of the laryngotracheal airway. There is variability in patient response to surgical intervention, but the mechanisms underlying this variability are unknown. In this pilot study, we measure expression of candidate targets at the mucosal surface of the subglottis in iSGS patients. We aim to identify putative biomarkers for iSGS that provide insights into the molecular basis of disease progression, yield a gene signature for the disease, and/or predict a response to therapy. Study Design In vitro comparative study of human cells. Methods Levels of candidate transcripts and proteins were measured in healthy and stenotic laryngotracheal tissue specimens taken from the mucosal surface in 16 iSGS patients undergoing endoscopic balloon dilation. Pre‐ and post‐operative pulmonary function test and patient reported voice and breathing outcomes were also assessed. Unsupervised clustering was used to define patient subgroups based on expression profile. Results Pulmonary function and voice and breathing outcome metrics demonstrated significant post‐operative improvement. Transcript levels of αSMA, CCL2, COL1A1, COL3A1, FN1, IFNG, and TGFB1 and protein levels of CCL2, IFNG, and IL‐6 were significantly upregulated in stenotic as compared to healthy tissues. Marked heterogeneity was observed in the patterns of expression of candidate markers across individuals and tissue types. Patient subgroups defined by expression profile did not show a statistically significant difference in dilation interval. Conclusion Pro‐inflammatory and pro‐fibrotic pathways are significantly upregulated along the mucosal surface of stenotic laryngotracheal tissues, and CCL2 and IFNG merit further investigation as potential iSGS biomarkers. Level of Evidence 4 Laryngoscope, 131:342–349, 2021

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Voice Outcomes After Endoscopic Treatment of Laryngotracheal Stenosis

Abstract: Following endoscopic management of stenosis, those with PGS have poorer voice outcomes compared to those with SGS/TS. The majority of those with SGS/TS are not dysphonic. Vocal outcomes are greatest for those with stenosis beginning at least 2 cm distal to the vocal folds.

Cited by 17 publications

References 29 publications

Effects of voice‐sparing cricotracheal resection on phonation in women

Effects of voice‐sparing cricotracheal resection on phonation in women

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

Laryngotracheal Mucosal Surface Expression of Candidate Biomarkers in Idiopathic Subglottic Stenosis

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