Outcome of a Multimodality Approach to the Management of Idiopathic Subglottic Stenosis

Laryngoscope. 2013 Oct;123(10):2474-84. doi: 10.1002/lary.23949. Epub 2013 Aug 5.

Abstract

Objectives/hypothesis: To assess the results of treating idiopathic subglottic stenosis (ISS), determine predictors of treatment success and outcome, and better define roles and limitations of endoscopic and open surgery.

Study design: Prospective observational study.

Methods: Fifty-four consecutive patients were treated between 2004 and 2012. Patient, stenosis and treatment details, complications, open surgery rates, and outcomes were recorded. Regression analyses were used to identify predictors of endoscopic treatment success; treatment frequency; and functional outcomes in airway, dyspnea, voice, and swallowing domains.

Results: All patients were female and mean age at diagnosis was 48 ± 12 years. Symptoms-to-diagnosis latency was 21 ± 20 months. There were 10 concomitant glottic and subglottic stenoses. Most lesions were Myer-Cotton grade 3 (48%). Overall, 78% of patients were managed endoscopically. Treatment included intralesional corticosteroids, laser surgery, balloon dilation, and temporary silastic stenting in selected cases. Annual intervention rate was 1.07 ± 0.79. Mean follow-up was 45 months. Factors associated with intervention frequency were stenosis location and severity. Twelve patients underwent anteroposterior laryngotracheal reconstruction with biological inhibition. This resulted in disease remission in all patients with subglottic stenosis, and in most patients with concomitant glottic and subglottic stenosis. Patients with total laryngotracheal stenosis required ongoing treatment for glottic disease. All patients maintained prosthesis-free airways, but in one patient this required a laryngectomy. Most patients achieved good functional outcomes. Stenosis location was the only independent predictor of dyspnea and voice outcomes.

Conclusions: ISS can be effectively treated with endoscopic surgery or a bespoke open reconstructive procedure that does not compromise on female voice quality.

Level of evidence: 4.

Keywords: Idiopathic subglottic stenosis; intralesional corticosteroids; laryngotracheal stenosis; skin graft.

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Combined Modality Therapy
  • Endoscopy
  • Female
  • Humans
  • Injections, Intralesional
  • Laryngostenosis
  • Middle Aged
  • Prospective Studies
  • Reconstructive Surgical Procedures
  • Tracheal Stenosis / surgery
  • Tracheal Stenosis / therapy*
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones

Supplementary concepts

  • Idiopathic subglottic tracheal stenosis