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Xie KZ, Bowen AJ, O'Byrne TJ, Wallerius KP, Awadallah AS, Aden AA, Bayan SL, Edell ES, Vassallo R, Kasperbauer JL, Ekbom DC. Symptom-Free Intervals Following Laser Wedge Excision for Recurrent Idiopathic Subglottic Stenosis. Otolaryngol Head Neck Surg 2024. [PMID: 38822766 DOI: 10.1002/ohn.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/08/2024] [Accepted: 04/27/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Analyze the duration of symptom-free intervals following laser wedge excision (LWE) for recurrent idiopathic subglottic stenosis (iSGS). Secondary aim includes evaluating the influence of patient-related or disease factors. STUDY DESIGN Retrospective review. SETTING Tertiary center. METHODS Review of iSGS patients who underwent LWE between 2002 and 2021. LWE patients without prior airway surgery were labeled LWE primary (LWEP) and those with prior history of dilation were labeled LWE secondary (LWES). A conditional frailty repeated events model was used to analyze the median time to recurrence (MTR) for each nth recurrence. Secondary analysis included stratification by use of medical therapy and initial preoperative characteristics of scar (Myer-Cotton grade, distance between the glottis and superior-most aspect of scar, DGS; length of scar, DL). RESULTS Two hundred and ten iSGS patients underwent LWE (131 LWEP, 79 LWES). The proportion of patients experiencing at least 1, 3, 6, and 12 recurrences, respectively, was 68.0% (n = 143), 40.7% (n = 85), 20.0% (n = 42), and 5.2% (n = 11). There was exponential time-shortening from the 1st to 12th recurrence (P < .0001). While MTR was 4.1 years after the first LWE, this fell to 2.8, 1.7, 1.0, and 0.7 years for the 2nd, 3rd, 6th, and 12th recurrences. Furthermore, LWEP patients experienced longer MTR than LWES counterparts within the first 6 recurrences (P < .01). There was no significant relationship between intersurgical interval and medication adherence, DL, DGS, or grade for recurrences beyond the first (P = .207, P = .20, P = .43, P = .16). CONCLUSION Symptom-free intervals in iSGS shorten with each subsequent recurrence and LWE. The difference in MTR between LWEP and LWES groups was significant within the first 6 recurrences with LWEP having longer MTR. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Katherine Z Xie
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Andrew J Bowen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine P Wallerius
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aisha A Aden
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Evermann M, Roesner I, Denk-Linnert DM, Klepetko W, Schweiger T, Hoetzenecker K. In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery. Eur J Cardiothorac Surg 2024; 65:ezae171. [PMID: 38637945 PMCID: PMC11078893 DOI: 10.1093/ejcts/ezae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/01/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Surgical treatment for airway stenosis necessitates personalized techniques based on the stenosis location and length, leading to favourable surgical outcomes. However, there is limited literature on functional outcomes following laryngotracheal surgery with an adequate number of patients. METHODS We conducted a retrospective analysis of patients who underwent laryngotracheal surgery at the Department of Thoracic Surgery, Medical University of Vienna, from January 2017 to June 2021. The study included standardized functional assessments before and after surgery, encompassing spirometry, voice measurements, swallowing evaluation and subjective patient perception. RESULTS The study comprised 45 patients with an average age of 51.9 ± 15.9 years, of whom 89% were female, with idiopathic being the most common aetiology (67%). Procedures included standard cricotracheal resection in 11%, cricotracheal resection with dorsal mucosal flap in 49%, cricotracheal resection with dorsal mucosal flap and lateral cricoplasty in 24% and single-stage laryngotracheal reconstruction in 16%. There were no in-hospital mortalities or restenosis cases during the mean follow-up period of 20.8 ± 13.2 months. Swallowing function remained intact in all patients. Voice evaluations showed a decrease in fundamental vocal pitch [203 (81-290) Hz vs 150 (73-364) Hz, P < 0.001] and dynamic voice range (23.5 ± 5.8 semitones vs 17.8 ± 6.7 semitones, P < 0.001). However, no differences in voice volume were observed (60.0 ± 4.1 dB vs 60.2 ± 4.8 dB, P = 0.788). The overall predicted voice profile changed from R0B0H0 to R1B0H1. CONCLUSIONS Laryngotracheal surgery proves effective in fully restoring breathing capacity while preserving vocal function. Even in cases of high-grade and complex airway stenosis necessitating laryngotracheal reconstruction, favourable functional outcomes can be achieved.
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Affiliation(s)
- Matthias Evermann
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Imme Roesner
- Division of Phoniatrics and Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Division of Phoniatrics and Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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3
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Sittel C, Koitschev A, Schön C, Reiter K. Reconstructive Surgery of the Laryngotracheal Junction. Laryngorhinootologie 2024; 103:S148-S166. [PMID: 38697146 DOI: 10.1055/a-2181-9576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The laryngotracheal junction is an anatomical region with special pathophysiological features. This review presents clinical pictures and malformations that manifest pre-dilectively at this localisation in children and adolescents as well as in adults. The diagnostic procedure is discussed. The possibilities of surgical reconstruction are presented depending on the pathology and age of the patient.
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Affiliation(s)
- Christian Sittel
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Standort Katharinenhospital, Haus D, Allgemeine HNO-Heilkunde, Standort Olgahospital: Pädiatrische HNO-Heilkunde, Otologie
| | - Assen Koitschev
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Standort Katharinenhospital, Haus D, Allgemeine HNO-Heilkunde, Standort Olgahospital: Pädiatrische HNO-Heilkunde, Otologie
| | - Carola Schön
- Kinderklinik der Universität München am Dr. Haunerschen Kinderspital, Klinikum der Universität München, Campus Innenstadt
| | - Karl Reiter
- Kinderklinik der Universität München am Dr. Haunerschen Kinderspital, Klinikum der Universität München, Campus Innenstadt
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Trabalza Marinucci B, Fiorelli S, Siciliani A, Menna C, Tiracorrendo M, Massullo D, Venuta F, Rendina EA, Ciccone AM, D’Andrilli A, Ibrahim M, Maurizi G. New Insight into Laryngo-Tracheal Surgery: High-Flow Oxygen Therapy to Prevent Early Complications after Surgery. J Pers Med 2024; 14:456. [PMID: 38793037 PMCID: PMC11122413 DOI: 10.3390/jpm14050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Early post-operative airway management after laryngo-tracheal surgery is crucial. Acute respiratory failure due to glottis' edema may occur, requiring reintubation. This can prolong ventilatory assistance, jeopardizing anastomosis. To date, only judicious steroid administration and fluid management are available to avoid more invasive procedures. High-flow oxygen therapy (HFOT) is a noninvasive O2 support method providing humidification, warmed air, and Positive End-Expiratory Pressure (AIRVO2). No data about HFOT use to prevent early complications after laryngo-tracheal surgery are reported in the literature. METHODS Between September 2020 and September 2022, 107 consecutive patients who underwent laryngo-tracheal surgery received HFOT (Group A). Data and long-term results were compared with those of 80 patients operated between September 2018 and August 2020 (Group B), when HFOT was not available. All patients were operated in a single center. No pre- or post-operative settings changed, except for HFOT introduction. We analyzed and compared the risk for "delayed" reintubation (unexpected reintubation within the first 24-48 h after extubating/laryngeal mask removal) in the two groups. RESULTS No patients reported HFOT-related adverse events. The control group (B) presented "delayed" reintubation in 37% (p = 0.027), intensive care unit admission in 67% (p = 0.005) and longer hospital stay (p = 0.001) compared to the HFOT group (A). The minor complications' rate was 3% in both group and overall mortality was 0%. Re-stenosis was described in 4.6% of the HFOT group, without a statistically significant difference (p = 0.7006). CONCLUSIONS Our study is the first to investigate HFOT use in patients undergoing laryngo-tracheal surgery, potentially representing a consistent innovation in the peri-operative management of these patients. With the limitation of a retrospective series, we would suggest HFOT use for preventing post-operative reintubation rate, possibly reducing ICU admissions and hospital stays.
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Affiliation(s)
- Beatrice Trabalza Marinucci
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Silvia Fiorelli
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (S.F.); (D.M.)
| | - Alessandra Siciliani
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Cecilia Menna
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Matteo Tiracorrendo
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Domenico Massullo
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (S.F.); (D.M.)
| | - Federico Venuta
- Thoracic Surgery Policlinico Umberto I, La Sapienza University, 00186 Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Anna Maria Ciccone
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Antonio D’Andrilli
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Mohsen Ibrahim
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Giulio Maurizi
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
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5
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Zhang Y, Dai Z, Xia Q, Wu Y, TingxiaoZhao, Chen Q, Xia C, Zhang J, Xu J. Bibliometric and visualized analysis of scientific publications on subglottic stenosis based on web of science core collection. J Cardiothorac Surg 2024; 19:55. [PMID: 38311728 PMCID: PMC10840188 DOI: 10.1186/s13019-024-02515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Subglottic Stenosis (SGS), with increasing numbers of studies, is the most specific and common clinical type of Laryngotracheal Stenosis (LTS). There is rapid publication turnover with newer management introduced and expanding research field. To our knowledge, there is no bibliometric analysis of SGS yet. METHODS In August 2022, we performed a thorough search in the Web of Science Core Collection database using the word "subglottic stenosis," and "SGS." The 580 articles were arranged based on correlation. The collected articles were then analyzed with an assessment of relevant factors. Meanwhile, we analyzed the top 100 most-cited articles on SGS. RESULTS The frequency of publication on SGS has increased substantially over time. The USA has contributed the most articles (n = 301). Vanderbilt University published most of the articles among other institutions (n = 18). Laryngoscope topped the list of journals and has published 89 SGS-related articles. Research hotspots shift from surgical treatment to conservative management. CONCLUSIONS The SGS-related literature has grown rapidly in recent years. This study represents the first bibliometric analysis of scientific articles on SGS. Areas to improve in SGS research can be identified after this analysis of the most impactful articles on this topic.
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Affiliation(s)
- Yaping Zhang
- Center for General Practice Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Zhanqiu Dai
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qixin Xia
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yufeng Wu
- Hangzhou Medical College, Hangzhou, People's Republic of China
| | - TingxiaoZhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Qi Chen
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Chen Xia
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, China.
| | - Jiongnan Xu
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
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Ratwani AP, Lentz RJ, Chen H, Schwartz E, Roller L, Shojaee S, Shepherd W, Noor Ul Husnain SM, Senitko M, Guo Y, Cumbo-Nacheli G, Raziq FI, Sachdeva A, Holden V, Gharaibeh K, Benn BS, Ferguson JS, Rickman OB, Yarmus L, Maldonado F. Spray Cryotherapy for Benign Large Airway Stenosis: A Multicenter Retrospective Cohort Study of Safety and Practice Patterns. J Bronchology Interv Pulmonol 2024; 31:63-69. [PMID: 37246305 DOI: 10.1097/lbr.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/17/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Benign airway stenosis (BAS) represents a significant burden on patients, providers, and healthcare systems. Spray cryotherapy (SCT) has been proposed as an adjunctive treatment to reduce BAS recurrence. We sought to examine safety and practice variations of the latest SCT system when used for BAS. METHODS We conducted a retrospective multicenter cohort study in seven academic institutions within the Interventional Pulmonary Outcomes Group. All patients who underwent at least one SCT session with a diagnosis of BAS at the time of procedure at these institutions were included. Demographics, procedure characteristics, and adverse events were captured through each center's procedural database and electronic health record. RESULTS A total of 102 patients underwent 165 procedures involving SCT from 2013 to 2022. The most frequent etiology of BAS was iatrogenic (n = 36, 35%). In most cases, SCT was used prior to other standard BAS interventions (n = 125; 75%). The most frequent SCT actuation time per cycle was five seconds. Pneumothorax complicated four procedures, requiring tube thoracostomy in two. Significant post-SCT hypoxemia was noted in one case, with recovery by case conclusion and no long-term effects. There were no instances of air embolism, hemodynamic compromise, or procedural or in-hospital mortality. CONCLUSION SCT as an adjunctive treatment for BAS was associated with a low rate of complications in this retrospective multicenter cohort study. SCT-related procedural aspects varied widely in examined cases, including actuation duration, number of actuations, and timing of actuations relative to other interventions.
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Affiliation(s)
- Ankush P Ratwani
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center
| | - Robert J Lentz
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Evan Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
| | - Lance Roller
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center
| | - Samira Shojaee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center
| | - Wes Shepherd
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Shaikh M Noor Ul Husnain
- Interventional Pulmonary Section, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Michal Senitko
- Section of Interventional Pulmonology Department of Medicine and Surgery University of Mississippi Medical Center Jackson, MS
| | - Yanglin Guo
- Spectrum Health, Michigan State University School of Human Medicine, Grand Rapids, MI
| | - Gustavo Cumbo-Nacheli
- Spectrum Health, Michigan State University School of Human Medicine, Grand Rapids, MI
| | - Fazal I Raziq
- Spectrum Health, Michigan State University School of Human Medicine, Grand Rapids, MI
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Van Holden
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kamel Gharaibeh
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bryan S Benn
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - J Scott Ferguson
- Interventional Pulmonology, School of Medicine and Public Health and the Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI
| | - Otis B Rickman
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center
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Gosman RE, Sicard RM, Cohen SM, Frank-Ito DO. Comparison of Inhaled Drug Delivery in Patients With One- and Two-level Laryngotracheal Stenosis. Laryngoscope 2023; 133:366-374. [PMID: 35608335 PMCID: PMC10332660 DOI: 10.1002/lary.30212] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/08/2022] [Accepted: 05/03/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS Laryngotracheal stenosis (LTS) is a functionally devastating condition with high respiratory morbidity and mortality. This preliminary study investigates airflow dynamics and stenotic drug delivery in patients with one- and two-level LTS. STUDY DESIGN A Computational Modeling Restropective Cohort Study. METHODS Computed tomography scans from seven LTS patients, five with one-level (three subglottic, two tracheal), and two with two-level (glottis + trachea, glottis + subglottis) were used to reconstruct patient-specific three-dimensional upper airway models. Airflow and orally inhaled drug particle transport were simulated using computational fluid dynamics modeling. Drug particle transport was simulated for 1-20 μm particles released into the mouth at velocities of 0 m/s, 1 m/s, 3 m/s, and 10 m/s for metered dose inhaler (MDI) and 0 m/s for dry powder inhaler (DPI) simulations. Airflow resistance and stenotic drug deposition in the patients' airway models were compared. RESULTS Overall, there was increased airflow resistance at stenotic sites in subjects with two-level versus one-level stenosis (0.136 Pa s/ml vs. 0.069 Pa s/ml averages). Subjects with two-level stenosis had greater particle deposition at sites of stenosis compared to subjects with one-level stenosis (average deposition 2.31% vs. 0.96%). One-level stenosis subjects, as well as one two-level stenosis subject, had the greatest deposition using MDI with a spacer (0 m/s): 2.59% and 4.34%, respectively. The second two-level stenosis subject had the greatest deposition using DPI (3.45%). Maximum deposition across all stenotic subtypes except one-level tracheal stenosis was achieved with particle sizes of 6-10 μm. CONCLUSIONS Our results suggest that patients with two-level LTS may experience a more constricted laryngotracheal airflow profile compared to patients with one-level LTS, which may enhance overall stenotic drug deposition. LEVEL OF EVIDENCE NA Laryngoscope, 133:366-374, 2023.
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Affiliation(s)
- Raluca E Gosman
- Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, U.S.A
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Ryan M Sicard
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Seth M Cohen
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Dennis O Frank-Ito
- Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, U.S.A
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, U.S.A
- Computational Biology and Bioinformatics PhD Program, Duke University, Durham, North Carolina, U.S.A
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, U.S.A
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8
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Huang CY, Chang TS, Alice Hwang L, Lin YS. Novel airway-cartilage combined model for medialization laryngoplasty and laryngotracheal reconstruction surgery planning. J Chin Med Assoc 2022; 85:1076-1082. [PMID: 35947024 DOI: 10.1097/jcma.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The clinical outcomes of surgical treatments for vocal cord paralysis and tracheal stenosis, such as medialization laryngoplasty and laryngotracheal reconstruction, vary owing to the complex anatomy and physiology of the human upper airway. However, advances in three-dimensional (3D) simulation and printing ushered its use on an office-based workstation to aid in several surgical areas. METHODS The preoperation neck computed tomography image was loaded into the InVesalius 3.0 software for manual segmentation of airway and nearby important anatomic landmarks including hyoid bone, thyroid cartilage, and cricoid cartilage. The 3D model of the desired anatomy structure was manufactured and used for presurgical planning and rehearsal of the surgery. RESULTS We review cases of four patients: two cases of unilateral vocal palsy undergoing medialization laryngoplasty and two cases of tracheal stenosis patients who used the air-cartilage combined model. CONCLUSION Preoperation planning of the medialization thyroplasty could be more precise by prevision of the paralyzed vocal cord plane. Tracheal surgery could benefit from a preoperative design of segmented length. The novel airway-cartilage combined model offers new insight into vocal cord and trachea surgery.
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Affiliation(s)
- Chien-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- College of Artificial Intelligence, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Lisa Alice Hwang
- Department of Oral and Maxillofacial Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC
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Soumagne T, Guibert N, Atallah I, Lacasse Y, Dutau H, Fortin M. Dilation versus laser resection in subglottic stenosis: protocol for a prospective international multicentre randomised controlled trial (AERATE trial). BMJ Open 2022; 12:e053730. [PMID: 35301206 PMCID: PMC8932266 DOI: 10.1136/bmjopen-2021-053730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Subglottic stenosis (SGS) is a rare condition that results from progressive narrowing of the upper airways. Outcomes and treatment options depend on the benign or complex nature of the stenosis. Treatment options for SGS include surgery and endoscopic techniques. The main endoscopic techniques used are dilation and laser resection. Observational and retrospective studies suggest that endoscopic laser resection may be more effective than dilation. We, therefore, aimed to compare the effectiveness of dilation and laser resection in preventing recurrence of SGS. METHODS AND ANALYSIS AERATE (dilAtion vs laser Endoscopic Resection in subglottic trAcheal sTEnosis) is a multicentre, investigator-initiated, randomised controlled trial, comparing endoscopic dilation to endoscopic laser resection for simple benign SGS (less than 1 cm long without underlying cartilaginous damage) referred for endoscopic treatment (first treatment or recurrence). The study will be conducted in three centres in France and one in Canada with other centres from France and Canada expected to join. The primary outcome is the recurrence rate of stenosis at 2 years. Recurrence is defined as having a new onset of symptoms along with a stenosis of more than 40% (confirmed by bronchoscopy) requiring a new procedure. A sample size of 100 patients is calculated for the primary endpoint assuming a 10% recurrence rate in the laser resection group and 33% in the dilation group with a statistical significance level of 5%, a power of 80%. ETHICS AND DISSEMINATION This study is approved by local and national ethics committees as required. Results will be published, and trial data will be made available. TRIAL REGISTRATION NUMBER NCT04719845.
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Affiliation(s)
- Thibaud Soumagne
- Service de pneumologie, Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec City, Quebec, Canada
- Service de pneumologie et soins intensifs respiratoires, Hôpital Européen Georges Pompidou, Assistance publique Hôpitaux de Paris, Paris, France
| | - Nicolas Guibert
- Service de pneumologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Ihab Atallah
- Clinique universitaire d'ORL, CHU Grenoble Alpes, Grenoble, France
| | - Yves Lacasse
- Service de pneumologie, Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec City, Quebec, Canada
| | - Hervé Dutau
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Marc Fortin
- Service de pneumologie, Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec City, Quebec, Canada
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10
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An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management. CURRENT PULMONOLOGY REPORTS 2022; 11:29-38. [PMID: 35261874 PMCID: PMC8892813 DOI: 10.1007/s13665-022-00286-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/27/2022]
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11
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Kanzara T, Rotman A, Kinshuck A, Al Yaghchi C, Tan MY, Yu C, Sandu G. Endoscopic management of idiopathic subglottic stenosis in pregnancy. Obstet Med 2021; 14:225-229. [PMID: 34880935 DOI: 10.1177/1753495x21991407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/30/2020] [Indexed: 11/15/2022] Open
Abstract
Aims To describe the use of laser, endoscopic balloon dilatation with jet ventilation anaesthesia in the treatment of pregnant women with idiopathic subglottic stenosis. Materials and methods This is a case review of pregnant women with idiopathic subglottic stenosis, presenting to a tertiary referral centre with worsening breathlessness. Data were extracted from patient case notes. Results Four women underwent surgical management of subglottic stenosis in pregnancy. One patient required two procedures during the course of their pregnancy due to restenosis. All women had improvement in symptoms post-operatively and went on to deliver healthy babies at term. Conclusion Endoscopic balloon dilatation of idiopathic subglottic stenosis is a safe and viable treatment option in pregnancy and should be offered as first-line treatment in symptomatic women.
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Affiliation(s)
- Todd Kanzara
- ENT Department, Aintree University Hospital, Liverpool, UK
| | - Anthony Rotman
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | | | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Min Yi Tan
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Yu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
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12
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Clunie GM, Anderson C, Savage M, Hughes C, Roe JWG, Sandhu G, McGregor A, Alexander CM. "A Major Quality of Life Issue": A Survey-Based Analysis of the Experiences of Adults With Laryngotracheal Stenosis with Mucus and Cough. Ann Otol Rhinol Laryngol 2021; 131:962-970. [PMID: 34622693 PMCID: PMC9340141 DOI: 10.1177/00034894211050627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To investigate how the symptoms of mucus and cough impact adults living with laryngotracheal stenosis, and to use this information to guide future research and treatment plans. Methods: A survey was developed with the support of patient advisors and distributed to people suffering with laryngotracheal stenosis. The survey comprised 15 closed and open questions relating to mucus and cough and included the Leicester Cough Questionnaire (LCQ). Descriptive statistics, X2 and thematic analyses were completed. Results: In total, 641 participants completed the survey, with 83.62% (n = 536) reporting problems with mucus; 79% having daily issues of varying severity that led to difficulties with cough (46.18%) and breathing (20.90%). Mucus affected voice and swallowing to a lesser degree. Respondents described a range of triggers; they identified smoky air as the worst environmental trigger. Strategies to manage mucus varied widely with drinking water (72.26%), increasing liquid intake in general (49.35%) and avoiding or reducing dairy (45.32%) the most common approaches to control symptoms. The LCQ showed a median total score of 14 (interquartile range 11-17) indicative of cough negatively affecting quality of life. Thematic analysis of free text responses identified 4 key themes—the Mucus Cycle, Social impact, Psychological impact, and Physical impact. Conclusion: This study shows the relevance of research focusing on mucus and cough and its negative impact on quality of life, among adults with laryngotracheal stenosis. It demonstrates the inconsistent advice and management strategies provided by clinicians for this issue. Further research is required to identify clearer treatment options and pathways.
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Affiliation(s)
- Gemma M Clunie
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Justin W G Roe
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Gurpreet Sandhu
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | | | - Caroline M Alexander
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
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13
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Catano J, Uzunhan Y, Paule R, Dion J, Régent A, Legendre P, Gonin F, Martinod E, Cohen P, Puéchal X, Le Guern V, Mouthon L, Coste A, Lorut C, Lacroix C, Périé S, Terrier B. Presentation, Diagnosis, and Management of Subglottic and Tracheal Stenosis During Systemic Inflammatory Diseases. Chest 2021; 161:257-265. [PMID: 34324839 DOI: 10.1016/j.chest.2021.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Subglottic stenosis (SGS) and tracheal stenosis (TS) are characterized by a narrowing of the airways. The goal of this study was to describe the characteristics and prognosis of nontraumatic and nontumoral SGS or TS. RESEARCH QUESTION What are the inflammatory etiologies of SGS and TS, and what are their characteristics and prognosis? STUDY DESIGN AND METHODS This multicenter, observational retrospective study was performed in patients with SGS or TS that was neither traumatic nor tumoral. RESULTS Eighty-one patients were included, 33 (41%) with granulomatosis with polyangiitis (GPA) and 21 (26%) with relapsing polychondritis (RP). GPA-related stenoses exhibited circumferential subglottic narrowing in 85% of cases, without calcifications. In contrast, RP-related stenoses displayed anterior involvement in 76%, in a longer distance from vocal cords (4 cm), with calcifications in 62%, and extension to bronchi in 86%. Other diagnoses included bullous dermatoses (n = 3), amyloidosis (n = 3), sarcoidosis (n = 2), and Crohn's disease (n = 2); the remaining stenoses (n = 15) were idiopathic. SGS/TS was the initial manifestation of the disease in 66% of cases, with a median interval from stenosis to disease diagnosis of 12 months (interquartile range, 0-48 months). Despite the use of glucocorticoids in 80%, combined with methotrexate in 49%, endoscopic procedures were required in 68% of patients. Relapses of stenoses occurred in 76% without any difference between causes (82% in GPA, 67% in RP, and 75% in idiopathic SGS/TS). Three patients died due to the stenosis, two of RP and one of GPA. INTERPRETATION These data show that GPA and RP are the two main inflammatory diseases presenting with SGS/TS. GPA-related stenoses are mostly subglottic and circumferential, whereas RP-related stenoses are mostly tracheal, anterior, and calcified with a frequent extension to bronchi. Relapses of stenoses are common, and relapse rates do not differ between causes. Diagnosis and management of SGS/TS require a multidisciplinary approach.
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Affiliation(s)
- Jennifer Catano
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Yurdagul Uzunhan
- Department of Pneumology, Reference Center for Rare Pulmonary Diseases, Hôpital Avicenne, AP-HP, INSERM U1272, Université Paris Nord, Bobigny, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Jérémie Dion
- Department of Clinical Immunology, Oncopôle, Toulouse, France
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Paul Legendre
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - François Gonin
- Department of Thoracic Surgery, Hôpital Foch, Suresnes, France
| | - Emmanuel Martinod
- Department of Thoracic Surgery, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - André Coste
- Department of Otolaryngology, Hôpital Intercommunal, Créteil, France
| | | | | | - Sophie Périé
- Department of Otolaryngology (S. Périé), Clinique Hartmann, Neuilly-Sur-Seine, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France.
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14
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Ali Akbari Ghavimi S, Gehret PM, Aronson MR, Schipani R, Smith KW, Borek RC, Germiller JA, Jacobs IN, Zur KB, Gottardi R. Drug delivery to the pediatric upper airway. Adv Drug Deliv Rev 2021; 174:168-189. [PMID: 33845038 DOI: 10.1016/j.addr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Pediatric upper airway disorders are frequently life-threatening and require precise assessment and intervention. Targeting these pathologies remains a challenge for clinicians due to the high complexity of pediatric upper airway anatomy and numerous potential etiologies; the most common treatments include systemic delivery of high dose steroids and antibiotics or complex and invasive surgeries. Furthermore, the majority of innovative airway management technologies are only designed and tested for adults, limiting their widespread implementation in the pediatric population. Here, we provide a comprehensive review of the most recent challenges of managing common pediatric upper airway disorders, describe the limitations of current clinical treatments, and elaborate on how to circumvent those limitations via local controlled drug delivery. Furthermore, we propose future advancements in the field of drug-eluting technologies to improve pediatric upper airway management outcomes.
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15
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Treviño-Villarreal JH, Reynolds JS, Langston PK, Thompson A, Mitchell JR, Franco RA. Down-Regulation of a Profibrotic Transforming Growth Factor-β1/Cellular Communication Network Factor 2/Matrix Metalloprotease 9 Axis by Triamcinolone Improves Idiopathic Subglottic Stenosis. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1412-1430. [PMID: 34111429 DOI: 10.1016/j.ajpath.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
Idiopathic subglottic stenosis (iSGS) is a progressive fibrotic disease characterized by life-threatening airway narrowing. Although the molecular underpinnings are unknown, previous reports showing that subglottic serial intralesional steroid injections (SILSIs) improve clinical outcomes suggest a steroid-sensitive pathway in iSGS. Herein, a prospective study was conducted to determine the changes in profibrotic markers during SILSI to identify steroid-sensitive profibrotic drivers. Seven newly diagnosed patients with iSGS were recruited for SILSI. Subglottic biopsies before and after SILSI treatments were evaluated for histologic and molecular markers by confocal microscopy and RT-qPCR. At baseline, iSGS subglottises contained abundant vimentin-positive/α-smooth muscle actin-negative fibroblasts, intermingled with a matrix of fibronectin and types I and VI collagen. Transforming growth factor (TGF)-β1 was up-regulated primarily in glandular epithelium. Cellular communication network factor 2 (CCN2) was mainly up-regulated in stromal fibroblasts surrounding TGF-β1-positive glandular structures. SILSI improved iSGS by reducing fibroblast infiltration and increasing matrix remodeling. Mechanistically, SILSI counteracted the effects of TGF-β1 by inducing matrix metalloprotease 9 (MMP9) expression while repressing CCN2 expression, without affecting TGFβ1 levels. Treatment of primary iSGS-derived fibroblasts with TGF-β1 recapitulated aspects of the disease in vivo, demonstrating that the induction in CCN2 and repression of MMP9 are caused by changes in histone acetylation induced by TGF-β1. Triamcinolone counteracted the coregulation of these genes by impairing SMAD2/3 binding to promoter regions, and not through histone acetylation. In conclusion, this study shows that SILSI counteracts a dysregulated TGF-β1/CCN2/MMP9 axis involved in iSGS development.
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Affiliation(s)
| | - Justin S Reynolds
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - P Kent Langston
- Department of Immunology, Harvard Medical School and Evergrande Center for Immunologic Diseases, Harvard Medical School, Boston, Massachusetts
| | - Andrew Thompson
- Dana Farber Cancer Institute/Harvard Medical School Rodent Histopathology Core Facility, Harvard Medical School, Boston, Massachusetts
| | - James R Mitchell
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ramon A Franco
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Laryngology, Department of Otolaryngology, Mass Eye and Ear and Harvard Medical School, Boston, Massachusetts.
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16
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Slama A, Zaatar M, Demir M, Okumus O, Mattheis S, Kampe S, Darwiche K, Lang S, Aigner C. Tracheal Resection after Previous Treatment Provides Comparable Outcome to Primary Surgery. Thorac Cardiovasc Surg 2021; 70:505-512. [PMID: 34062598 DOI: 10.1055/s-0041-1728772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tracheal and laryngotracheal surgery provides both excellent functional results and long-term outcomes in the treatment of tracheal stenosis. Consequently, challenging re-resections are rarely necessary. The purpose of this study was to compare the outcome of (laryngo-)tracheal re-resection and surgery after bronchoscopic interventions with that of primary surgery. METHODS Patients undergoing resection for benign tracheal stenosis at our center between 1/2016 and 4/2020 were included. Perioperative characteristics and functional outcomes of patients were used for statistical analysis. RESULTS Sixty-six patients who underwent (laryngo-)tracheal resection were included (previous resection [A = 6], previous stent [B = 6], previous bronchoscopic intervention w/o stenting [C = 19], untreated [D = 35]). Baseline parameters were largely comparable between groups with exception from group B that had significantly worse lung function. Group A necessitated more complex reconstructions (end-to-end: n = 1: 17%| cricotracheal n = 2: 33%| cricotracheal with mucosectomy n = 2: 33%| laryngoplasty: n = 1: 17%) than patients in group D (end-to-end n = 21: 60%| cricotracheal n = 14: 40%). Postoperative outcomes were comparable throughout groups (intensive care unit: 1[1-18] days; hospital stay: 8[5-71] days). Anastomotic complications were higher after previous stenting (A: 0%; B: 33.3%; C: 10.5%; D: 2.9%; B/D p = 0.008| surgical revisions: A: 16.7%; B: 33.3%; C: 0%; D: 5.7%; B/D, p = 0.035). Overall, postoperative lung function was significantly better (forced expiratory volume in 1 second: 63% ± 24 vs. 75% ± 20; p = 0.001 | PeakEF 3.3 ± 1.9 vs. 5.0 ± 2.2L; p = 0.001). No 90-day mortality was observed in any group. Median follow-up was 12(1-47) months. CONCLUSION In carefully selected patients treated in a specialized center, tracheal or laryngotracheal resection after previous tracheal interventions provides comparable outcome to primary surgery.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Mohamed Zaatar
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Muhittin Demir
- Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
| | - Oezlem Okumus
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
| | - Sandra Kampe
- Department of Anesthesiology, Ruhrlandklinik, University Medicine Essen, Essen, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany
| | - Kaid Darwiche
- Division of Interventional Pneumology, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
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17
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Frank-Ito DO, Cohen SM. Orally Inhaled Drug Particle Transport in Computerized Models of Laryngotracheal Stenosis. Otolaryngol Head Neck Surg 2021; 164:829-840. [PMID: 33045904 PMCID: PMC8294408 DOI: 10.1177/0194599820959674] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Adjuvant management for laryngotracheal stenosis (LTS) may involve inhaled corticosteroids, but metered dose inhalers are designed for pulmonary drug delivery. Comprehensive analyses of drug particle deposition efficiency for orally inhaled corticosteroids in the stenosis of LTS subjects are lacking. STUDY DESIGN Descriptive research. SETTING Academic medical center. METHODS Anatomically realistic 3-dimensional reconstructions of the upper airway were created from computed tomography images of 4 LTS subjects-2 subglottic stenosis and 2 tracheal stenosis subjects. Computational fluid dynamics modeling was used to simulate airflow and drug particle transport in each airway. Three inhalation pressures were simulated, 10 Pa, 25 Pa, and 40 Pa. Drug particle transport was simulated for 100 to 950 nanoparticles and 1 to 50 micron-particles. Particles were released into the airway to mimic varying inhaler conditions with and without a spacer chamber. RESULTS Based on smallest to largest cross-sectional area ratio, the laryngotracheal stenotic segment shrunk by 57% and 47%, respectively, for subglottic stenosis models and by 53% for both tracheal stenosis models. Airflow resistance at the stenotic segment was lower in subglottic stenosis models than in tracheal stenosis models: 0.001 to 0.011 Pa.s/mL vs 0.024 to 0.082 Pa.s/mL. Drug depositions for micron-particles and nanoparticles at stenosis were 0.06% to 2.48% and 0.10% to 2.60% for subglottic stenosis and tracheal stenosis models, respectively. Particle sizes with highest stenotic deposition were 6 to 20 µm for subglottic stenosis models and 1 to 10 µm for tracheal stenosis models. CONCLUSION This study suggests that at most, 2.60% of inhaled drug particles deposit at the stenosis. Particle size ranges with highest stenotic deposition may not represent typical sizes emitted by inhalers.
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Affiliation(s)
- Dennis Onyeka Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Computational Biology & Bioinformatics PhD Program, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Seth Morris Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Effect of inhaled fluticasone propionate on laryngotracheal stenosis after balloon dilation: a randomized controlled trial. Eur Arch Otorhinolaryngol 2021; 278:1505-1513. [PMID: 33496811 PMCID: PMC7835446 DOI: 10.1007/s00405-021-06622-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Laryngotracheal stenosis describes various airflow compromising conditions leading to laryngeal and tracheal narrowing, including subglottic and tracheal stenosis. Direct laryngobronchoscopy is the diagnostic gold standard for laryngotracheal stenosis. This study aimed to explore the effect of inhaled fluticasone propionate as adjuvant medical therapy in patients with laryngotracheal stenosis after balloon dilation. METHODS This prospective randomized controlled trial was conducted from April 2019 to April 2020. Fourteen adults (≥ 18 years) with laryngotracheal stenosis consented to participate. All patients underwent endoscopic balloon dilation. Seven patients were treated with inhaled fluticasone propionate, and seven acted as controls. Detailed documentation of operative findings and pre- and post-balloon dilation spirometry measurements were recorded. Basic demographic data and operative details, including information about the percentage of laryngotracheal stenosis, distance of laryngotracheal stenosis from the vocal cords, the stenotic segment vertical length, and the largest endotracheal tube used before and after dilation were noted. RESULTS Spirometry measurements were obtained on 34 occasions (17 before and 17 after balloon dilation). The two groups were similar in spirometry values after treatment. Both groups had significantly improved on most spirometry values after balloon dilation. CONCLUSION We found that using inhaled steroids after balloon dilatation in patients with laryngotracheal stenosis had no benefit over non-user patients in spirometry parameters during the short postoperative follow-up. To confirm this outcome, we recommend a large-scale double-blind study with a longer follow-up period.
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Abstract
OBJECTIVE The incidence of recurrent stenosis after cricotracheal resection is 3-9.5 per cent. Management of such patients is challenging. This study aimed to review our experience in revision cricotracheal resection. METHODS The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, on nine patients with recurrent stenosis following cricotracheal resection. Revision cricotracheal resection was performed in all patients. Surgiflo was applied on the site of anastomosis to enhance healing. RESULTS No intra-operative complications were recorded. Minor post-operative complications occurred in two patients (surgical emphysema and temporary choking); no major complications were reported. Re-stenosis occurred in one patient. Successful decannulation was achieved in eight of the nine patients. CONCLUSION Revision cricotracheal resection is the definitive curative treatment for recurrent stenosis after previous unsuccessful resection. It has high success rates, provided that careful pre-operative assessment and meticulous operative technique are performed.
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20
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Clunie GM, Roe JWG, Alexander C, Sandhu G, McGregor A. Voice and Swallowing Outcomes Following Airway Reconstruction in Adults: A Systematic Review. Laryngoscope 2021; 131:146-157. [PMID: 31943240 PMCID: PMC7754401 DOI: 10.1002/lary.28494] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery. STUDY DESIGN Systematic review. METHODS Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. RESULTS A total of 143 abstracts were reviewed, with 67 articles selected for full-text review. Twenty studies met the inclusion criteria. Data extraction was completed with the Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous, and there was limited information provided about rationale or reliability. CONCLUSIONS The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there are no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement. Laryngoscope, 131:146-157, 2021.
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Masui T, Uemura H, Syugyo M, Kitahara T. Resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage for subglottic stenosis. BMJ Case Rep 2020; 13:13/12/e239203. [PMID: 33318283 PMCID: PMC7737046 DOI: 10.1136/bcr-2020-239203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Subglottic stenosis is a disease that causes dyspnoea by congenital or acquired stenosis of the cricoid cartilage and trachea. The cause of acquired subglottic stenosis varies. In this case, we present a case of idiopathic subglottic stenosis. Tracheotomies are performed in many cases, but they require long-term insertion of a tracheal cannula and make treatment difficult. In this case study, we performed a tracheoplasty by resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage and implemented a cannula-free observation protocol.
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Affiliation(s)
- Takashi Masui
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Hirokazu Uemura
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Masayuki Syugyo
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Tadashi Kitahara
- Otolaryngolgy-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
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Anderson C, Sandhu G, Al Yaghchi C. Impact of the COVID-19 Pandemic on Patients With Idiopathic Subglottic Stenosis. EAR, NOSE & THROAT JOURNAL 2020; 100:122S-130S. [PMID: 33302743 DOI: 10.1177/0145561320977467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine the number of patients with idiopathic subglottic stenosis (iSGS) who have contracted coronavirus disease 2019 (COVID-19), the impact of the pandemic on patients' attitudes on seeking help and attending hospitals, as well as the delays in the offer of treatment from the local health care systems. METHODS A 29-question survey was distributed to an international mailing list of patients with subglottic stenosis to assess the patient experience during the COVID-19 pandemic. RESULTS A total of 543 patients with iSGS participated. Fewer than 1 in 10 patients with iSGS have experienced COVID-19 symptoms, which were predominantly mild to moderate, with only 2 hospitalizations. Most patients with iSGS (80.0%) have not been advised they are high risk for COVID-19, despite 36.5% of patients with iSGS being obese (body mass index of 30+). Delays to surgeries and in-office procedures have impacted 40.1% of patients currently receiving treatment, with 38.8% of patients increasingly struggling to breathe as a result. Anxiety and stress are increasing among patients, with 3 in 4 (75.2%) reporting they are anxious about travelling by public transport, contracting the virus in hospital and infecting loved ones (69.0% and 71.9%, respectively). Of greater concern is that 23.1% with increasing dyspnea state they are staying away from hospital despite their deteriorating health. CONCLUSIONS The COVID-19 pandemic has had an impact on the physical and psychological health of patients with iSGS. Surgeons managing cases of laryngotracheal stenosis need to offer appropriate support and communication to these high risk patients. During the pandemic, this should include self-isolation if they are dyspneic or on treatments that may have reduced their immunity. In addition, they should offer safe clinical pathways to airway assessment and treatments, if they become necessary. To minimize unnecessary travel, much of the clinical monitoring can be carried out remotely, using telephone or video-based consultations, in conjunction with local health professionals.
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Affiliation(s)
- Catherine Anderson
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, 129367Charing Cross Hospital, London, United Kingdom
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, 129367Charing Cross Hospital, London, United Kingdom
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, 129367Charing Cross Hospital, London, United Kingdom
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Abstract
Cervical stenosis of the trachea caused by tracheotomy, tumor or induced by inflammatory disease can be treated by resection and anastomosis with good early and long-term results. Involvement of the ring cartilage makes the procedure technical demanding and increases the risk of morbidity. We describe our technique of laryngotracheal resection and reconstruction and compare the perioperative results with standard trachea resection. Between January 2005 and September 2018, we performed 92 standard cervical tracheal resections and 50 laryngotracheal resection including 6 procedures with widening of the ring cartilage. The resections were realized by direct anastomosis using dorsal flaps and/or interposition of rib cartilage in the posterior part of the ring cartilage. In one case intraoperative tracheotomy and intralaryngeal stenting was used. Patient records have been analyzed for perioperative data retrospectively. The main cause for stenosis or defect of the trachea and operation is preceding tracheotomy. Idiopathic stenosis, tumors and subglottic stenosis in Wegener disease are less common. Healing of the anastomosis was not disturbed in any patient. In two patients, bronchoscopic resection of granulation tissue was necessary. Tracheotomy in the course of treatment for intralaryngeal swelling or recurrent nerve palsy was necessary in 3 patients including one intraoperative tracheotomy for glottic stenting. Postoperative tracheostomy was closed in all patients within 3 months. Pulmonary complications and persistent recurrent nerve palsy occurred in 4 and 2 of the patients, respectively. Two patients died of pulmonary complications. The laryngotracheal resection is a relevant part of cervical tracheal surgery. It can be performed without significant elevated morbidity and is able to restore lung function and quality of voice.
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Affiliation(s)
- Erich Stoelben
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, Private University of Witten/Herdecke, Köln, Germany
| | - Armen Aleksanyan
- Lung Clinic, Hospital of Cologne, Chair of Thoracic Surgery, Private University of Witten/Herdecke, Köln, Germany
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Dwyer CD, Qiabi M, Fortin D, Inculet RI, Nichols AC, MacNeil SD, Malthaner R, Yoo J, Fung K. Idiopathic Subglottic Stenosis: An Institutional Review of Outcomes With a Multimodality Surgical Approach. Otolaryngol Head Neck Surg 2020; 164:1068-1076. [PMID: 33048608 DOI: 10.1177/0194599820966978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Christopher D Dwyer
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Mehdi Qiabi
- Division of Thoracic Surgery, Western University, London, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Western University, London, Canada
| | | | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western Univer-sity, London, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western Univer-sity, London, Canada
| | | | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western Univer-sity, London, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western Univer-sity, London, Canada
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McCrary H, Torrecillas V, Conley M, Anderson C, Smith M. Idiopathic Subglottic Stenosis during Pregnancy: A Support Group Survey. Ann Otol Rhinol Laryngol 2020; 130:188-194. [PMID: 32772565 DOI: 10.1177/0003489420947780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To determine how pregnancy affects idiopathic subglottic stenosis (iSGS) symptoms. (2) To determine treatments utilized (including operating room (OR) and in-office procedures) for iSGS before, during, and after pregnancy. METHODS A 24-question survey was distributed to an international iSGS support group to assess the patient experience among individuals who have been pregnant with diagnosis of iSGS. Descriptive statistics and chi2 analyses were completed. RESULTS A total of 413 iSGS patients participated; 84.7% (n = 350) of patients were diagnosed prior to menopause. A total of 25.5% patients reported being pregnant when they had airway stenosis; 71.1% of those reported more severe airway symptoms during pregnancy. The proportion of patients that reported requiring ≥1 OR interventions (microlaryngoscopy and bronchoscopy, laser, balloon dilation, or steroid injection) before, during and after pregnancy was the following, respectively: 37.3%, 35.6%, 51.3%. Whereas the proportion of patients that reported requiring ≥1 in-office interventions (awake balloon dilation or steroid injection) before, during and after pregnancy was the following, respectively: 13.6%, 11.8%, 15.8%. Number of pregnancies and age of diagnosis was not related to severity of symptoms or requiring more airway interventions (P > .05). CONCLUSIONS This survey reveals worsening of symptoms during pregnancy, however, this did not lead to increase in operative or clinic interventions to improve airway symptoms during pregnancy. Future avenues for research include optimizing management of airway symptoms during pregnancy to limit OR-based interventions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hilary McCrary
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vanessa Torrecillas
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew Conley
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Marshall Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Mizuno K, Kanazawa Y, Takeuchi M, Kishimoto Y, Kawakami K, Omori K. Indications and postoperative outcomes of surgery for laryngotracheal stenosis: A descriptive study. Auris Nasus Larynx 2020; 48:110-115. [PMID: 32682596 DOI: 10.1016/j.anl.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Tracheal reconstruction is a rare surgical procedure and the actual incidence of or indications for this procedure have not been thoroughly elucidated. We performed the nationwide database analysis to clarify the real-world situation of laryngotracheal surgery requiring cervical tracheal reconstruction. METHODS Patients who underwent surgical treatment for laryngotracheal stenosis or defect from 2008 to 2016 were identified from the Diagnosis Procedure Combination inpatient database, collected from 270 acute care hospitals in Japan. Patients were divided into two groups based on presence/absence of malignancy, and T-tube or tracheotomy dependence at 6 months after surgery was compared between the two groups. RESULTS One hundred and thirty-four patients (75 males) were identified. The median age at surgery was 65.5 years. The most common indication for surgery was malignancy (n = 60, 44.8%), followed by iatrogenic (n = 25, 18.6%), trauma (n = 6, 4.5%), malformation of the larynx and trachea (n = 6, 4.5%), and chronic inflammatory disease (n = 4, 2.8%). Thyroid cancer was the most common malignancy (n = 38). Thirty patients (22.4%) failed to decannulate within 6 months and malignancy was associated with a lower dependence on T-tube or tracheotomy at 6 months after surgery (adjusted odds ratio: 0.25, 95% confidence interval: 0.08-0.79). CONCLUSION A Japanese health insurance claims database provided a useful overview of the clinical features and outcomes of patients who underwent cervical tracheal reconstruction surgery for laryngotracheal stenosis or defect.
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Affiliation(s)
- Kayoko Mizuno
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 650-8507, Japan; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto 650-8501, Japan
| | - Yuji Kanazawa
- Department of Otolaryngology, Shiga Medical Center for Children, Shiga 524-0022, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto 650-8501, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 650-8507, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto 650-8501, Japan.
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 650-8507, Japan
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Menapace DC, Ekbom DC, Larson DP, Lalich IJ, Edell ES, Kasperbauer JL. Evaluating the Association of Clinical Factors With Symptomatic Recurrence of Idiopathic Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2020; 145:524-529. [PMID: 31070681 DOI: 10.1001/jamaoto.2019.0707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Idiopathic subglottic stenosis (iSGS) is a progressive and potentially life-threatening condition with very few targeted treatment options. Objective To characterize the clinical factors of patients with iSGS, including body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), and evaluate their association with iSGS symptomatic recurrence. Design, Setting, and Participants This retrospective medical record review included 186 adult patients with iSGS treated at a single tertiary referral center between January 1, 1989, and December 31, 2015. All data analysis took place from January 1, 2018 to June 30, 2018. Main Outcomes and Measures The 3 BMI categories were examined for their association with iSGS recurrence. Outcome measurements included time to first symptomatic recurrence (TTFR) and recurrence-free survival (RFS). Comorbidities were recorded. Results Of the 186 patients in the study, 182 (98%) were women; mean (interquartile range) patient age, 49 (41-60) years. At iSGS diagnosis, 65 (35%) patients were underweight or normal weight; 45 (24%) were overweight; and 76 (41%) were obese (class 1, 2, or 3). Median BMI was 27.4. Ninety-one patients experienced TTFR at a median of 14 months. Compared with underweight or normal-weight patients, the hazard ratios for the associations of overweight, obese class 1, and obese class 2/3 patients with recurrence were 1.14 (95% CI, 0.65-1.99), 1.74 (95% CI, 1.04-2.93), and 1.04 (95% CI, 0.54-1.99), respectively. No differences in concomitant medical treatment regimens were found. While several comorbidities (gastroesophageal reflux disease, hypertension, hyperlipidemia, and diabetes mellitus) were associated with increasing BMI, they were not associated with iSGS symptomatic recurrence on multivariable analysis. Conclusions and Relevance Results of this retrospective review show that class 1 obesity was associated with an increased rate of iSGS symptomatic recurrence compared with underweight or normal-weight patients. This association was not seen in class 2 or class 3 obesity. Patients with class 1 obesity should be counseled about this risk to aid in the assessment and management of symptoms.
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Affiliation(s)
- Deanna C Menapace
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - David P Larson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Ian J Lalich
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eric S Edell
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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28
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Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation. Crit Care Med 2020; 47:1699-1706. [PMID: 31634236 DOI: 10.1097/ccm.0000000000004015] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Upper airway injury is a recognized complication of prolonged endotracheal intubation, yet little attention has been paid to the consequences of laryngeal injury and functional impact. The purpose of our study was to prospectively define the incidence of acute laryngeal injury and investigate the impact of injury on breathing and voice outcomes. DESIGN Prospective cohort study. SETTING Tertiary referral critical care center. PATIENTS Consecutive adult patients intubated greater than 12 hours in the medical ICU from August 2017 to May 2018 who underwent laryngoscopy within 36 hours of extubation. INTERVENTIONS Laryngoscopy following endotracheal intubation. MEASUREMENTS AND MAIN RESULTS One hundred consecutive patients (62% male; median age, 58.5 yr) underwent endoscopic examination after extubation. Acute laryngeal injury (i.e., mucosal ulceration or granulation tissue in the larynx) was present in 57 patients (57%). Patients with laryngeal injury had significantly worse patient-reported breathing (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 1.05; interquartile range, 0.48-2.10) and vocal symptoms (Voice Handicap Index-10: median, 2; interquartile range, 0-6) compared with patients without injury (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 0.20; interquartile range, 0-0.80; p < 0.001; and Voice Handicap Index-10: median, 0; interquartile range, 0-1; p = 0.005). Multivariable logistic regression independently associated diabetes, body habitus, and endotracheal tube size greater than 7.0 with the development of laryngeal injury. CONCLUSIONS Acute laryngeal injury occurs in more than half of patients who receive mechanical ventilation and is associated with significantly worse breathing and voicing 10 weeks after extubation. An endotracheal tube greater than size 7.0, diabetes, and larger body habitus may predispose to injury. Our results suggest that acute laryngeal injury impacts functional recovery from critical illness.
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29
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Karakattu SM, Vijayan K, Haddad I, El Abbassi A. Idiopathic Subglottic Tracheal Stenosis Misdiagnosed As Vocal Cord Dysfunction and Successfully Treated with Laser and Controlled Radial Expansion Balloon Dilation. Cureus 2020; 12:e7702. [PMID: 32431981 PMCID: PMC7233505 DOI: 10.7759/cureus.7702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Idiopathic tracheal stenosis (ITS) is a rare condition, and diagnosis of exclusion should be suspected in patients with exercise intolerance, wheezing, and dyspnea on exertion with a flow-volume loop suggestive of fixed airway obstruction. We report a case of a 32-year-old asthmatic woman with an existing diagnosis of vocal cord dysfunction and previous normal CT scan of the neck. She continued to have fixed upper airway obstruction on repeated flow-volume loops with persistent wheezing and cough along with occasional stridor and hoarseness of voice despite appropriate management of her asthma. She was finally diagnosed with ITS on a repeat CT scan of the neck for which she underwent laser surgery, steroid injection, and controlled radial expansion balloon dilation with a successful reduction of stenosis. This case illustrates the importance of clinical suspicion for early diagnosis of ITS in poorly controlled asthmatic patients and the relevance of non-surgical management of this condition.
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Affiliation(s)
- Sajin M Karakattu
- Pulmonary and Critical Care, East Tennessee State University, Johnson City, USA
| | - Karthik Vijayan
- Pulmonary and Critical Care, East Tennessee State University, Johnson City, USA
| | - Ibrahim Haddad
- Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Adel El Abbassi
- Pulmonary and Critical Care, East Tennessee State University, Johnson City, USA
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30
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Aravena C, Almeida FA, Mukhopadhyay S, Ghosh S, Lorenz RR, Murthy SC, Mehta AC. Idiopathic subglottic stenosis: a review. J Thorac Dis 2020; 12:1100-1111. [PMID: 32274178 PMCID: PMC7139051 DOI: 10.21037/jtd.2019.11.43] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive workup that includes a complete history, physical examination, pulmonary function testing, auto-antibodies, imaging studies, and endoscopic procedures. This approach, however, helps to exclude other conditions such as granulomatosis with polyangiitis (GPA). It is also helpful to characterize the lesion and outline management strategies. Therapeutic endoscopic procedures and surgery are the most common management modalities, but medical therapy can also play a significant role in preventing or delaying recurrence. In this review, we describe the morphology, pathophysiology, clinical presentation, evaluation, management, and prognosis of iSGS.
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Affiliation(s)
- Carlos Aravena
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco A Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sanjay Mukhopadhyay
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Subha Ghosh
- Department of Diagnostic Radiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert R Lorenz
- Head and Neck Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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31
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Managing Otolaryngologic Complications in Cardiothoracic Surgery. Ann Thorac Surg 2020; 110:676-683. [PMID: 31982445 DOI: 10.1016/j.athoracsur.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiothoracic procedures are often lifesaving operations, and because of their complexity they are not without complications. Although major complications are often recognized and treated immediately, there are many less commonly identified complications that can and frequently should be addressed by otolaryngology colleagues during a patient's hospital course. METHODS This comprehensive review describes otolaryngologic complications of cardiac and thoracic surgery. RESULTS Dysphonia, dysphagia, stridor, tracheotomy hemorrhage, and pharyngeal tear are all complications of cardiothoracic procedures. Indications for treatment and treatment options are reviewed. The impact on quality of life and long-term morbidity is also discussed. CONCLUSIONS Otolaryngologic complications are common after cardiothoracic procedures. An otolaryngologist should be asked to evaluate a patient with dysphonia, dysphagia, or stridor while the patient is an inpatient. Patients experiencing persistent or nonacute problems should be referred to otolaryngologists to discuss more long-term interventions.
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32
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Gray AJ, Huston M, Didericksen D, Meyer TK, Merati A, Brisebois S. The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis. Laryngoscope 2019; 130:1775-1779. [PMID: 31593339 DOI: 10.1002/lary.28331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Dyspnea Index (DI) is a validated patient-reported outcome (PRO) instrument that has been used in the management of laryngotracheal stenosis (LTS). The minimal clinically important difference (MCID) is an established concept to help determine the change in a PRO instrument that reflects meaningful change for the patient. It is not known what change in the DI is of clinical significance in airway surgery. This study aims to determine the MCID for the DI in patients undergoing surgical treatment for LTS. METHODS This is a prospective cohort study in which 26 patients with LTS completed the DI (score range 0 to 40) before and 6 to 8 weeks postoperatively, in addition to a Global Ratings Change Questionnaire (GRCQ), scored from -7 to +7, at the postoperative interval. A hypothesis test was carried out to test the association between GRCQ and change in DI. The MCID for change in DI was determined using anchor-based analysis. RESULTS Overall mean change in DI was -11, and mean change in GRCQ was +5. Change in DI scores were significantly different among the improvement and no improvement groups (P value <0.002). Area under the receiver operating curve was 0.92, demonstrating high discriminatory ability of the change in DI score. A change of -4 was determined to be the threshold that discriminated between significant improvement and no improvement. CONCLUSION A decrease of 4 in the DI can be considered as the MCID for patients with LTS after surgical treatment. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1775-1779, 2020.
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Affiliation(s)
- Alan J Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Molly Huston
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Devin Didericksen
- Department of Statistics, University of Washington, Seattle, Washington, U.S.A
| | - Tanya K Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Albert Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Simon Brisebois
- Department of Surgery, Otolaryngology-Head and Neck Division, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Woliansky J, Paddle P, Phyland D. Laryngotracheal Stenosis Management: A 16-Year Experience. EAR, NOSE & THROAT JOURNAL 2019; 100:360-367. [PMID: 31547701 DOI: 10.1177/0145561319873593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years, it has become increasingly apparent that the laryngotracheal stenosis (LTS) cohort comprises distinct etiological subgroups; however, treatment of the disease remains heterogeneous with limited research to date assessing predictors of treatment outcome. We aim to assess clinical and surgical predictors of endoscopic treatment outcome for LTS, as well as to further characterize the disease population. A retrospective chart review of adult patients with LTS presenting over a 16-year period was conducted. Seventy-five patients were identified and subdivided into 4 etiologic subgroups: iatrogenic, idiopathic, autoimmune, and "other" groups. Statistical comparison of iatrogenic and idiopathic groups was performed. Subsequently, stepwise logistic regression was employed to examine the association between clinical/surgical factors and treatment outcome, as measured by tracheostomy incidence and dependence. We demonstrate that patients with iatrogenic LTS were significantly more morbid (P < .001) and had worse disease, with significantly greater percentage stenosis (P = .015) and increased incidence of tracheostomy (P < .001). Analyzing the predictive effect of clinical and surgical variables on endoscopic treatment outcome, we have shown that when adjusted for age, sex, and iatrogenic etiology, patients with an American Society of Anesthesiologist score >2 were significantly more likely to undergo tracheostomy (adjusted odds ratio = 11.23, 95% confidence interval [CI] = 1.47-86.17). Similarly, when compared with their idiopathic counterparts, patients with iatrogenic LTS had higher odds of undergoing tracheostomy (17.33, 95% CI = 1.93-155.66) as were patients with Cotton-Myer grade 3-4 stenosis (9.84, 95% CI = 1.36-71.32). The odds of tracheostomy dependence at time of last follow-up were significantly higher in patients with gastroesophageal reflux disease (15.38, 95% CI = 1.36-174.43) and cerebrovascular accident (9.03, 95% CI = 1.01-81.08), even after adjustment. No surgical techniques were significantly associated with either outcome when adjusted. We present a heterogeneous LTS cohort comprised of homogeneous subgroups with distinct levels of morbidity, disease morphology, and treatment burden. Further our data suggest that the treatment outcome is more dependent on patient factors, rather than surgical technique used.
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Affiliation(s)
- Jonathan Woliansky
- Department of Otolaryngology-Head and Neck Surgery, 96038Monash Health, Victoria, Australia.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Paul Paddle
- Department of Otolaryngology-Head and Neck Surgery, 96038Monash Health, Victoria, Australia.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Debra Phyland
- Department of Otolaryngology-Head and Neck Surgery, 96038Monash Health, Victoria, Australia.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Fiz I, Monnier P, Koelmel JC, Di Dio D, Fiz F, Missale F, Piazza C, Peretti G, Sittel C. Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis. Laryngoscope 2019; 130:1640-1645. [PMID: 31508817 DOI: 10.1002/lary.28274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/06/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high-grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient-related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes. STUDY DESIGN Retrospective cohort study. METHODS We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I-IV, Myer-Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications. RESULTS Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1-11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively). CONCLUSIONS ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1640-1645, 2020.
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Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Philippe Monnier
- Department of Otolaryngology-Head and Neck Surgery, University Hospital, Vaud University Hospital Center, Lausanne, Switzerland
| | - Jan C Koelmel
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Diana Di Dio
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Radiology, University of Tuebingen, Tuebingen, Germany
| | - Francesco Missale
- Departement of Internal Medicine, University of Genoa, Genoa, Italy.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Scientific Institute for Research and Healthcare Foundation, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Departement of Internal Medicine, University of Genoa, Genoa, Italy.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany
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Vocal fold fixation due to proximal stenosis progression complicating idiopathic subglottic stenosis. Eur Arch Otorhinolaryngol 2019; 276:2293-2300. [PMID: 31187240 PMCID: PMC6616212 DOI: 10.1007/s00405-019-05494-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/09/2019] [Indexed: 11/03/2022]
Abstract
Purpose This study examined the incidence and risk factors for vocal fold fixation due to proximal progression of idiopathic subglottic stenosis (ISS) over the course of serial treatments. Methods Records of 22 consecutive patients with ISS treated between 2004 and 2016 were retrospectively reviewed. Patient, stenosis, and treatment details were recorded. Cox regression was used to identify independent predictors of vocal fold fixation. Results All patients were female and mean age at diagnosis was 46 ± 7 years. In five patients, the stenosis was within 15 mm of the glottis at first treatment. Vocal fold fixation due to proximal stenosis progression occurred in seven (32%) patients. It led to permanent hoarseness due to unilateral vocal fold fixation in two patients and caused airway compromise due to bilateral vocal fixation in two other patients. No airway-related deaths occurred and no patient required a tracheostomy. Stenosis incision using coblation or potassium titanyl phosphate laser, and an initial glottis-to-stenosis (GtS) distance < 15 mm significantly increased the risk of proximal stenosis progression on univariable analysis. Conclusion Vocal fold fixation due to proximal stenosis progression is a significant complication of idiopathic subglottic stenosis and causes permanent voice and/or airway sequelae. It should be actively looked for and documented every time a patient is assessed. If a reduction in the GtS distance is observed, definitive surgery should be promptly considered before proximal stenosis progression compromises the efficacy and safety of definitive treatment or, worse, causes vocal fold fixation.
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Fiz I, Koelmel JC, Piazza C, Fiz F, Di Dio D, Bittar Z, Peretti G, Sittel C. Predictors of recurrence after surgical treatment of idiopathic progressive subglottic stenosis. ACTA ACUST UNITED AC 2019; 38:417-423. [PMID: 30498269 PMCID: PMC6265673 DOI: 10.14639/0392-100x-1872] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/16/2017] [Indexed: 12/27/2022]
Abstract
Idiopathic progressive subglottic stenosis is a rare cause of tracheal narrowing. Partial cricotracheal resection and anastomosis can cure idiopathic stenosis, even if some patients may require multiple interventions and experience voice and swallowing deterioration. We investigated risk factors for retreatment and assessed the impact of crico-tracheal resection on functional parameters. We conducted a retrospective multicentric study on 44 female patients (mean age 52.6 ± 13.1 years) affected by idiopathic stenosis and treated by crico-tracheal resection between 2002 and 2016. Functional outcomes after crico-tracheal resection were assessed by the airway-dyspnoea-voice-swallowing score (range 1-5, with “1” expressing normal and “5” completely altered function). Previous treatments, grade of stenosis, site, airway comorbidities, age and resection length were tested as predictors of postoperative complications and number of additional treatments, using bivariate and multivariate analysis. The overall decannulation rate was 97.3%. The dyspnoea score improved (mean variation 1.4 ± 1.0; p < 0.001), while voice and swallowing were negatively affected (mean variation 1.6 ± 0.9 and 0.5 ± 0.7, respectively; p < 0.001). Airway comorbidities were associated with a higher rate of complications (p < 0.05). Retreatments were more frequent in patients with postoperative complications (p < 0.05). The length of resection correlated with the number of subsequent treatments (R = 0.52; p < 0.01). At multivariate analysis, post-operative complications were predicted by comorbidities and disease stage (p < 0.05); number of retreatments was linked to the length of resection (p < 0.05) as well as with the application of mitomycin C (p < 0.001). Crico-tracheal resection for idiopathic progressive subglottic stenosis offers good functional results in terms of airway patency. These data suggest that a higher complication rate can be expected in patients affected by comorbidities. Moreover, more extensive surgical resection seems to be associated with the occurrence and number of subsequent retreatments. On the contrary, the local application of an anti-proliferative drug does not seem to be of use in preventing recurrences.
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Affiliation(s)
- I Fiz
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Germany
| | - J C Koelmel
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Germany
| | - C Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Italy
| | - F Fiz
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tuebingen, Germany.,Department of Internal Medicine, University of Genoa, Italy
| | - D Di Dio
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Germany
| | - Z Bittar
- Institute for Pathology, Klinikum Stuttgart, Germany
| | - G Peretti
- Department of Otorhinolaryngology Head and Neck Surgery, University of Genoa, Italy
| | - C Sittel
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Germany
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Aleksanyan A, Stoelben E. [Laryngo-Tracheal Resection as an Alternative to Permanent Tracheostomy]. Pneumologie 2019; 73:211-218. [PMID: 30703818 DOI: 10.1055/a-0809-0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cervical stenosis of the trachea caused by tracheotomy, tumor or without defined reason (idiopathic) can be treated by resection and anastomosis with good early and long-term results. Involvement of the ring cartilage makes the procedure technically demanding and increases the risk of morbidity. We describe our technique of laryngotracheal resection and reconstruction and compare the perioperative results with standard tracheal resection. PATIENTS AND METHODS Between January 2005 and December 2015, we performed about 800 procedures on the trachea including 76 standard cervical tracheal resections and 35 laryngotracheal resection. Resections were carried out with direct anastomosis without intraoperative tracheotomy or intralaryngeal stenting. Patient records were retrospectively analysed for perioperative data. RESULTS The main cause of stenosis or defect of the trachea and operation was preceding tracheotomy. Idiopathic stenosis, tumors and subglottic stenosis in Wegener disease were less common. There were no disturbances of healing of the anastomosis in any patient. Tracheotomy in the course of treatment for intralaryngeal swelling or recurrent nerve palsy was necessary in 3 (standard) and 2 (laryngotracheal) patients. Postoperative tracheostomy was closed in all patients within 3 months. Pulmonary complications and recurrent nerve palsy occurred in 5/4 and 2/2 of the patients without significant differences between the 2 groups. One patient died in each group from pulmonary complications. CONCLUSION The laryngotracheal resection is a relevant part of cervical tracheal surgery. It can be performed without significantly higher morbidity and can restore lung function and quality of voice.
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Affiliation(s)
- A Aleksanyan
- Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, private Universität Witten/Herdecke, Köln
| | - E Stoelben
- Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, private Universität Witten/Herdecke, Köln
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Woliansky J, Phyland D, Paddle P. Systemic safety of serial intralesional steroid injection for subglottic stenosis. Laryngoscope 2018; 129:1634-1639. [DOI: 10.1002/lary.27673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Jonathan Woliansky
- Department of Otolaryngology-Head and Neck Surgery; Monash Health; Clayton Victoria Australia
| | - Debra Phyland
- Department of Otolaryngology-Head and Neck Surgery; Monash Health; Clayton Victoria Australia
| | - Paul Paddle
- Department of Otolaryngology-Head and Neck Surgery; Monash Health; Clayton Victoria Australia
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39
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Wood DE. Giants in Chest Medicine: Douglas J. Mathisen, MD. Chest 2018; 154:476-478. [PMID: 30195340 DOI: 10.1016/j.chest.2018.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Douglas E Wood
- Douglas E. Wood is from the Department of Surgery, University of Washington, Seattle, WA.
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40
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Nouraei SAR, Heathcote KJ. A patient-centred multidomain instrument for improving the clarity of outcomes reporting and documentation in complex airway surgery. Clin Otolaryngol 2018; 43:1634-1639. [PMID: 29664213 DOI: 10.1111/coa.13114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- S A R Nouraei
- The Robert White Centre for Airway, Voice and Swallowing, Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - K J Heathcote
- The Robert White Centre for Airway, Voice and Swallowing, Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
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Carpenter PS, Pierce JL, Smith ME. Outcomes after cricotracheal resection for idiopathic subglottic stenosis. Laryngoscope 2018; 128:2268-2272. [DOI: 10.1002/lary.27263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Patrick S. Carpenter
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
| | - Jenny L. Pierce
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
| | - Marshall E. Smith
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
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Donahoe L, Keshavjee S. Contemporary Management of Idiopathic Laryngotracheal Stenosis. Thorac Surg Clin 2018; 28:167-175. [DOI: 10.1016/j.thorsurg.2018.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gelbard A, Shyr Y, Berry L, Hillel AT, Ekbom DC, Edell ES, Kasperbauer JL, Lott DG, Donovan DT, Garrett CG, Sandhu G, Daniero JJ, Netterville JL, Schindler JS, Smith ME, Bryson PC, Lorenz RR, Francis DO. Treatment options in idiopathic subglottic stenosis: protocol for a prospective international multicentre pragmatic trial. BMJ Open 2018; 8:e022243. [PMID: 29643170 PMCID: PMC5898326 DOI: 10.1136/bmjopen-2018-022243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Idiopathic subglottic stenosis (iSGS) is an unexplained progressive obstruction of the upper airway that occurs almost exclusively in adult, Caucasian women. The disease is characterised by mucosal inflammation and localised fibrosis resulting in life-threatening blockage of the upper airway. Because of high recurrence rates, patients with iSGS will frequently require multiple procedures following their initial diagnosis. Both the disease and its therapies profoundly affect patients' ability to breathe, communicate and swallow. A variety of treatments have been advanced to manage this condition. However, comparative data on effectiveness and side effects of the unique approaches have never been systematically evaluated. This study will create an international, multi-institutional prospective cohort of patients with iSGS. It will compare three surgical approaches to determine how well the most commonly used treatments in iSGS 'work' and what quality of life (QOL) trade-offs are associated with each approach. METHODS AND ANALYSIS A prospective pragmatic trial comparing the 'Standard of Care' for iSGS at multiple international institutions. Patients with a diagnosis of iSGS without clinical or laboratory evidence of vasculitis or a history of endotracheal intubation 2 years prior to symptom onset will be included in the study. Prospective evaluation of disease recurrence requiring operative intervention, validated patient-reported outcome (PRO) measures as well as patient-generated health data (mobile peak flow recordings and daily steps taken) will be longitudinally tracked for 36 months. The primary endpoint is treatment effectiveness defined as time to recurrent operative procedure. Secondary endpoints relate to treatment side effects and include PRO measures in voice, swallowing, breathing and global QOL as well as patient-generated health data. ETHICS AND DISSEMINATION This protocol was approved by the local IRB Committee of the Vanderbilt University Medical Center in July 2015. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and directly to patient with iSGS via social media-based support groups. TRIAL REGISTRATION NUMBER NCT02481817.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynne Berry
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Alexander T Hillel
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric S Edell
- Department of Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Donald T Donovan
- Department Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - C. Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Guri Sandhu
- Department of Otolaryngology, Imperial College Healthcare NHS, London, UK
| | - James J Daniero
- Department Otolaryngology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James L Netterville
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Josh S Schindler
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA
| | - Marshall E Smith
- Department of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - Paul C Bryson
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio, USA
| | - David O Francis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Abstract
Idiopathic subglottic stenosis is a rare condition of unknown etiology characterized by circumferential stenosis in the subglottic larynx and upper trachea. Historically, patients were treated with dilation or ablation, however this approach has proven to be largely palliative and often leads to recurrence and the need for tracheostomy. A single-staged laryngotracheal resection and reconstruction is now the preferred definitive treatment for idiopathic subglottic stenosis and can be performed with excellent patient outcomes and rare subsequent progression of the disease. Avoiding anastomotic tension and devascularization are important technical keys to minimizing complications.
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Affiliation(s)
- Andrea L Axtell
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas J Mathisen
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Subglottic Stenosis in Granulomatosis With Polyangiitis: The Role of Laryngotracheal Resection. Ann Thorac Surg 2018; 105:249-253. [DOI: 10.1016/j.athoracsur.2017.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/11/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
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Naunheim MR, Naunheim ML, Rathi VK, Franco RA, Shrime MG, Song PC. Patient Preferences in Subglottic Stenosis Treatment: A Discrete Choice Experiment. Otolaryngol Head Neck Surg 2017; 158:520-526. [PMID: 29161192 DOI: 10.1177/0194599817742851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Subglottic stenosis can be addressed with several different surgical techniques, but patient preferences for these treatment modalities are poorly understood. Economic methods are increasingly being used to understand how patients make decisions. The objective of this pilot study was to assess preferences in subglottic stenosis treatment using patient-centric stated preference techniques. Study Design Discrete choice experiment (DCE). Setting Academic research facility. Subjects and Methods A computer-based DCE was administered in a monitored setting to volunteers from the general population. Signs and symptoms of subglottic stenosis were described, and participants were asked to imagine they had subglottic stenosis. Hypothetical treatments were offered, with 5 systematically varied attributes: need for external incision, length of hospital stay, postoperative voice quality, likelihood of repeat procedures, and risk of complication. A conditional logistic model was used to assess the relative attribute importance. Results In total, 162 participants were included. Attributes with the greatest impact on decision making included potential need for repeat procedures (importance 30.2%; P < .001), amount of operative risk (importance 28.1%; P < .001), and postoperative voice quality (importance 27.7%; P < .001), whereas presence of incision (importance 5.0%; P = .001) was less important, and hospital stay was not (importance 9.0%; P = .089). Based on aggregate responses for these attributes, the model demonstrated that most participants (80.4%) would prefer endoscopic surgery for subglottic stenosis as opposed to open tracheal resection (19.6%). Conclusion In this pilot population, most participants preferred voice-sparing, low-risk procedures as treatment for subglottic stenosis, consistent with an endoscopic approach, even if multiple procedures were required.
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Affiliation(s)
- Matthew R Naunheim
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret L Naunheim
- 3 Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA
| | - Vinay K Rathi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramon A Franco
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark G Shrime
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.,4 Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip C Song
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Franco RA, Husain I, Reder L, Paddle P. Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis. Laryngoscope 2017; 128:610-617. [DOI: 10.1002/lary.26874] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/15/2017] [Accepted: 07/26/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Ramon A. Franco
- Division of Laryngology, Department of Otolaryngology; Harvard Medical School and Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
| | - Inna Husain
- Department of Otolaryngology; Rush University Medical Center; Chicago Illinois U.S.A
| | - Lindsay Reder
- Department of Otolaryngology; University of Southern California; Los Angeles California U.S.A
| | - Paul Paddle
- Monash Health and Alfred Health; Victoria Melbourne Australia
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Lee KH, Rutter MJ. Role of Balloon Dilation in the Management of Adult Idiopathic Subglottic Stenosis. Ann Otol Rhinol Laryngol 2017; 117:81-4. [DOI: 10.1177/000348940811700201] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives We evaluated the efficacy of balloon dilation for adjunctive and symptomatic management of isolated idiopathic subglottic stenosis in adults. Methods Adults with airway obstruction symptoms classified as idiopathic subglottic stenosis based on history and findings of a single discrete stenotic area on microlaryngoscopy and bronchoscopy were included in this series. Patients who met these criteria underwent dilation with a 10- to 14-mm balloon in a single procedure or in 2 consecutive dilations within 7 days. The patients were followed for up to 30 months after dilation. Results Six patients met the criteria. One of the 6 had prior laser treatments and a cricotracheal resection. One patient had a previous scar band lysis procedure. The remaining 4 patients had no prior procedures. The airway sizes prior to dilation ranged from a 2.5 endotracheal tube to a 5.0 endotracheal tube. In all cases the airway was dilated to 2.0 to 3.5 endotracheal tube sizes larger than the initial size. To date, 4 patients have been followed for 10 to 30 months without symptoms of recurrent airway stenosis. One patient was symptom-free for 22 months, then presented with progressive airway difficulty following an upper respiratory tract infection, and has undergone a repeat dilation. No patients had adverse effects or complications from the procedure. Conclusions Balloon dilation of idiopathic subglottic stenosis in adults is a relatively safe and effective method to manage this disease entity for cases of isolated and discrete lesions. Patients who underwent a single procedure have remained symptom-free for up to 30 months after balloon dilation.
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Affiliation(s)
- Kenneth H. Lee
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael J. Rutter
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Feinstein AJ, Goel A, Raghavan G, Long J, Chhetri DK, Berke GS, Mendelsohn AH. Endoscopic Management of Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2017; 143:500-505. [PMID: 28241174 DOI: 10.1001/jamaoto.2016.4131] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Optimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection. Objective To determine whether surgical technique or adjunctive measures are associated with duration between surgical procedures. Design, Setting, and Participants Adult patients with subglottic stenosis treated endoscopically between 1995-2015 at a quaternary academic medical center were identified. Patients with isolated subglottic (cricotracheal) stenosis 18 years and older were included. Patients with prior open surgical procedures, prior laryngeal surgical procedures, glottic stenosis, or vocal fold paralysis were excluded. Interventions Patients underwent endoscopic procedures including laser radial incisions, balloon dilation, or both, with some patients receiving topical mitomycin, glucocorticoid injection, or both. Main Outcomes and Measures Time interval between endoscopic treatments. Results A total of 101 patients (mean [SD] age, 52.3 [15.9] years; 77.2% female) were included in the analysis, with etiologies including idiopathic (47 [46.5%]), intubation (31 [30.7%]), granulomatosis with polyangiitis (9 [8.9%]), and other autoimmune diseases (6 [5.9%]). Among the 219 operations, both laser and balloon dilation were used in 117 (53.4%), while balloon dilation alone was used in 96 (43.8%) and laser alone in 6 (2.7%). Mitomycin application and steroid injection were used in 144 (65.8%) and 93 (42.5%) cases, respectively. Mitomycin application was associated with improvement in the mean interval to next procedure from 317 to 474 days (absolute difference, 157 days; 95% CI, 15-299 days). Advanced grade of stenosis, dilation technique, and steroid injection did not significantly alter the surgical intervals. Conclusions and Relevance Endoscopic surgery for subglottic stenosis is a critical aspect of patient management. Neither surgical technique nor grade of stenosis was seen to alter the surgical intervals. Mitomycin application was associated with an extended time interval between endoscopic treatments.
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Affiliation(s)
- Aaron J Feinstein
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles
| | - Alex Goel
- medical student at David Geffen School of Medicine at University of California Los Angeles
| | - Govind Raghavan
- medical student at David Geffen School of Medicine at University of California Los Angeles
| | - Jennifer Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles
| | - Gerald S Berke
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles
| | - Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles
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Soliman AMS. Commentary on Menapace et al, "Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques". Otolaryngol Head Neck Surg 2017; 156:781-782. [PMID: 28457219 DOI: 10.1177/0194599817701423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ahmed M S Soliman
- 1 Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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