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Ferney A, Ferney T, Giraud L, Briault A, Aboussouan MP, Castellanos PF, Atallah I. Endoscopic management of adult subglottic stenosis: an alternative to open surgery. Eur Arch Otorhinolaryngol 2023; 280:1865-1873. [PMID: 36401098 DOI: 10.1007/s00405-022-07733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Various surgical techniques could be used to treat subglottic stenosis (SGS). The aim of this study is to present our experience in endoscopic management of SGS and show the impact of symptoms' evaluation, clinical examination and spirometry in the therapeutic decision. METHODS Endoscopic treatment was performed in patients referred for SGS and consisted of CO2 scar lysis associated with balloon dilation and concomitant steroids' injection for patients with grade II or higher on the mMRC (modified Medical Research Council) dyspnea scale associated with a DI (Dyspnea Index) score higher than 10/40 and objective stenosis equal or higher than grade II. The preoperative DI score, EDI (expiratory disproportion index) and voice parameters were compared to postoperative results. The mean interval between endoscopic procedures (IEP) was calculated and we looked for the evolution of the IEP during repeated procedures. RESULTS Nineteen patients were included. 35 dilations were performed. The mean IEP was 86 weeks. There was a significant decrease of the postoperative DI scores by 18.6 points ± 11 (SD). An important difference of 20.1 ± 13.5 (SD) was identified between the pre and postoperative EDI. Minimal changes occured in voice parameters. CONCLUSIONS Endoscopic treatment with CO2 scar lysis associated with balloon dilation and concomitant steroids' injection is a safe, reliable and minimally invasive endoscopic procedure to treat SGS. Decision to treat has to be on an individual basis taking into account subjective symptoms including Dyspnea Index score and objective laryngoscopic findings and spirometry.
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Affiliation(s)
- Adrien Ferney
- Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France
- School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France
| | - Thibault Ferney
- Food Science and Engineering, Nantes-Atlantic National College of Veterinary Medicine, Oniris, BP 40706, 44307, Nantes Cedex 03, France
| | - Ludovic Giraud
- Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France
- School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France
| | - Amandine Briault
- School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France
- Food Science and Engineering, Nantes-Atlantic National College of Veterinary Medicine, Oniris, BP 40706, 44307, Nantes Cedex 03, France
- Pulmonology Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France
| | - Marie-Pierre Aboussouan
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France
| | - Paul F Castellanos
- Mercy Health, St. Rita's Ear, Nose and Throat, 770 West High Street, Suite 460, Lima, OH, 4580, USA
| | - Ihab Atallah
- Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France.
- School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France.
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