EDI can reliably diagnose LTS using routine lung function data. Its simplicity and clinical utility, first recognized by Duncan Empey, are underpinned by a unique physiology whereby PEFR, being determined by total tracheobronchial tree resistance, falls disproportionately compared with FEV1 , which is determined within small intrathoracic airways. EDI provides valuable information about the presence and extent of LTS particularly in nonspecialist clinical settings and its routine inclusion within standard lung function reports could prevent the prolonged morbidity and mortality that currently result from missed and delayed diagnoses.

Clinical COPD Questionnaire is a valid and sensitive instrument for assessing symptom severity and levels of function and well-being in adult patients with laryngotracheal stenosis and can be used as a patient-centred disease-specific outcome measure for this condition.

Two methods can be used to assess the intra-cuff pressure of tracheostomy tubes: digital palpation of the pilot balloon and use of a hand-held manometer. We conducted a telephone survey to determine the prevalence of both methods in intensive care units within 21 teaching hospitals across the United Kingdom. Forty-two per cent of the intensive care units surveyed used a protocol for monitoring cuff pressure with a manometer.A study to compare these two methods, using the manometer as the reference standard, was then carried out. The cuff pressure was correctly estimated in pre-inflated tracheostomy tubes, in a tracheal model, by 61 per cent of a cross-section of intensive care unit and otolaryngology staff.Using pilot balloon palpation is inaccurate and leaves a significant proportion of patients at risk of tracheal injury. We advocate the wider availability of hand-held pressure manometers in intensive care units and the institution of protocols for monitoring cuff pressure for any patient with a tracheostomy tube with an inflated cuff in situ.

L aryngotracheal stenosis is a treatable cause of disability following mechanical ventilation in intensive care units (ICUs). Early diagnosis favourably modifies the natural history of the disease, 1 while diagnostic failure causes significant pulmonary morbidity and can progress to life-threatening airway compromise. Prevention and early recognition of post-ICU complications is an increasing focus of intensive care medicine and in this context, planning screening programmes for this condition through ICU follow-up clinics or as standalone programmes requires understanding of the incidence of post-intubation laryngotracheal stenosis. We undertook an exercise to estimate the incidence of this condition in the UK.The average number of admissions to all ICUs in the UK is 130,000 per annum. 2 It is not precisely known how many patients receive mechanical ventilation and for how long, but 34.2% of UK patients stay in ICU for more than two days and this patient group has a survival rate of 70.2%. 3 An international study of 15,757 patients estimated that 32.9% of ICU patients received mechanical ventilation for more than 12 hours, with a survival rate of 69.3%. 4 If we therefore assume that only 33% of UK ICU patients receive mechanical ventilation and that their survival rate is 70%, which gives an estimate of 30,030 annual survivors of mechanical ventilation and therefore represents an estimate of the at-risk population in the UK.The incidence of late post-intubation laryngotracheal stenosis (PILS) can be estimated from a prospective study of 654 consecutive intensive care patients undergoing mechanical ventilation, which identified 12 cases of severe glottic, subglottic or tracheal stenoses 6-12 months following extubation among the 389 survivors, which translates to an incidence of late PILS among survivors of mechanical ventilation of 3.1%. If lesser degrees of subglottic/tracheal stenosis are also considered, the incidence of late PILS rises to 4.6%. 5 Extrapolating this to the UK population of survivors of mechanical ventilation with these numbers gives an estimate of the incidence of severe late PILS of 926 new cases per year. Alarmingly, however, based on the number of annual patients undergoing laryngotracheal surgery, we have previously estimated the annual population incidence of patients treated to be 197, 6 which on the surface suggests that as many as four out of five patients with severe PILS do not receive treatment.We accept that there are significant limitations to the derivation of this number, due primarily to the unavailability of accurate UK data for the number of patients receiving mechanical ventilation in intensive care and the duration of this support. To our knowledge, there are currently no prospective cohort studies of the incidence of PILS from a UK sample of intensive care patients. In the absence of this information, the current calculation provides the best available estimate of the incidence of adult PILS. If confirmed, the fact that as many as four in five patients with severe postin...

Successful surgical outcomes can be achieved with the use of a structured history, clinical evaluation and physiological testing. Flow-volume loops can help elucidate the cause of nasal obstruction. The newly formed NASION scale is a validated retrospective single time-point patient outcome measure.

No abstract