Balloon Laryngoplasty for Subglottic Stenosis Caused by Orotracheal Intubation at a Tertiary Care Pediatric Hospital

Abstract

Introduction In recent years, there has been a reduction in mortality rates in neonatal intensive care units (NICUs) due to the impact of modern technological advances in the perinatal field. As a consequence, prolonged orotracheal intubation is used more frequently, and there has been an increase in acquired subglottic stenosis (SGS) in children. Subglottic stenosis is a narrowing of the endolarynx and one of the most common causes of stridor and respiratory distress in children. The laryngoplasty balloon has proven effective in dealing with stenosis both as primary and secondary treatments, after open surgery, with the added advantage of being less invasive and not requiring external access. Materials and Methods This study involved children from pediatric intensive care units or NICUs suffering from respiratory distress and who presented an endoscopic diagnosis of Myer and Cotton grade I to III SGS. These patients underwent balloon laryngoplasty with different numbers of interventions depending on the response in each individual case. Results All the patients responded satisfactorily to the balloon laryngoplasty. None required tracheostomy after treatment and all remained asymptomatic even after 6-month follow-up. One patient required just 1 dilation, 4 required 2, 3 underwent the procedure 3 times, and another had 5 dilations. Conclusion The experience presented here is that of balloon laryngoplasty post–orotracheal intubation SGS with very satisfactory results at a tertiary care pediatric hospital. Although the number of patients is limited, our incidence corroborates other studies that demonstrate the efficacy and safety of balloon dilatation in the treatment of SGS.

Predicting outcomes of balloon laryngoplasty in children with subglottic stenosis

“…Although tracheotomy resolves respiratory insufficiency it is a scary reality that completely changes the family dynamics having to deal with the life-threatening possibility of a mucus plug or displacement of the cannula. BL can be an excellent option in the treatment of acute SGS helping avoid tracheotomies even in very young infants, a finding that has been confirmed in previous studies of acute subglottic stenosis treated with BL also with 100% resolution of respiratory symptoms [9,10]. There is a possibility that good outcome can also be related to natural, favorable, history of some inflammatory stenosis and not only to the effects of BL.…”

“…The presence of an otolaryngologist trained in the evaluation of pediatric airway in the pediatric intensive care unit (PICU) and NICU is essential to change this scenario. Tracheotomies may frequently be avoided as shown by the high success rates of BL for acute SGS in this and other studies [9][10][11]. Although tracheotomy resolves respiratory insufficiency it is a scary reality that completely changes the family dynamics having to deal with the life-threatening possibility of a mucus plug or displacement of the cannula.…”

“…Balloon dilatation has been used to treat laryngeal and tracheal stenosis in children since the early 1980's with encouraging results [9,10], particularly in immature, inflammatory scar tissue. Its main advantage compared to other methods of dilatation is that it promotes centrifuge expansion even in the presence of a very reduced lumen.…”

Ongoing Laryngeal Stenosis: Conservative Management and Alternatives to Tracheostomy

“…The balloon size was selected according to the ideal subglottic diameter for the patient's age (3, 29, 32-34, 36, 37). An inflation/deflation handle mounted with a syringe and gauge assembly designed to monitor and maintain the pressure was used by all authors (29)(30)(31)(32)(33)(34)(35)(36)(37)(38). The balloon was inflated to rated burst pressure by some authors (33,36,37).…”

Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

“…It may obviate the need for tracheostomy or open surgery in many patients and can help facilitate decannulation of patients who have undergone tracheostomy or laryngotracheal reconstruction. 1 Although endoscopic balloon dilation has been consistently described as a valuable modality for treating pediatric subglottic stenosis, [1][2][3][4][5][6][7][8][9][10][11] there is no evidence-based consensus regarding its technical parameters. A recent study employed a live rabbit model to determine the appropriate balloon size required to address subglottic stenosis effectively and safely 12 ; however, the appropriate duration of balloon inflation remains unclear, as indicated by its variability among studies.…”