Predictors of Posterior Glottic Stenosis

Abstract

Objective To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients. Methods PGS patients diagnosed between September 2012 – May 2014 at three tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, ETT size, and indication for intubation were recorded. PGS patients were compared to control patients represented by patients intubated in intensive care units (ICU). Results Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (p<0.05), diabetes (p<0.01), length of intubation (p<0.01) were significant risk factors for the development of PGS. 14/14 (100%) males were intubated with a size 8 or larger ETT compared to 47/65 (72.3%) male controls (p<0.05). PGS (p<0.01), length of intubation (p<0.001), and obstructive sleep apnea (p<0.05) were significant risk factors for tracheostomy. Conclusion Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.

Laryngotracheal Stenosis: Risk Factors for Tracheostomy Dependence and Dilation Interval

“…Diabetes has previously been shown to increase the likelihood of tracheal injury and long-term tracheostomy dependence, presumably through microvascular injury resulting in impaired wound healing. 4,9,11 It is possible that tobacco exposure may prime the large airway mucosa for injury and lead to worse outcomes, particularly in iatrogenic stenosis where direct damage to the airway through instrumentation is occurring. As in COPD, smoking-induced damage to large airway mucosa lessens the vascular supply, rendering the area more susceptible to mechanical injury, thereby promoting pathologic wound repair of the epithelium and lamina propria.…”

“…4,7 Studies show endotracheal tube sizes larger than 7.5 place patients at higher risk for tracheal stenosis and posterior glottic stenosis. 8,9 Additionally, comorbidities adversely affecting wound healing, including diabetes, were found to be intrinsic risk factors for glottic stenosis and associated with iatrogenic LTS. 9–11 Nevertheless further studies are necessary to improve our understanding of etiology-specific factors, patient comorbidities, and treatment modalities impact on patient outcomes.…”

Laryngeal complications of COVID‐19

“…These factors include type 2 diabetes mellitus, obesity, hypertension, cardiovascular disease, and smoking. [38][39][40]43,44 It is thought that these factors may predispose patients to ETT-induced mucosal injury of the larynx and impaired healing once injury occurs. 40 Several of these comorbidities have also been associated with increased severity of COVID-19 infection, 42,45 suggesting that not only are these patients at greater risk of intubation but also at increased risk of subsequent intubation-related laryngeal sequelae.…”

T‐Helper 2 Lymphocyte Immunophenotype Is Associated With Iatrogenic Laryngotracheal Stenosis

“…5–7 iLTS occurs more frequently than other etiologies, with studies demonstrating that endotracheal tube sizes 7.5 or greater place patients at higher risk for iLTS. 4,8–10 iLTS generally presents more distal to the vocal folds and has a greater length and severity of stenosis when compared with other etiologies. 8 In addition, iLTS patients have greater comorbidities, including those that promote microvascular injury and dysregulated wound healing such as smoking, chronic obstructive pulmonary disease, and diabetes, as well as obstructive sleep apnea and hypertension.…”