Endoscopic Management of Idiopathic Tracheal Stenosis

Perotin-Collard, Jeanne-Marie; Jeanfaivre, T.; Thibout, Y.; Jouneau, S.; Léna, H.; Dutau, Hervé; Ramon, P; Lorut, Christine; Noppen, Marc; Vergnon, Jean‐Michel; Vallerand, H.; Mérol, J.-C.; Marquette, Charles-Hugo; Lebargy, F.; Deslée, G.

doi:10.1016/j.athoracsur.2011.03.129

Cited by 49 publications

(48 citation statements)

References 19 publications

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“…The optimal treatment of ISS remains elusive given the paucity of data, particularly with regard to endoscopic management . As reported by Ashiku and colleagues, open resection was associated with excellent results in 19 of 73 patients, with good results in 47 patients (with mostly secondary voice changes for complications) and fair results in five patients (the need for repeat dilatation).…”

Section: Discussionmentioning

confidence: 92%

“…Endoscopic surgery for ISS is supported by even less evidence than open resection. However, most of these procedures are outpatient procedures and preserve vocal function—with the caveat that recurrences may be frequently encountered, as illustrated by the 87% recurrence rate at 5 years among 23 ISS patients reported by Perotin . Reduction in the recurrence rate after endoscopic treatment would undeniably be of major interest for ISS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory manifestations typically consist of progressively worsening dyspnea on exertion, accompanied in advanced stages by stridor and hoarseness . Management options for patients with ISS include open resection with end‐to‐end anastomosis or endoscopic‐based techniques . While open resection appears effective and may be associated with few recurrences, it is reserved for centers with significant expertise, requires a hospital stay, may result in a significant lowering of the pitch of the voice, and is often considered after less invasive endoscopic techniques have been shown to be either ineffective or associated with an unacceptable recurrence rate.…”

Section: Introductionmentioning

confidence: 99%

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Idiopathic subglottic stenosis: An evolving therapeutic algorithm

et al. 2013

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Idiopathic subglottic stenosis: An evolving therapeutic algorithm

et al. 2013

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“…Similarly, dilatation is the first choice in cases with submucosal or extrinsic lesions who require an emergency response, and stent is recommended in suitable patients [8]. Mechanical dilatation can provide sufficient treatment, particularly in cases with web-style ISS [1]. Bronchoscopic, radiological, and pathological findings of the case made us consider a submucosal-type stenosis, and no finding was detected regarding cartilaginous type-stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Rarer, inflammatory diseases such as Wegener's granulomatosis (WG), connective tissue diseases, and sarcoidosis can play roles in the etiopathogenesis. When all these causes are excluded, the diagnosis is idiopathic subglottic stenosis (ISS) [1]. ISS is a very rare disease, more commonly observed in women.…”

Section: Introductionmentioning

confidence: 99%

A Case of Idiopathic Subglottic and Bilateral Bronchial Stenosis

Aydoğmuş

Yuncu

Türk

2016

Turk Toraks Dergisi

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Subglottic stenosis is rarely idiopathic. In this case report, a 40-year-old female patient presented with subglottic stenosis with an unidentified etiology along with bilateral bronchial stenosis. Hoarseness arose in the last 4 years in this patient, who was undergoing treatment because of asthma for 13 years. Her physical examination revealed the presence of bilateral rhonci. Her tomography analysis revealed tracheal stenosis in a 2-cm segment at the C6-7 level. Her bronchoscopy analysis revealed subglottic stenosis. White plaques were observed in the entire tracheobronchial tree; biopsy was performed and lavage was taken. Samples were sent for pathological and microbiological examinations. Stenosis in the bronchial system was clear in the left main bronchus entry and at the right intermediate bronchus level. Dilatation was performed. Chronic active inflammation and squamous hyperplasia were observed in the pathology of the biopsies. Growth did not occur in tuberculosis and nonspecific cultures. Reflux was not present in the gastrointestinal system examination. All serological and rheumatologic examinations performed were normal. Idiopathic subglottic stenosis is exceedingly rare. Bronchial system stenosis accompanying idiopathic tracheal stenosis is even rarer, and its treatment is difficult.

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Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis

Carpenter

Ferrante

Bakos

et al. 2019

JAMA Otolaryngol Head Neck Surg

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aryngotracheal stenosis (LTS) is a broad set of diagnoses encompassing a heterogeneous group of fibroinflammatory conditions relating to narrowing of the glottis, supraglottis, subglottis, and trachea. 1 The subset of patients with isolated subglottic stenosis accounts for nearly half of LTS cases. 2 Idiopathic subglottic stenosis (iSGS) is a rare and slowly progressive condition with an unknown primary cause that results in fibrosis of the subglottic airway. It generally presents in otherwise healthy middle-aged white women with symptoms of dyspnea and stridor. [3][4][5][6] Current management of iSGS relies on a combination of surgical and adjuvant therapies based on physician preference and individual patient needs. Many patients can be treated suc-cessfully through endoscopic intervention, but owing to the recurrent nature of iSGS, greater than 85% of these patients required repeated intervention within 5 years. 7 Routine follow-up is necessary to monitor for recurrence of stenosis between interventions and as a means of quantifying response to treatment.The use of pulmonary function tests (PFTs) for the diagnosis of upper airway obstruction was first described in the 1960s, and several studies have since identified PFT values that can be used to follow gradual change in the degree of stenosis over time. [8][9][10][11][12][13][14] In 2013, Nouraei et al 9 established the expiratory disproportion index (EDI) as a highly sensitive and specific tool for differentiating LTS from other illnesses that pre-IMPORTANCE Because of the recurrent nature of idiopathic subglottic stenosis, routine follow-up is necessary for monitoring progression of stenosis. However, no easily accessible, standardized objective measure exists to monitor disease progression.OBJECTIVE To determine whether peak expiratory flow (PEF) can be used as a reliable and easily accessible biometric indicator of disease progression relative to other validated spirometry measures in patients with idiopathic subglottic stenosis. DESIGN, SETTING, AND PARTICIPANTSProspectively collected data on PEF, expiratory disproportion index (EDI), and total peak flow (TPF) from 42 women with idiopathic subglottic stenosis without comorbid lower airway or parenchymal lung disease who were treated at a single tertiary referral center between 2014 and 2018 were analyzed. The mean follow-up period was 18.2 months (range, 2-40 months). Ten patients initially screened were not included in the analysis owing to comorbid glottic or supraglottic stenosis or nonidiopathic etiology. MAIN OUTCOMES AND MEASURESMeasurements of PEF, EDI, and TPF were taken at preoperative visits and at all other visits. RESULTS Forty-two women (mean age, 51.5 years; 98% white [n = 41]) met the inclusion criteria. The area under the curve for PEF was 0.855 (95% CI, 0.784-0.926). The optimal cutoff value was 4.4 liters per second (264 L/min), with a sensitivity and specificity of 84.4% and 82.0%, respectively. The area under the curve for EDI was 0.853 (95% CI, 0.782-0.925). For TPF, this was 0.836 (...

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Endoscopic Management of Idiopathic Tracheal Stenosis

Cited by 49 publications

References 19 publications

Idiopathic subglottic stenosis: An evolving therapeutic algorithm

Idiopathic subglottic stenosis: An evolving therapeutic algorithm

A Case of Idiopathic Subglottic and Bilateral Bronchial Stenosis

Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis

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