Impact of Serial Intralesional Steroid Injections on Idiopathic Subglottic Stenosis

Abstract

ObjectivesSerial intralesional steroid injection (SILSI) has been increasingly used to treat idiopathic subglottic stenosis (iSGS). Prior studies have shown effectiveness, but not in all patients. This multi‐institutional study evaluates the effect of SILSI on time to recurrent operation, peak expiratory flow (PEF), and dyspnea.MethodsPost‐hoc secondary analysis of the North American Airway Collaborative data were performed to evaluate the outcomes of iSGS patients undergoing and not undergoing SILSI. The primary outcome was time to recurrent operation, evaluated using Kaplan–Meier curves and Cox regression analysis. Secondary outcomes were change in PEF and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score. Within patients undergoing SILSI, demographics, time from last procedure, and PEF at initiation of SILSI were evaluated to determine the effect on recurrence.ResultsTwo hundred and ninety patients were included, 238 undergoing endoscopic dilation alone and 52 undergoing dilation and SILSI. No differences in baseline characteristics were observed. There was no difference in time to recurrence (hazard ratio: 0.64; p = 0.183). There were no differences in PEF or CCQ across the 2.5‐year study period. Among 52 patients undergoing SILSI, PEF at the time of starting SILSI did not affect recurrence (χ2 = 0.09, p = 0.77).ConclusionPatients undergoing and not undergoing SILSI had similar times to recurrence, PEF, and CCQ. Factors predicting recurrence among patients undergoing SILSI were not identified. These results support a randomized controlled trial with a uniform SILSI protocol to quantify the effects of SILSI on objective and subjective outcomes and help determine which iSGS patients benefit most.Level of Evidence3 Laryngoscope, 133:2255–2263, 2023

Long-Term Follow-up of 64 Patients With Idiopathic Subglottic Stenosis: Treatment Pathways, Outcomes, and Impact of Serial Intralesional Steroid Injections

“…27 Lastly, not all patients appear to benefit from SILSI and a recent multi-institutional study did not show a comparative benefit for heterogeneously implemented SILSI on time to recurrence, peak expiratory flow, or clinical COPD questionnaire scores. 17 Accordingly, identifying which patients are most likely to benefit is desirable. In our dataset, 2 measures reflecting pre-SILSI disease severity (number of operations prior to SILSI and most recent inter-operative interval) predicted higher likelihood of needing additional procedures after starting SILSI.…”

“…Further, a recent multi-institutional study did not show significant benefit for adding SILSI after endoscopic dilation for time to recurrent operation, peak expiratory flow, or clinical COPD questionnaire score. 17 Of note, that multi-institutional study did not employ a uniform SILSI protocol and steroid injections began a median of 1 year after dilation. Naunheim et al reported the largest single institution cohort of 55 patients with average follow-up of 3.5 years.…”

Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review

“…When comparing the 52 patients who underwent serial intralesional steroid injection to the 238 patients of similar stenosis who did not, they ultimately found no difference in time to recurrence, need for secondary procedure, or dyspnea scores. 29 It is currently unclear if pregnant women would benefit from this procedure more than non-pregnant persons.…”

Predictors of Clinical Outcomes in Adult Laryngotracheal Stenosis

“…Surgery is the primary treatment for LTS, but numerous adjuvant and neoadjuvant medical therapies exist, including corticosteroid injections, inhaled corticosteroids, mitomycin C application, antibiotics, and proton pump inhibitors 9 . Serial intralesional steroid injections (SILSIs) are an increasingly popular adjuvant medical option for LTS 10,11 . Surgical treatment options are either endoscopic or open procedures.…”