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

Abstract

Objective: To describe treatment pathways and long-term outcomes in 64 patients with idiopathic subglottic stenosis (iSGS), including the impact of serial intralesional steroid injection (SILSI) on degree of stenosis, need for subsequent operation, and patient-reported outcome measures. Methods: Retrospective review of 64 female patients with iSGS undergoing varied management approaches, 57 of whom underwent SILSI as at least part of their care. Treatment pathways included SILSI only, endoscopic intervention followed by SILSI only, endoscopic interventions only, endoscopic intervention followed by SILSI followed by need for repeat endoscopic intervention, open surgery, and tracheotomy. Outcomes assessed included subjectively estimated percent airway stenosis, dyspnea index (DI), modified medical research council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), number of operative and office-based procedures performed, need for subsequent operative intervention, and inter-operative interval. Results: Treatment pathways included SILSI alone (n = 6), endoscopic intervention(s) followed by SILSI only (n = 31), SILSI followed by additional endoscopic or office-based procedures (n = 16), open surgery (n = 3), and tracheostomy (n = 4). 57 of 64 patients underwent SILSI as at least part of their treatment. Inter-operative interval was increased after starting SILSI. Of patients undergoing SILSI, those with more procedures or shorter inter-operative interval prior to SILSI were more likely to return to the operating room. Estimated stenosis, DI, MMRC, and VHI-10 decreased with SILSI. Stenosis was not correlated with DI, MMRC, or VHI-10, though DI was correlated with both MMRC and VHI-10 score. Conclusion: Of 57 patients undergoing SILSI, 37 did not require further operative intervention. Improvements in inter-operative interval, dyspnea, and voice were observed across patients. Randomized trials to identify which patients may benefit most from SILSI are warranted.

Laser Versus Cold Steel for Endoscopic Management of Subglottic Stenosis

“…Although not statistically significant, patients who had cold steel (RTFS at 2 years: 31.9 vs 50.2%; hazard ratio [HR], CI: 1.69, 0.96-2.97; P = .07), smoking history (33.3 vs 38.1%; HR, CI: 1.51, 0.81-2.81; P = . 19), and intubation as the stenosis etiology (30.5 vs 37.7%; HR, CI: 1.79, 0.96-3.31; P = .07) all trended toward worse RTFS within 2 years. Since there was a potential impact between treatment modality and history of prior airway surgery on RTFS, further analysis was stratified by prior surgical history (Table 3, Figure 1).…”

“…repeat surgery or lengthening the time interval between surgeries. 7,[19][20][21] The first SILSI performed at our institution was in December 2018, which was after the data collection period for this study. The relationship between SILSI and stenosis lysis modality (cold steel versus laser) could be an area of potential future research.…”

“…However, diabetes did not appear to influence RTFS on univariate analysis (HR and CI: 1.57, 0.76‐3.27, P = .22). Additionally, serial intralesional steroid injections (SILSI) for SGS have recently shown great promise for reducing need for repeat surgery or lengthening the time interval between surgeries 7,19‐21 . The first SILSI performed at our institution was in December 2018, which was after the data collection period for this study.…”