Physiology‐based minimum clinically important difference thresholds in adult laryngotracheal stenosis

Nouraei, Seyed Mahmoud; Franco, Ramon A.; Dowdall, Jayme R.; Nouraei, S.A.R.; Mills, Heide; Virk, Jag S.; Sandhu, Guri; Polkey, Mike

doi:10.1002/lary.24641

Cited by 26 publications

(52 citation statements)

References 25 publications

(38 reference statements)

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“…Pressure‐flow relationships can be measured with a pneumotachograph and a pressure catheter, or less invasively with spirometry . Pulmonary function variables, such as the expiratory disproportion index (ratio of the forced expiratory volume in 1 second to the peak expiratory flowrate), which are commonly used to diagnose lung pathologies including chronic obstructive pulmonary disease and asthma, have been shown to reliably diagnose adult laryngotracheal stenosis . Nouraei et al reported a strong correlation of pulmonary compliance (change in lung volume in response to unit change in driving pressure) with both anatomical stenosis severity and perceptual dyspnea severity .…”

Section: Discussionmentioning

confidence: 99%

Relationship between degree of obstruction and airflow limitation in subglottic stenosis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Relationship between degree of obstruction and airflow limitation in subglottic stenosis

et al. 2017

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“…Recent literature has indicated that some of the metrics measured within PFTs may aide in differentiating LTS from other bronchopulmonary abnormalities 32 and may be useful in objectively assessing outcomes in LTS after airway surgery. 31,33 Further limitations include the sex distribution and sample size of our patient population. Future prospective studies would benefit from having more robust numbers that include more male patients to achieve an equal general distribution, data such as distance of stenosis from the glottis, length of stenosis, and percentage of stenosis to help stratify outcome differences between patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

Samad

Akst

Karataylı-Özgürsoy

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. OBJECTIVE To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. DESIGN, SETTING, AND PARTICIPANTS This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. MAIN OUTCOMES AND MEASURES The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. RESULTS Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95%CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, −20.3; 95%CI, −27.9 to −12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, −2.2; 95% CI, −3.4 to −0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95%CI, 0.3–1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, −27.5 cm H2O/L/s; 95%CI, −44.8 to −10.3 cm H2O/L/s) postoperatively. CONCLUSIONS AND RELEVANCE Patients demonstrate statistically clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons’ regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.

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“…7,8 Several measures, including peak inspiratory flow, peak expiratory flow, and areas under the curve, have been shown to be reliable predictors of disease severity for fixed extrathoracic lesions, as seen in idiopathic subglottic stenosis. 7,9 In the last two decades, a renewed interest has focused on using this data as an objective outcome measure in interventions for upper airway obstruction. 10 Most recently, these measures have been applied to subglottic stenosis to quantify surgical outcomes and disease severity in patients with ISGS.…”

Section: Introductionmentioning

confidence: 99%

Quality‐of‐Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

Naunheim

Paddle

Husain³

et al. 2018

The Laryngoscope

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Physiology‐based minimum clinically important difference thresholds in adult laryngotracheal stenosis

Abstract: Flow-volume loops provide a quantitative method of objectively assessing outcomes in LTS. TPF is the most convenient index for this purpose, but AUCTotal /FVC provides marginally greater sensitivity and specificity.

Cited by 26 publications

References 25 publications

Relationship between degree of obstruction and airflow limitation in subglottic stenosis

Relationship between degree of obstruction and airflow limitation in subglottic stenosis

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

Quality‐of‐Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

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