Voice‐Related Quality of Life in Idiopathic Subglottic Stenosis: Effect of Serial Intralesional Steroid Injections

Abstract

Objectives Serial intralesional steroid injection (SILSI) is an emerging treatment for idiopathic subglottic stenosis (ISGS), providing improvement in both subjective symptoms and objective airflow parameters. Little is known about how this airway remodeling affects the voice. This project analyzes subjective voice changes after SILSI and correlates these with airflow parameters. Methods An ISGS database containing voice‐related quality of life (V‐RQOL) and spirometry (peak expiratory flow percentage [%PEF]) was retrospectively queried. Included were ISGS patients from 2009 to 2019 who had at least one SILSI treatment. Encounters without complete data were excluded. Differences between preprocedure and postprocedure metrics were calculated. Correlations and nonparametric bivariate analysis were performed. Results Six hundred and seventeen steroid injections were performed in 55 patients, with an average of 3.5 years of follow‐up. The average V‐RQOL for all patient encounters, both pre‐ and postprocedure, showed little subjective dysphonia (83.5 of 100, 95% confidence interval [CI] 81.6 to 85.4). Considering SILSI‐only treatments, there were 143 encounters with full data; of these, V‐RQOL improved in 70 (49.0%), did not change in 40 (28.0%), and worsened in 33 (23.0%). Average V‐RQOL improvement for the entire cohort was 1.9 points (95% CI: 0.7 to 3.2), which was small but significant (P = .0003). Across all data, there was a weak but significant correlation between PEF% and V‐RQOL (ρ = 0.22, P = .0043). Conclusion SILSI was associated with improvement in subjective voice ratings in about half of patients, and the improvement correlated with improved airflow measurements. This research adds to the growing body of data regarding SILSI and suggests that further work on functional changes to the larynx with airway remodeling is imperative. Level of Evidence 4 Laryngoscope, 131:366–369, 2021

Impact of Serial Intralesional Steroid Injections on Idiopathic Subglottic Stenosis

“…Prior retrospective single institution studies with defined SILSI protocols have demonstrated benefits in time to recurrence, estimated airway stenosis, dyspnea index, and PEF 5,8–11 . Those same benefits were not observed in this prospective multi‐institutional cohort with a heterogeneous approach to SILSI.…”

“…This method has since become a popular adjunctive or primary treatment for iSGS. Multiple retrospective case series have reported improvements in subjective percent airway stenosis by surgeon estimate, peak expiratory flow (PEF), voice‐related quality of life, dyspnea index, and time between operative interventions 5,8–11 …”

An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

“…A retrospective review of side effects found about half of patients (55%) reported minimal tolerable side effects (the most common being menstrual irregularities), all of which resolved after completion of treatment [89]. SILSI was also shown to have a small but significant improvement in voice-related quality of life, as well as a weak correlation with spirometry data [90]. Preliminary retrospective data is promising for SILSI reducing the need for surgical intervention in SGS, but prospective studies with adequate power and length of follow-up may help define a role for this treatment.…”

Long‐Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis

“…Previous authors have reported various parameters to describe changes in voice post‐CTR: patient qualitative description, measurement of pitch, voice‐related quality of life, voice handicap, and expert clinician perceptual ratings. CTR has been documented to impact both subjective and objective measurements of voice 10,11 . In Grillo's retrospective analysis of 73 iSGS patients, qualitative statements from patients revealed that 64% experienced dysphonia following CTR 6 .…”

“…CTR has been documented to impact both subjective and objective measurements of voice. 10,11 In Grillo's retrospective analysis of 73 iSGS patients, qualitative statements from patients revealed that 64% experienced dysphonia following CTR. 6 Specifically, patients were asked if vocal intensity or singing was impacted following CTR, highlighting clinically meaningful voice outcomes for patients.…”