Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis

Kraft, Shannon; Sykes, Kevin J.; Palmer, Andrew D.; Schindler, Joshua S.

doi:10.1177/0003489414548915

Cited by 29 publications

(47 citation statements)

References 29 publications

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“…Questionnaires such as the dyspnea index provide valuable information regarding impact of stenosis on function and quality of life and will be used in future studies. Pulmonary function data have been used to monitor changes after operative management of subglottic stenosis and would also be useful if repeated in the office setting over injection cycles. Such subjective and objective data could also be used in conjunction with evaluation by transnasal tracheoscopy to guide timing of the next follow‐up visit and injection series.…”

Section: Discussionmentioning

confidence: 99%

Serial office‐based steroid injections for treatment of idiopathic subglottic stenosis

2017

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Section: Discussionmentioning

confidence: 99%

Serial office‐based steroid injections for treatment of idiopathic subglottic stenosis

2017

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“…Rather, our goal primarily was to correlate objective and subjective measures at distinct moments in time. Future studies may integrate these two components . Finally, we did not include any formal pulmonary screening in this cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Future studies may integrate these two components. 12 Finally, we did not include any formal pulmonary screening in this cohort. We rely on the primary care physicians and pulmonologists to screen and treat any clinically significant pulmonary disease.…”

Section: Discussionmentioning

confidence: 99%

“…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 . Most recently, these measures have been applied to subglottic stenosis to quantify surgical outcomes and disease severity in patients with ISGS . Peak expiratory flow (PEF) and peak inspiratory flow (PIF), values determined through forced spirometry and measured in liters per second, provide quantitative values to assess outcomes in adult laryngotracheal stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…10 Most recently, these measures have been applied to subglottic stenosis to quantify surgical outcomes and disease severity in patients with ISGS. 11,12 Peak expiratory flow (PEF) and peak inspiratory flow (PIF), values determined through forced spirometry and measured in liters per second, provide quantitative values to assess outcomes in adult laryngotracheal stenosis. Because of the mechanics of airflow through a fixed obstruction, there is good correlation between PEF and PIF.…”

Section: Introductionmentioning

confidence: 99%

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

Naunheim

Paddle

Husain³

et al. 2018

The Laryngoscope

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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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Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis

Abstract: PEF, PIF, FEV1/PEF, and FIF50% improved significantly after endoscopic incision and dilation of iSGS, and this could potentially be used as a metric by which to evaluate outcomes in the endoscopic management of subglottic stenosis.

Cited by 29 publications

References 29 publications

Serial office‐based steroid injections for treatment of idiopathic subglottic stenosis

Serial office‐based steroid injections for treatment of idiopathic subglottic stenosis

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

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis

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