Oral presentation at the Triological Society Meeting, San Diego, California, U.S.A., April 20, 2012.
Outcome of a multimodality approach to the management of idiopathic subglottic stenosis
Article first published online: 5 AUG 2013
Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 123, Issue 10, pages 2474–2484, October 2013
How to Cite
Nouraei, S. A. R. and Sandhu, G. S. (2013), Outcome of a multimodality approach to the management of idiopathic subglottic stenosis. The Laryngoscope, 123: 2474–2484. doi: 10.1002/lary.23949
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 23 SEP 2013
- Article first published online: 5 AUG 2013
- Manuscript Accepted: 27 NOV 2012
- Manuscript Revised: 20 NOV 2012
- Manuscript Received: 23 APR 2012
- Idiopathic subglottic stenosis;
- laryngotracheal stenosis;
- intralesional corticosteroids;
- skin graft
To assess the results of treating idiopathic subglottic stenosis (ISS), determine predictors of treatment success and outcome, and better define roles and limitations of endoscopic and open surgery.
Prospective observational study.
Fifty-four consecutive patients were treated between 2004 and 2012. Patient, stenosis and treatment details, complications, open surgery rates, and outcomes were recorded. Regression analyses were used to identify predictors of endoscopic treatment success; treatment frequency; and functional outcomes in airway, dyspnea, voice, and swallowing domains.
All patients were female and mean age at diagnosis was 48 ± 12 years. Symptoms-to-diagnosis latency was 21 ± 20 months. There were 10 concomitant glottic and subglottic stenoses. Most lesions were Myer-Cotton grade 3 (48%). Overall, 78% of patients were managed endoscopically. Treatment included intralesional corticosteroids, laser surgery, balloon dilation, and temporary silastic stenting in selected cases. Annual intervention rate was 1.07 ± 0.79. Mean follow-up was 45 months. Factors associated with intervention frequency were stenosis location and severity. Twelve patients underwent anteroposterior laryngotracheal reconstruction with biological inhibition. This resulted in disease remission in all patients with subglottic stenosis, and in most patients with concomitant glottic and subglottic stenosis. Patients with total laryngotracheal stenosis required ongoing treatment for glottic disease. All patients maintained prosthesis-free airways, but in one patient this required a laryngectomy. Most patients achieved good functional outcomes. Stenosis location was the only independent predictor of dyspnea and voice outcomes.
ISS can be effectively treated with endoscopic surgery or a bespoke open reconstructive procedure that does not compromise on female voice quality.
Level of Evidence
4. Laryngoscope, 123:2474–2484, 2013