Transglottic corticosteroid injection for treatment of soft post-intubation subglottic stenosis: a retrospective analysis of 26 children
Surgical treatment is generally recommended for severe subglottic lesions following traumatic endotracheal intubation in children. An alternative approach is early transglottic corticosteroid administration to reduce scar formation and prevent the need for subsequent surgical intervention. This technique has been practiced successfully for several decades at the Children’s Hospital of Cologne and the outcomes of 26 subsequent patients reviewed in this analysis.
All patients who underwent transglottic corticosteroid injection for treatment of post-intubation stridor and dyspnoea between 2012 and 2018 were identified and their records and endoscopy images analysed. Severity of the endoscopic findings was assessed using the Myer–Cotton classification (MCC) and an Expected Need for Surgical Intervention (ENSI) score (1 = inevitable; 2 = very likely necessary; 3 = probably avoidable and 4 = most likely not necessary) was recorded. Treatment was considered successful if the children had a complete resolution of clinical symptoms.
A total of 26 patients with a median (range) age of 1.9 (0.02–7.2) years and weight of 9.8 (1.8–25) kg were identified and included into the analysis. Endoscopic images were available for 22 children. All children underwent transglottic corticosteroid injection prior to any potential surgical treatment. A total of 22 patients (85%) improved following transglottic corticosteroid injection including 4 of 5 patients with a MCC = 3 and ENSI = 1 avoiding surgical intervention. None of the patients experienced a deterioration of clinical symptoms or endoscopic findings.
Transglottic corticosteroid injections as first-line treatment in children with severe post-endotracheal intubation trauma can successfully resolve symptoms and prevent invasive surgery.
KeywordsPost-intubation stridor Subglottic stenosis Iatrogenic laryngeal lesion Paediatrics
We discussed our observations with Hans L. J. Hoeve, MD, PhD, Rotterdam and thank him for his constructive contribution to our discussion.
No external funding was received for this work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human rights and animal participants
All procedures performed were in accordance with the ethical standards of the institutional research committee (waiver of formal ethical approval by Ethics Committee of University Witten/Herdecke, May 12th 2018 due to retrospective analysis with no personal data reported) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 4.Smith DF, de Alarcon A, Jefferson ND, Tabangin ME, Rutter MJ, Cotton RT, Hart CK (2018) Short- versus long-term stenting in children with subglottic stenosis undergoing laryngotracheal reconstruction. Otolaryngol Head Neck Surg 158(2):375–380. https://doi.org/10.1177/0194599817737757 CrossRefPubMedGoogle Scholar
- 7.Robles DT, Berg D (2007) Abnormal wound healing: keloids. Clin Dermatol 25(1):26–32. https://doi.org/10.1016/j.clindermatol.2006.09.009 CrossRefPubMedGoogle Scholar
- 9.Smith RM, Rockoff MA (2011) CHAPTER 41—history of pediatric anesthesia. In: Cladis FP, Motoyama EK (eds) Smith's anesthesia for infants and children, 8th edn. Mosby, Philadelphia, pp 1294–1308. https://doi.org/10.1016/B978-0-323-06612-9.00041-9 CrossRefGoogle Scholar
- 20.Yanagihara N, Azuma F, Koike Y, Honjo I, Imanishi Y (1964) Intracordal injection of dexamethasone. Pract Otorhinolaryngol 57:496–500Google Scholar
- 25.Massie RJ, Robertson CF, Berkowitz RG (2000) Long-term outcome of surgically treated acquired subglottic stenosis in infancy. Pediatr Pulmonol 30(2):125–130. https://doi.org/10.1002/1099-0496(200008)30:2%3c125:AID-PPUL7%3e3.0.CO;2-U CrossRefPubMedGoogle Scholar