Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic management of adult subglottic stenosis: an alternative to open surgery

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Various surgical techniques could be used to treat subglottic stenosis (SGS). The aim of this study is to present our experience in endoscopic management of SGS and show the impact of symptoms’ evaluation, clinical examination and spirometry in the therapeutic decision.

Methods

Endoscopic treatment was performed in patients referred for SGS and consisted of CO2 scar lysis associated with balloon dilation and concomitant steroids’ injection for patients with grade II or higher on the mMRC (modified Medical Research Council) dyspnea scale associated with a DI (Dyspnea Index) score higher than 10/40 and objective stenosis equal or higher than grade II. The preoperative DI score, EDI (expiratory disproportion index) and voice parameters were compared to postoperative results. The mean interval between endoscopic procedures (IEP) was calculated and we looked for the evolution of the IEP during repeated procedures.

Results

Nineteen patients were included. 35 dilations were performed. The mean IEP was 86 weeks. There was a significant decrease of the postoperative DI scores by 18.6 points ± 11 (SD). An important difference of 20.1 ± 13.5 (SD) was identified between the pre and postoperative EDI. Minimal changes occured in voice parameters.

Conclusions

Endoscopic treatment with CO2 scar lysis associated with balloon dilation and concomitant steroids' injection is a safe, reliable and minimally invasive endoscopic procedure to treat SGS. Decision to treat has to be on an individual basis taking into account subjective symptoms including Dyspnea Index score and objective laryngoscopic findings and spirometry.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

Data is available upon request.

References

  1. Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH (2007) A proposed classification system of central airway stenosis. Eur Respir J 30:7–12. https://doi.org/10.1183/09031936.00132804

    Article  CAS  PubMed  Google Scholar 

  2. McCaffrey TV (1992) Classification of laryngotracheal stenosis. Laryngoscope 102:1335–1340. https://doi.org/10.1288/00005537-199212000-00004

    Article  CAS  PubMed  Google Scholar 

  3. Nouraei SM, Mahmoud Nouraei S, Patel A, Virk JS, Butler CR, Sandhu GS et al (2013) Use of pressure-volume loops for physiological assessment of adult laryngotracheal stenosis. Laryngoscope 123:2735–2741. https://doi.org/10.1002/lary.24061

    Article  PubMed  Google Scholar 

  4. Poetker DM, Ettema SL, Blumin JH, Toohill RJ, Merati AL (2006) Association of airway abnormalities and risk factors in 37 subglottic stenosis patients. Otolaryngol Head Neck Surg 135:434–437. https://doi.org/10.1016/j.otohns.2006.04.013

    Article  PubMed  Google Scholar 

  5. Mankarious LA, Adams AB, Pires VL (2002) Patterns of cartilage structural protein loss in human tracheal stenosis. Laryngoscope 112:1025–1030. https://doi.org/10.1097/00005537-200206000-00017

    Article  PubMed  Google Scholar 

  6. Dwyer CD, Qiabi M, Fortin D, Inculet RI, Nichols AC, MacNeil SD et al (2021) Idiopathic subglottic stenosis: an institutional review of outcomes with a multimodality surgical approach. Otolaryngol Head Neck Surg 164:1068–1076. https://doi.org/10.1177/0194599820966978

    Article  PubMed  Google Scholar 

  7. Nouraei SAR, Sandhu GS (2013) Outcome of a multimodality approach to the management of idiopathic subglottic stenosis. Laryngoscope 123:2474–2484. https://doi.org/10.1002/lary.23949

    Article  CAS  PubMed  Google Scholar 

  8. Baguant A, Aboussouan M-P, Castellanos PF, Atallah I (2022) Decannulation of tracheostomy-dependent patients: results and review of techniques of reconstructive transoral laser microsurgery. Ann Otol Rhinol Laryngol. https://doi.org/10.1177/00034894221097183

    Article  PubMed  Google Scholar 

  9. Hu HH, Wu FJ, Zhang JS, Chen E (2019) Treatment of secondary benign airway stenosis after tracheotomy with Montgomery T-tube. Math Biosci Eng 16:7839–7849. https://doi.org/10.3934/mbe.2019394

    Article  PubMed  Google Scholar 

  10. Myer CM 3rd, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319–323. https://doi.org/10.1177/000348949410300410

    Article  PubMed  Google Scholar 

  11. Nouraei SAR, Nouraei SM, Randhawa PS, Butler CR, Magill JC, Howard DJ et al (2008) Sensitivity and responsiveness of the Medical Research Council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis. Clin Otolaryngol 33:575–580. https://doi.org/10.1111/j.1749-4486.2008.01832.x

    Article  CAS  PubMed  Google Scholar 

  12. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T (2004) Development and validation of the voice handicap index-10. Laryngoscope 114:1549–1556. https://doi.org/10.1097/00005537-200409000-00009

    Article  PubMed  Google Scholar 

  13. Hogikyan ND, Sethuraman G (1999) Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice 13:557–569

    Article  CAS  PubMed  Google Scholar 

  14. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J et al (2008) Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 117:919–924. https://doi.org/10.1177/000348940811701210

    Article  PubMed  Google Scholar 

  15. Gartner-Schmidt JL, Shembel AC, Zullo TG, Rosen CA (2014) Development and validation of the Dyspnea Index (DI): a severity index for upper airway-related dyspnea. J Voice 28:775–782. https://doi.org/10.1016/j.jvoice.2013.12.017

    Article  PubMed  Google Scholar 

  16. Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16:274–277. https://doi.org/10.1016/s0892-1997(02)00097-8

    Article  PubMed  Google Scholar 

  17. Nouraei SAR, Nouraei SM, Patel A, Murphy K, Giussani DA, Koury EF et al (2013) Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the expiratory disproportion index. Laryngoscope 123:3099–3104. https://doi.org/10.1002/lary.24192

    Article  PubMed  Google Scholar 

  18. Davis RJ, Lina I, Motz K, Gelbard A, Lorenz RR, Sandhu GS et al (2022) Endoscopic resection and mucosal reconstitution with epidermal grafting: a pilot study in idiopathic subglottic stenosis. Otolaryngol Head Neck Surg 166:917–926. https://doi.org/10.1177/01945998211028163

    Article  PubMed  Google Scholar 

  19. Gelbard A, Anderson C, Berry LD, Amin MR, Benninger MS, Blumin JH et al (2020) Comparative treatment outcomes for patients with idiopathic subglottic stenosis. JAMA Otolaryngol Head Neck Surg 146:20–29. https://doi.org/10.1001/jamaoto.2019.3022

    Article  PubMed  Google Scholar 

  20. Wicke C, Halliday B, Allen D, Roche NS, Scheuenstuhl H, Spencer MM et al (2000) Effects of steroids and retinoids on wound healing. Arch Surg 135:1265–1270. https://doi.org/10.1001/archsurg.135.11.1265

    Article  CAS  PubMed  Google Scholar 

  21. Koshkareva Y, Gaughan JP, Soliman AMS (2007) Risk factors for adult laryngotracheal stenosis: a review of 74 cases. Ann Otol Rhinol Laryngol 116:206–210. https://doi.org/10.1177/000348940711600308

    Article  PubMed  Google Scholar 

  22. Shabani S, Hoffman MR, Brand WT, Dailey SH (2017) Endoscopic management of idiopathic subglottic stenosis: factors affecting inter-dilation interval. Ann Otol Rhinol Laryngol 126:96–102. https://doi.org/10.1177/0003489416675357

    Article  PubMed  Google Scholar 

  23. Little FB, Koufman JA, Kohut RI, Marshall RB (1985) Effect of gastric acid on the pathogenesis of subglottic stenosis. Ann Otol Rhinol Laryngol 94:516–519. https://doi.org/10.1177/000348948509400521

    Article  CAS  PubMed  Google Scholar 

  24. Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT (2017) Inaugural symposium on advanced surgical techniques in adult airway reconstruction: proceedings of the north American airway collaborative (NoAAC). JAMA Otolaryngol Head Neck Surg 143:609–613. https://doi.org/10.1001/jamaoto.2016.4126

    Article  PubMed  PubMed Central  Google Scholar 

  25. Roediger FC, Orloff LA, Courey MS (2008) Adult subglottic stenosis: management with laser incisions and mitomycin-C. Laryngoscope 118:1542–1546. https://doi.org/10.1097/MLG.0b013e318179247a

    Article  PubMed  Google Scholar 

  26. Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL (2017) Idiopathic subglottic stenosis: long-term outcomes of open surgical techniques. Otolaryngol Head Neck Surg 156:906–911. https://doi.org/10.1177/0194599817691955

    Article  PubMed  Google Scholar 

  27. Tie K, Buckmire RA, Shah RN (2020) The Role of spirometry and dyspnea index in the management of subglottic stenosis. Laryngoscope 130:2760–2766. https://doi.org/10.1002/lary.28337

    Article  PubMed  Google Scholar 

  28. Kocdor P, Siegel ER, Suen JY, Richter G, Tulunay-Ugur OE (2016) Comorbidities and factors associated with endoscopic surgical outcomes in adult laryngotracheal stenosis. Eur Arch Otorhinolaryngol 273:419–424. https://doi.org/10.1007/s00405-015-3750-2

    Article  PubMed  Google Scholar 

  29. Hseu AF, Benninger MS, Haffey TM, Lorenz R (2014) Subglottic stenosis: a ten-year review of treatment outcomes. Laryngoscope 124:736–741. https://doi.org/10.1002/lary.24410

    Article  PubMed  Google Scholar 

  30. Gelbard A, Donovan DT, Ongkasuwan J, Nouraei SAR, Sandhu G, Benninger MS et al (2016) Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. Laryngoscope 126:1390–1396. https://doi.org/10.1002/lary.25708

    Article  PubMed  Google Scholar 

  31. Valdez TA, Shapshay SM (2002) Idiopathic subglottic stenosis revisited. Ann Otol Rhinol Laryngol 111:690–695. https://doi.org/10.1177/000348940211100806

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Otolaryngology-Head and Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France

    Adrien Ferney, Ludovic Giraud & Ihab Atallah

  2. School of Medicine, Grenoble Alpes University, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble Cedex 9, France

    Adrien Ferney, Ludovic Giraud, Amandine Briault & Ihab Atallah

  3. Food Science and Engineering, Nantes-Atlantic National College of Veterinary Medicine, Oniris, BP 40706, 44307, Nantes Cedex 03, France

    Thibault Ferney & Amandine Briault

  4. Pulmonology Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France

    Amandine Briault

  5. Department of Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France

    Marie-Pierre Aboussouan

  6. Mercy Health, St. Rita’s Ear, Nose and Throat, 770 West High Street, Suite 460, Lima, OH, 4580, USA

    Paul F. Castellanos

Authors
  1. Adrien Ferney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thibault Ferney
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ludovic Giraud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amandine Briault
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie-Pierre Aboussouan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul F. Castellanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ihab Atallah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ihab Atallah.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 235030 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferney, A., Ferney, T., Giraud, L. et al. Endoscopic management of adult subglottic stenosis: an alternative to open surgery. Eur Arch Otorhinolaryngol 280, 1865–1873 (2023). https://doi.org/10.1007/s00405-022-07733-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07733-9

Keywords

Search

Navigation