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Assessment of side effects after serial intralesional steroid injections for idiopathic subglottic stenosis

  • Laryngology
  • Published:
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Abstract

Purpose

To assess the incidence and severity of 12 systemic side effects of serial intralesional steroid injections (SILSI) in patients with idiopathic subglottic stenosis (iSGS).

Methods

This retrospective study included patients with iSGS who underwent SILSI with Triamcinolone 40 mg/dL. After SILSI, the patients were asked to answer 12 questions regarding frequently encountered systemic side effects of steroids. Each answer was rated as mild, moderate, or severe. Descriptive statistics were used to analyze and present the findings.

Results

The study included 49 patients (42 female and 7 male) with a mean age of 59.1 years (range 21–83 years). Post-SILSI treatment, 27 (55%) reported experiencing side effects while 22 (45%) patients reported no side effects. The most frequent side effect reported in women of reproductive age (n: 8) was menstrual irregularities (3/8, 37%). Other frequently reported side effects were feeling joyful and sleeping difficulties, each reported by 30% of the patients. All side effects resolved after the completion of SILSI.

Conclusions

SILSI can be administered with minimal tolerable side effects. Clinicians should make their patients aware of the most frequent side effects. Special attention should be given to women of reproductive age to inform them of the possibility of menstrual irregularities during SILSI.

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References

  1. Hseu AF, Benninger MS, Haffey TM, Lorenz R (2014) Subglottic stenosis: a ten-year review of treatment outcomes. Laryngoscope 124(3):736–741

    Article  PubMed  Google Scholar 

  2. Carpenter PS, Pierce JL, Smith ME (2018) Outcomes after cricotracheal resection for idiopathic subglottic stenosis. Laryngoscope 128(10):2268–2272

    Article  PubMed  Google Scholar 

  3. Gouveris H, Karaiskaki N, Koutsimpelas D, Chongolwatana C, Mann W (2013) Treatment for adult idiopathic and Wegener-associated subglottic stenosis. Eur Arch Otorhinolaryngol 270(3):989–993

    Article  PubMed  Google Scholar 

  4. Morrison RJ, Katsantonis NG, Motz KM, Hillel AT, Garrett CG, Netterville JL et al (2019) Pathologic fibroblasts in idiopathic subglottic stenosis amplify local inflammatory signals. Otolaryngol Head Neck Surg 160(1):107–115

    Article  PubMed  Google Scholar 

  5. Franco RA Jr, Husain I, Reder L, Paddle P (2018) Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis. Laryngoscope 128(3):610–617

    Article  PubMed  Google Scholar 

  6. Cobb WB, Sudderth JF (1972) Intralesional steroids in laryngeal stenosis. A preliminary report. Arch Otolaryngol 96(1):52–56

    Article  CAS  PubMed  Google Scholar 

  7. Hoffman MR, Coughlin AR, Dailey SH (2017) Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. Laryngoscope 127(11):2475–2481

    Article  CAS  PubMed  Google Scholar 

  8. Schäcke H, Döcke WD, Asadullah K (2002) Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 96(1):23–43

    Article  PubMed  Google Scholar 

  9. Pan DR, Rosow DE (2019) Office-based corticosteroid injections as adjuvant therapy for subglottic stenosis. Laryngoscope Investig Otolaryngol 4:414–419

    Article  PubMed  PubMed Central  Google Scholar 

  10. Naunheim MR, Paddle PM, Husain I, Wangchalabovorn P, Rosario D, Franco RA Jr (2018) Quality-of-life metrics correlate with disease severity in idiopathic subglottic stenosis. Laryngoscope 128:1398–1402

    Article  Google Scholar 

  11. Hoffman MR, Francis DO, Mai JP, Dailey SH (2020) Office-based steroid injections for idiopathic subglottic stenosis: patient-reported outcomes, effect on stenosis, and side effects. Ann Otol Rhinol Laryngol 129(4):361–368

    Article  PubMed  Google Scholar 

  12. Song SA, Franco RA (2019) Serial intralesional steroid injection for subglottic stenosis. The Laryngoscope 130(3):698–701

    Article  PubMed  Google Scholar 

  13. Takahashi TA, Johnson KM (2015) Menopause. Med Clin North Am 99(3):521–534

    Article  PubMed  Google Scholar 

  14. Blaiss MS (2011) Safety update regarding intranasal corticosteroids for the treatment of allergic rhinitis. Allergy Asthma Proc 32(6):413–418

    Article  CAS  PubMed  Google Scholar 

  15. Senturk E, Tugrul S, Yıldırım YS, Dogan R, Eren SB, Ozturan O (2018) Are there any systemic effects of the intratympanic administration of dexamethasone? Bezmialem Sci 6(3):186–190

    Article  Google Scholar 

  16. Sood S, Strachan DR, Tsikoudas A, Stables GI (2002) Allergic otitis externa. Clin Otolaryngol Allied Sci 27(4):233–236

    Article  CAS  PubMed  Google Scholar 

  17. Robertson DB, Maibach HI (1982) Topical corticosteroids. Int J Dermatol 21(2):59–67

    Article  CAS  PubMed  Google Scholar 

  18. Mygind N, Dahl R (1996) The rationale for use of topical corticosteroids in allergic rhinitis. Clin Exp Allergy 26(Suppl 3):2–10

    Article  CAS  PubMed  Google Scholar 

  19. Woliansky J, Phyland D, Paddle P (2019) Systemic safety of serial intralesional steroid injection for subglottic stenosis. Laryngoscope 129(7):1634–1639

    Article  CAS  PubMed  Google Scholar 

  20. Mens JM, Nico de Wolf A, Berkhout BJ, Stam HJ (1998) Disturbance of the menstrual pattern after local injection with triamcinolone acetonide. Ann Rheum Dis 57(11):700

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Brann DW, McDonald JK, Putnam CD, Mahesh VB (1991) Regulation of hypothalamic gonadotropin-releasing hormone and neuropeptide Y concentrations by progesterone and corticosteroids in immature rats: correlation with luteinizing hormone and follicle—stimulating hormone release. Neuroendocrinology 54:425–432

    Article  CAS  PubMed  Google Scholar 

  22. Brown ES, Chandler PA (2001) Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry 3(1):17–21

    Article  PubMed  PubMed Central  Google Scholar 

  23. Richards RN (2008) Side effects of short-term oral corticosteroids. J Cutan Med Surg. 12(2):77–81

    Article  CAS  PubMed  Google Scholar 

  24. Carpenter WT Jr, Gruen PH (1982) Cortisol’s effects on human mental functioning. J Clin Psychopharmacol 2(2):91–101

    Article  CAS  PubMed  Google Scholar 

  25. Wolkowitz OM, Reus VI, Canick J, Levin B, Lupien S (1997) Glucocorticoid medication, memory and steroid psychosis in medical illness. Ann N Y Acad Sci 14(823):81–96

    Article  Google Scholar 

  26. Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster CS (2016) Long-term side effects of glucocorticoids. Expert Opin Drug Saf 15(4):457–465

    Article  CAS  PubMed  Google Scholar 

  27. Brown ES, Chandler PA (2001) Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry 3:17–21

    Article  PubMed  PubMed Central  Google Scholar 

  28. Curtis JR, Westfall AO, Allison J, Bijlsma JW, Freeman A, George V, Kovac SH, Spettell CM, Saag KG (2006) Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum 55(3):420–426

    Article  PubMed  Google Scholar 

  29. Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG (2017) Prevention and management of glucocorticoid-induced side effects: a comprehensive review: a review of glucocorticoid pharmacology and bone health. J Am Acad Dermatol 76(1):1–9

    Article  PubMed  Google Scholar 

  30. Conn HO, Poynard T (1994) Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med 236:619–632

    Article  CAS  PubMed  Google Scholar 

  31. Messer J, Reitman D, Sacks HS, Smith H Jr, Chalmers TC (1983) Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med 309:21–24

    Article  CAS  PubMed  Google Scholar 

  32. Garcia Rodriguez LA, Lin KJ, Hernandez-Diaz S, Johansson S (2011) Risk of upper gastrointestinal bleeding with low-dose acetyl-salicylic acid alone and in combination with clopidogrel and other medications. Circulation 123:1108–1115

    Article  CAS  PubMed  Google Scholar 

  33. Narum S, Westergren T, Klemp M (2014) Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open 4:e004587

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kelly JJ, Mangos G, Williamson PM, Whitworth JA (1998) Cortisol and hypertension. Clin Exp Pharmacol Physiol Suppl 25:S51–S56

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

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Authors and Affiliations

  1. Istanbul Training and Research Hospital, Otolaryngology Head and Neck Surgery Clinic, Istanbul, Turkey

    Ozlem Onerci Celebi

  2. Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA

    Ozlem Onerci Celebi, Sungjin A. Song & Ramon A. Franco Jr

  3. Department of Otolaryngology, Harvard Medica School, Boston, MA, USA

    Sungjin A. Song & Ramon A. Franco Jr

  4. Department of Otorhinolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand

    Alena Santeerapharp

  5. Department of Otolaryngology, Panyananthapikkhu Chonprathan Medical Center Srinakharinwirot University, Bangkok, Thailand

    Kanittha Choksawad

  6. Division of Laryngology, Department of Otolaryngology, Voice and Speech Laboratory, Mass Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA

    Ramon A. Franco Jr

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  1. Ozlem Onerci Celebi
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  2. Sungjin A. Song
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  5. Ramon A. Franco Jr
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Correspondence to Ramon A. Franco Jr.

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Celebi, O.O., Song, S.A., Santeerapharp, A. et al. Assessment of side effects after serial intralesional steroid injections for idiopathic subglottic stenosis. Eur Arch Otorhinolaryngol 278, 445–450 (2021). https://doi.org/10.1007/s00405-020-06371-3

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  • DOI: https://doi.org/10.1007/s00405-020-06371-3

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