Matthew R Hoffman1, Adam R Coughlin1, Seth H Dailey1. 1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Current treatment options for idiopathic subglottic stenosis include endoscopic interventions, resection, and tracheotomy. Recently, serial office-based steroid injections were proposed as an alternative that may stabilize or induce regression of airway stenosis without the need for repeated operations. Procedure completion rate, pain, complications, effect on stenosis, time since the last operation, and limitations have not been described. STUDY DESIGN: Retrospective case series. METHODS: Retrospective series of 19 patients undergoing serial office-based steroid injection for idiopathic subglottic stenosis. Outcome measures included completion rate, procedure-related pain scores, complications, percentage of airway stenosis, and time since the last operative intervention. RESULTS: Procedure completion rate was 98.8%. Average pain score during the procedure was 2.3 ± 1.7 on a 10-point scale. There were no immediate complications. One patient underwent awake tracheotomy 8 days after her second injection and was later decannulated. Average stenosis decreased from 35% ± 15% to 25% ± 15% (n = 16; P = .086) over the first of three injections and 40% ± 15% to 25% ± 10% to 20% ± 10% (n = 8; P = .002) for those patients completing two sets of three injections. Fourteen of 17 patients undergoing at least three injections have not returned to the operating room since the first injection. CONCLUSIONS: Office-based steroid injection represents a promising new treatment pathway for a disease that requires long-term management, offering a purely pharmacologic approach to a disorder that has traditionally been approached from a mechanical perspective. It is safe, well tolerated, and effective. Furthermore, it may help patients and physicians avoid repeated trips to the operating room and the associated risks. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2475-2481, 2017.
OBJECTIVES/HYPOTHESIS: Current treatment options for idiopathic subglottic stenosis include endoscopic interventions, resection, and tracheotomy. Recently, serial office-based steroid injections were proposed as an alternative that may stabilize or induce regression of airway stenosis without the need for repeated operations. Procedure completion rate, pain, complications, effect on stenosis, time since the last operation, and limitations have not been described. STUDY DESIGN: Retrospective case series. METHODS: Retrospective series of 19 patients undergoing serial office-based steroid injection for idiopathic subglottic stenosis. Outcome measures included completion rate, procedure-related pain scores, complications, percentage of airway stenosis, and time since the last operative intervention. RESULTS: Procedure completion rate was 98.8%. Average pain score during the procedure was 2.3 ± 1.7 on a 10-point scale. There were no immediate complications. One patient underwent awake tracheotomy 8 days after her second injection and was later decannulated. Average stenosis decreased from 35% ± 15% to 25% ± 15% (n = 16; P = .086) over the first of three injections and 40% ± 15% to 25% ± 10% to 20% ± 10% (n = 8; P = .002) for those patients completing two sets of three injections. Fourteen of 17 patients undergoing at least three injections have not returned to the operating room since the first injection. CONCLUSIONS: Office-based steroid injection represents a promising new treatment pathway for a disease that requires long-term management, offering a purely pharmacologic approach to a disorder that has traditionally been approached from a mechanical perspective. It is safe, well tolerated, and effective. Furthermore, it may help patients and physicians avoid repeated trips to the operating room and the associated risks. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2475-2481, 2017.
Authors: Robert J Morrison; Nicolas-George Katsantonis; Kevin M Motz; Alexander T Hillel; C Gaelyn Garrett; James L Netterville; Christopher T Wootten; Susan M Majka; Timothy S Blackwell; Wonder P Drake; Alexander Gelbard Journal: Otolaryngol Head Neck Surg Date: 2018-10-16 Impact factor: 3.497
Authors: Stephen S Schoeff; Xudong Shi; William G Young; Chad W Whited; Resha S Soni; Peng Liu; Irene M Ong; Seth H Dailey; Nathan V Welham Journal: Laryngoscope Date: 2020-07-03 Impact factor: 3.325