Matthew R Hoffman1,2, Ankita Patro3, Li-Ching Huang4, Sheau-Chiann Chen4, Lynn D Berry4, Alexander Gelbard3, David O Francis2. 1. Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama, U.S.A. 2. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A. 3. Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. 4. Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Adjuvant medications including proton pump inhibitors (PPI), antibiotics (trimethoprim/sulfamethoxazole [TMP-SMX]), and inhaled corticosteroids (ICS) may be prescribed for patients with idiopathic subglottic stenosis (iSGS). We describe medication use with endoscopic dilation (ED) or endoscopic resection with medical treatment (ERMT) and evaluate impact on outcomes. STUDY DESIGN: International, prospective, 3-year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. METHODS: Post hoc secondary analysis of prospectively collected North American Airway Collaborative data on outcomes linked with adjuvant medication utilization. Primary outcome was time to recurrent operation, evaluated using Kaplan-Meier curves and Cox regression analysis. Secondary outcomes of change in peak expiratory flow (PEF) and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score over 12 months were compared. RESULTS: Sixty-one of 129 patients undergoing ED received PPI (47%), and 10/143 patients undergoing ED received ICS (7%). TMP-SMX was used by 87/115 patients (76%) undergoing EMRT. PPI use in the ED group did not affect time to recurrence (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.53-1.88; P = .99) or 12-month change in PEF (L/min) (median [interquartile range], 12.0 [10.7-12.2] vs. 8.7 [-5.1 to 24.9]; P = .59), but was associated with 12-month change in CCQ (-0.05 [-0.97 to 0.75] vs. -0.50 [-1.60 to 0.20]; P = .04). ICS did not affect outcome measures. TMP-SMX use in ERMT did not affect time to recurrence (HR = 0.842, 95% CI: 0.2345-3.023; P = .79), PEF at 12 months (75 [68-89] vs. 81 [68-89]; P = .92), or 12-month change in CCQ (0.20 [-1.05 to 0.47] vs. -0.30 [-1.00 to 0.10]; P = .45). CONCLUSION: There is no standard practice for prescribing adjuvant medications. These data do not support that adjuvant medications prolong time to recurrence or increase PEF. Patients with iSGS and gastroesophageal reflux disease may experience some symptom benefit with PPI. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2880-E2886, 2021.
OBJECTIVES/HYPOTHESIS: Adjuvant medications including proton pump inhibitors (PPI), antibiotics (trimethoprim/sulfamethoxazole [TMP-SMX]), and inhaled corticosteroids (ICS) may be prescribed for patients with idiopathic subglottic stenosis (iSGS). We describe medication use with endoscopic dilation (ED) or endoscopic resection with medical treatment (ERMT) and evaluate impact on outcomes. STUDY DESIGN: International, prospective, 3-year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. METHODS: Post hoc secondary analysis of prospectively collected North American Airway Collaborative data on outcomes linked with adjuvant medication utilization. Primary outcome was time to recurrent operation, evaluated using Kaplan-Meier curves and Cox regression analysis. Secondary outcomes of change in peak expiratory flow (PEF) and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score over 12 months were compared. RESULTS: Sixty-one of 129 patients undergoing ED received PPI (47%), and 10/143 patients undergoing ED received ICS (7%). TMP-SMX was used by 87/115 patients (76%) undergoing EMRT. PPI use in the ED group did not affect time to recurrence (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.53-1.88; P = .99) or 12-month change in PEF (L/min) (median [interquartile range], 12.0 [10.7-12.2] vs. 8.7 [-5.1 to 24.9]; P = .59), but was associated with 12-month change in CCQ (-0.05 [-0.97 to 0.75] vs. -0.50 [-1.60 to 0.20]; P = .04). ICS did not affect outcome measures. TMP-SMX use in ERMT did not affect time to recurrence (HR = 0.842, 95% CI: 0.2345-3.023; P = .79), PEF at 12 months (75 [68-89] vs. 81 [68-89]; P = .92), or 12-month change in CCQ (0.20 [-1.05 to 0.47] vs. -0.30 [-1.00 to 0.10]; P = .45). CONCLUSION: There is no standard practice for prescribing adjuvant medications. These data do not support that adjuvant medications prolong time to recurrence or increase PEF. Patients with iSGS and gastroesophageal reflux disease may experience some symptom benefit with PPI. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2880-E2886, 2021.
Authors: Meaghan Noud; Kristen Hovis; Alexander Gelbard; Nila A Sathe; David F Penson; Irene D Feurer; Melissa L McPheeters; David O Francis Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-08-01 Impact factor: 6.223
Authors: Fabien Maldonado; Andrea Loiselle; Zachary S Depew; Eric S Edell; Dale C Ekbom; Michael Malinchoc; Clinton E Hagen; Eran Alon; Jan L Kasperbauer Journal: Laryngoscope Date: 2013-08-08 Impact factor: 3.325
Authors: S A R Nouraei; P S Randhawa; E F Koury; A Abdelrahim; C R Butler; A Venkataraman; D J Howard; G S Sandhu Journal: Clin Otolaryngol Date: 2009-08 Impact factor: 2.597
Authors: Delaney J Carpenter; Sergio Ferrante; Stephen R Bakos; Matthew S Clary; Alexander H Gelbard; James J Daniero Journal: JAMA Otolaryngol Head Neck Surg Date: 2019-01-01 Impact factor: 6.223
Authors: Alexander T Hillel; Sharon S Tang; Camila Carlos; Joseph H Skarlupka; Madhu Gowda; Linda X Yin; Kevin Motz; Cameron R Currie; Garret Suen; Susan L Thibeault Journal: mSphere Date: 2019-05-01 Impact factor: 4.389
Authors: Alexander Gelbard; Nicolas-George Katsantonis; Masanobu Mizuta; Dawn Newcomb; Joseph Rotsinger; Bernard Rousseau; James J Daniero; Eric S Edell; Dale C Ekbom; Jan L Kasperbauer; Alexander T Hillel; Liying Yang; C Gaelyn Garrett; James L Netterville; Christopher T Wootten; David O Francis; Charles Stratton; Kevin Jenkins; Tracy L McGregor; Jennifer A Gaddy; Timothy S Blackwell; Wonder P Drake Journal: Laryngoscope Date: 2016-06-14 Impact factor: 3.325
Authors: Alexander Gelbard; Yu Shyr; Lynne Berry; Alexander T Hillel; Dale C Ekbom; Eric S Edell; Jan L Kasperbauer; David G Lott; Donald T Donovan; C Gaelyn Garrett; Guri Sandhu; James J Daniero; James L Netterville; Josh S Schindler; Marshall E Smith; Paul C Bryson; Robert R Lorenz; David O Francis Journal: BMJ Open Date: 2018-04-10 Impact factor: 2.692