2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

C. Management of laryngotracheal stenosis Franco RA Jr, Husain I, Reder L, Paddle P. Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis. Laryngoscope . 2018; 128(3):610-617. EBM level 4..............................................258-265 Summary : This is a retrospective cohort study examining the records of subjects over a mean of 3 years to determine whether in-office steroid injection into idiopathic subglottic stenosis could improve patients’ airways without surgical intervention. In a group of six patients, the improvement in breathing was sufficient in five of them to avoid surgery. In those with worse disease, operative intervention was initially undertaken, but in-office steroids were then used to decrease the need for further surgery. Gelbard A, Donovan DT, Ongkasuwan J, et al. Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. Laryngoscope . 2016; 126(6):1390-1396. EBM level 4..............................................................................................................266-272 Summary : This publication compiles results from 11 international centers to include almost 500 patients with idiopathic subglottic stenosis and presents their epidemiologic findings and overall treatment outcomes. They found great heterogeneity in treatment algorithms between centers as well as an inverse correlation between recurrences and surgical volume (follow-up averaging 4 to 5 years). Lewis S, Earley M, Rosenfeld R, Silverman J. Systematic review for surgical treatment of adult and adolescent laryngotracheal stenosis. Laryngoscope . 2017; 127(1):191-198. EBM level 4..............................................................................................................273-280 Summary : This systematic review does a good job of highlighting how much remains unknown and the overall inadequacy of the available evidence in the management of this group of disorders. Findings include resection and anastomosis as superior in achieving decannulation and avoiding future surgery, and that the etiology of stenosis affects decannulation rates and the need for further surgery. Prasanna Kumar S, Ravikumar A, Thanka J. Role of topical medication in prevention of post-extubation subglottic stenosis. Indian J Otolaryngol Head Neck Surg . 2017; 69(3):401-408. EBM level N/A...............................................................................281-288 Summary : A rabbit model has been established studying postextubation subglottic stenosis. This study assessed effects of topical mitomycin-C and triamcinolone on postextubation mucosal ulceration, scab, and submucosal thickening/fibrosis. The study was well-designed with appropriate controls. One weakness is that it is an animal study, albeit one that brings more rigorous histopathologic analysis to treatment of postextubation subglottic stenosis.