2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Fig. 2. We use a handheld digital spirometer (Microloop Spirometer; CareFusion, Sheffield, United Kingdom) to generate the peak inspira- tory flow and peak expiratory flow values. This is a maximal effort study, and values obtained can only be underestimated because they are limited by effort. The nasal cavity is occluded and the subject is coached while breathing completely through the disposable mouthpiece attached to the spirometer. Three complete exhalation–inhalation cycles are per- formed three separate times, with a break between each cycle (nine cycles in total). [Color figure can be viewed in the online issue, which is available at www.laryngo- scope.com.]

Group 2 (OR) had a mean %PEF increase of 25.1%, underwent a mean 2.1 rounds of SILSI, and a mean of 5.9 injections per round separated by 5.2 weeks, and were followed a mean of 2.7 years. Paired t test analysis demonstrated a 95% confidence interval of 9.59% to 40.69% ( P 5 .002). The increases in the %PEF between

active serial steroid injections would prompt consideration of in- office/OR techniques to improve the airway size (resection/dila- tion). Decline in function during periods of active observation prompted the start of a new steroid round of four to six injec- tions with/without surgical intervention. Figure 3 is a flowchart depicting our protocol for injection and surveillance. Statistics A two-sample t test was used to assess the significance of any observed difference between the mean initial and ending %PEFs. The t tests calculated the significance of differences in mean %PEF between the groups and mean change in %PEF/ round for each group. Stata/IC version 13.1 (StataCorp, College Station, TX) was used for statistical calculations. RESULTS All 13 subjects were women diagnosed with iSGS by history, cytoplasmic antineutrophil cytoplasmic antibody seronegative, and had bland, nongranulomatous histol- ogy. Group 1 comprised six subjects who exclusively underwent office-based SILSI. Group 2 comprised seven subjects who underwent initial endoscopic debridement, steroid injection, and balloon dilation in the OR followed by office-based SILSI. The two groups were statistically similar with respect to their initial %PEF values (65.4% vs. 57.4%), and both groups ended up with postinjection %PEF values in the normal range (group 1 5 88.6%, group 2 5 82.5%). Group 1 subjects (SILSI) had a mean increase/round of 23.1% %PEF, underwent an average of 1.3 rounds of treatment with 5.3 injections/round, a mean of 5.9 weeks between injections, and were followed for a mean of 3.3 years. Paired t test analysis of mean change/round %PEF demonstrated a 95% confidence interval of 6.4% to 39.8% ( P 5 .007). Figure 4 depicts the %PEF changes over time for all six SILSI-treated sub- jects (90 data points). Values above 80% are normal.

Fig. 3. Flowchart depicting the clinical pathway for subjects with idiopathic subglottic stenosis treated with serial intralesional ste- roid injections (SILSI). OR 5 operating room; PEF 5 peak expira- tory flow.

Laryngoscope 00: Month 2017

Franco et al.: Intralesional Steroid Injections for iSGS

260