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Idiopathic subglottic stenosis

Maria Tyse Aarnæs, Leiv Sandvik, Kjell Brøndbo
A retrospective epidemiological study of patients treated for idiopathic subglottic stenosis (ISS) during 2003-2013 at Oslo University Hospital, Rikshospitalet, was undertaken to assess its incidence, management and treatment outcomes. Out of a total of 123 patients with subglottic stenosis (84 female, 39 men), 38 patients were diagnosed with ISS, all of whom were female. Of these, 23 lived in the South-Eastern Norway Regional Health Authority, representing an incidence of 0.2 per 100,000 (95% CI 0.13-0.3) in this region of 2...
May 2017: European Archives of Oto-rhino-laryngology
Aaron J Feinstein, Alex Goel, Govind Raghavan, Jennifer Long, Dinesh K Chhetri, Gerald S Berke, Abie H Mendelsohn
Importance: Optimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection. Objective: To determine whether surgical technique or adjunctive measures are associated with duration between surgical procedures. Design, Setting, and Participants: Adult patients with subglottic stenosis treated endoscopically between 1995-2015 at a quaternary academic medical center were identified...
February 23, 2017: JAMA Otolaryngology—Head & Neck Surgery
Deanna C Menapace, Mara C Modest, Dale C Ekbom, Eric J Moore, Eric S Edell, Jan L Kasperbauer
Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting...
February 1, 2017: Otolaryngology—Head and Neck Surgery
Kristine Tanner, Christopher Dromey, Mark L Berardi, Lisa M Mattei, Jenny L Pierce, Jonathan J Wisco, Eric J Hunter, Marshall E Smith
INTRODUCTION: Individuals with idiopathic subglottic stenosis (SGS) are at risk for voice disorders prior to and following surgical management. This study examined the nature and severity of voice disorders in patients with SGS before and after a revised cricotracheal resection (CTR) procedure designed to minimize adverse effects on voice function. METHOD: Eleven women with idiopathic SGS provided presurgical and postsurgical audio recordings. Voice Handicap Index (VHI) scores were also collected...
November 24, 2016: Laryngoscope
Sepehr Shabani, Matthew R Hoffman, William T Brand, Seth H Dailey
OBJECTIVE: To describe a homogeneous idiopathic subglottic stenosis (ISS) population undergoing endoscopic balloon dilation and evaluate factors affecting inter-dilation interval (IDI). METHODS: Retrospective review of 37 patients. Co-morbidity prevalence versus normal population was evaluated using chi-square tests. Correlations were evaluated using Pearson product moment tests. Independent samples t tests/rank sum tests assessed differences between groups of interest...
February 2017: Annals of Otology, Rhinology, and Laryngology
Anna M Ciccone, Camilla Vanni, Giulio Maurizi, Antonio D'Andrilli, Stylianos Korasidis, Mohsen Ibrahim, Claudio Andreetti, Federico Venuta, Erino A Rendina
Idiopathic subglottic stenosis is the most challenging condition in the field of upper airway reconstruction. We describe a successful novel technique for enlarging the airway space at the site of the laryngotracheal anastomosis in very high-level reconstructions.
November 2016: Annals of Thoracic Surgery
K Hoetzenecker, T Schweiger, W Klepetko
Idiopathic subglottic stenosis is a disease characterized by slow, progressive scarring and constriction of the subglottic airway. It almost always occurs in females between the 3rd and 5th decade of life. Symptoms are frequently misinterpreted as asthma and patients are referred for endoscopic evaluation only when asthma medications fail to alleviate their symptoms. Treatment options can be divided into endoscopic and open surgical techniques. Microlaryngoscopic scar reduction by laser followed by balloon dilation usually delivers good short-term results...
September 2016: Zentralblatt Für Chirurgie
Alfonso Fiorelli, Salvatore Mazzone, Giuseppe Costa, Mario Santini
Herein, we described a novel method as the use of AcuBlade robotic microsurgery system to manage idiopathic subglottic stenosis in a 73 years old lady. Compared to traditional CO2 lasers, AcuBlade facilitated the scar resection by the generation of different shape of beams (straight, curved, or disk). The same setting used for phonomicrosurgery (1-mm beam length, power of 10 W and pulse duration of 0.05-s) allowed to obtain fast, long, and uniform cuts. In addition, the reduction of the number of laser passes over the same area prevented injury of adjacent tissue and thus reduced the risk of recurrence...
July 27, 2016: Clinical Respiratory Journal
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
OBJECTIVES/HYPOTHESIS: Idiopathic subglottic stenosis (iSGS) is a rare and devastating extrathoracic obstruction involving the lower laryngeal and upper tracheal airway. It arises without known antecedent injury or associated disease process. Persistent mucosal inflammation and a localized fibrotic response are hallmarks of the disease. Despite the initial clinical description of iSGS more than 40 year ago, there have been no substantive investigations into the pathogenesis of this enigmatic and progressive airway obstruction...
November 2016: Laryngoscope
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
OBJECTIVES/HYPOTHESIS: Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a hallmark of the disease. Epithelial microbiota dysbiosis is found in other chronic inflammatory mucosal diseases; however, the relationship between tracheal microbiota composition and iSGS is unknown. Given the critical role for host defense at mucosal barriers, we analyzed tissue specimens from iSGS patients for the presence of microbial pathogens...
January 2017: Laryngoscope
M Wierzbicka, M Tokarski, M Puszczewicz, W Szyfter
OBJECTIVE: To determine the long-term efficacy of submucosal corticosteroid injection plus dilatation for subglottic stenosis as a single modality treatment in granulomatosis with polyangiitis and relapsing polychondritis, as compared with idiopathic subglottic stenosis and traumatic subglottic stenosis. METHOD: Patients who underwent dilatation for autoimmune causes were identified. Corticosteroid injection into the submucosa of a stenotic segment was followed by serial dilatation...
July 2016: Journal of Laryngology and Otology
Richard Heyes, Sergio S Cervantes, Jaime Matthaeus, Dawn Jaroszewski, David G Lott
A 72-year-old female with a history of idiopathic subglottic tracheal stenosis suffered tracheal rupture during endoscopic balloon dilation. The defect measured 7.5 cm in length, through which the mediastinum was visualized. An 80 × 20-mm silicone-covered tracheobronchial stent was deployed over the defect. The patient was extubated subsequent to intraoperative computed tomography demonstrating minimal air escape. Postoperatively, the patient saw no further complications and was discharged 3 days later. The stent was removed 80 days postoperatively revealing healed trachea...
December 2016: Laryngoscope
Soroush Zaghi, Jose Alonso, Michael Orestes, Natalie Kadin, William Hsu, Gerald Berke
OBJECTIVE: To assess the size of the cervical and thoracic trachea among female patients with idiopathic subglottic stenosis (SGS). METHODS: Computed tomography (CT) scans of neck/chest from female patients with idiopathic SGS (n = 7) and normal controls (n = 30) were analyzed. Only female patients were included. The diameter and cross-sectional area of the trachea were measured at the level of the subglottic larynx, mid-cervical trachea, and mid-thoracic trachea...
August 2016: Annals of Otology, Rhinology, and Laryngology
Antonio D'Andrilli, Giulio Maurizi, Claudio Andreetti, Anna Maria Ciccone, Mohsen Ibrahim, Camilla Poggi, Federico Venuta, Erino Angelo Rendina
OBJECTIVES: Long-term results of patients undergoing laryngotracheal resection for benign stenosis are reported. This is the largest series ever published. METHODS: Between 1991 and March 2015, 109 consecutive patients (64 males, 45 females; mean age 39 ± 10.9 years) underwent laryngotracheal resection for subglottic postintubation (93) or idiopathic (16) stenosis. Preoperative procedures included tracheostomy in 35 patients, laser in 17 and laser plus stenting in 18...
July 2016: European Journal of Cardio-thoracic Surgery
Alexander Gelbard, Donald T Donovan, Julina Ongkasuwan, S A R Nouraei, Guri Sandhu, Michael S Benninger, Paul C Bryson, Robert R Lorenz, William S Tierney, Alexander T Hillel, Shekhar K Gadkaree, David G Lott, Eric S Edell, Dale C Ekbom, Jan L Kasperbauer, Fabien Maldonado, Joshua S Schindler, Marshall E Smith, James J Daniero, C Gaelyn Garrett, James L Netterville, Otis B Rickman, Robert J Sinard, Christopher T Wootten, David O Francis
OBJECTIVES/HYPOTHESIS: Idiopathic subglottic stenosis (iSGS) is a rare and potentially life-threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes. STUDY DESIGN: Medical record abstraction...
June 2016: Laryngoscope
Haifeng Wang, Cameron D Wright, John C Wain, Harald C Ott, Douglas J Mathisen
BACKGROUND: Idiopathic subglottic stenosis is a rare inflammatory condition affecting the subglottic larynx. We have treated 263 patients (only 2 were male) with this condition. The purpose of this study is to determine factors affecting outcome and predisposing to complications. METHODS: Information was gathered from chart reviews, surveys, and a prospective database. RESULTS: Median time from diagnosis to surgery was 24 months. Antinuclear antibodies when measured were positive in 76 patients (47%)...
November 2015: Annals of Thoracic Surgery
Sharon H Gnagi, Brittany E Howard, Catherine Anderson, David G Lott
OBJECTIVES: To report and compare patients' experiences with acquired subglottic stenosis (AS) versus idiopathic subglottic and tracheal stenosis (ISTS). METHODS: A survey was made available to patients with AS and ISTS. Results were analyzed for inter- and intragroup differences using a 2-tailed t test. RESULTS: The study included 160 survey participants (AS n = 28; ISTS n = 132), with a predominance of female participants (82% AS, 98% ISTS)...
September 2015: Annals of Otology, Rhinology, and Laryngology
Adam C Nunn, S Ali R Nouraei, P Jeremy George, Guri S Sandhu, S A Reza Nouraei
Laryngotracheal stenosis (LTS) is a rare condition that occurs most commonly as a result of instrumentation of the airway but may also occur as a result of inflammatory conditions or idiopathically. Here, we present the case of a patient who developed LTS as a complication of granulomatosis with polyangiitis (GPA), which was misdiagnosed as asthma for 6 years. After an admission with respiratory symptoms that worsened to the extent that she required intubation, a previously well 14-year-old girl was diagnosed with GPA...
2014: Case Reports in Otolaryngology
C L Chan, C A Frauenfelder, A Foreman, T Athanasiadis, E Ooi, A S Carney
BACKGROUND: Acquired airway stenosis can be challenging to manage endoscopically because of difficult field visualisation, instrument limitations and the risk of laser fire. At our institution, radiofrequency coblation has been successfully used for the resection of subglottic and tracheal stenosis in adults. This paper presents our experience with this technique. METHOD: A retrospective case note analysis of all cases of airway stenosis in adults from 2007 to 2012 was performed...
January 2015: Journal of Laryngology and Otology
S Mahmoud Nouraei, Ramon A Franco, Jayme R Dowdall, S A Reza Nouraei, Heide Mills, Jag S Virk, Guri S Sandhu, Mike Polkey
OBJECTIVES/HYPOTHESIS: Delivering evidence-based patient care is predicated on the availability of objective and validated outcome measures. We aimed to calculate physiology-based minimum clinically important difference (MCID) values for adult laryngotracheal stenosis (LTS). STUDY DESIGN: Prospective observational study. METHODS: Patient demographics, morbidities, and stenosis severity were assessed preoperatively. Flow-volume loops and Medical Research Council (MRC) dyspnea grades were measured in 21 males and 44 females before and 6 to 8 weeks after airway surgery, and before treating recurrent disease in 10 patients...
October 2014: Laryngoscope
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