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Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis
Alexander Gelbard1, Catherine Anderson1, Lynne D Berry2
1Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Endoscopic dilation for idiopathic subglottic stenosis (iSGS) has a high recurrence rate. Cricotracheal resection offers durability but has risks, while endoscopic resection with medical therapy provides a balance for iSGS treatment.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Rare Diseases
Background:
- Idiopathic subglottic stenosis (iSGS) is a rare airway disease.
- Surgical treatment comparisons are challenging due to patient distribution.
- Emerging technologies can help overcome research barriers.
Purpose of the Study:
- To prospectively compare outcomes of three common surgical approaches for iSGS.
- Evaluate endoscopic dilation (ED), endoscopic resection with medical therapy (ERMT), and cricotracheal resection (CTR).
Main Methods:
- International, prospective, 3-year multicenter cohort study.
- 810 patients with iSGS enrolled after ED, ERMT, or CTR.
- Recruitment via clinical practices and an online iSGS community.
- Primary endpoint: time to recurrent surgical procedure.
- Secondary endpoints: quality of life (CCQ, VHI-10, EAT-10, SF-12v2) and complications.
Main Results:
- Recurrence rates varied significantly: CTR (1.2%), ERMT (12.4%), ED (28.0%).
- Endoscopic dilation (ED) was inferior to ERMT (HR, 3.16).
- CTR provided the best quality of life scores (CCQ, SF-12v2) but the worst voice outcomes (VHI-10) and highest perioperative risk.
Conclusions:
- Endoscopic dilation for iSGS is associated with higher recurrence rates.
- Cricotracheal resection offers durability but carries higher risks and poorer voice outcomes.
- Endoscopic resection with medical therapy shows improved disease control over ED with minimal vocal impact.
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