Does Idiopathic Subglottic Stenosis Length and Location Change with Serial Endoscopic Interventions?

Area of Science:

• Otolaryngology
• Surgical Innovation
• Airway Management

Background:

• Idiopathic subglottic stenosis (iSGS) is a rare condition affecting the airway below the vocal cords.
• Endoscopic surgical intervention, including excision and dilation, is the primary treatment for iSGS.
• Understanding the long-term physical changes in stenosis following repeated procedures is crucial for effective management.

Purpose of the Study:

• To evaluate how serial endoscopic surgical interventions affect the physical dimensions of subglottic stenosis.
• To assess changes in stenosis length and its proximal distance from the vocal process over time.
• To determine if repeated endoscopic treatments lead to significant alterations in iSGS physical parameters.

Main Methods:

• Retrospective chart review of 52 patients with iSGS undergoing multiple endoscopic procedures (2014-2022).
• Intraoperative measurements of stenosis length and proximal distance from the vocal process were compared across serial treatments.
• Statistical analysis using nonparametric methods (Mann Whitney U, Fisher exact, linear regression) was performed.

Main Results:

• A statistically significant decrease in mean stenosis length was observed between the first and second procedures (p=0.014).
• The mean stenosis length decreased by approximately 0.11 cm from the 1st to 2nd procedure (p=0.0003).
• No statistically significant changes were found in the distance of the stenosis from the glottis (p=0.833) or in subsequent procedures.

Conclusions:

• Serial endoscopic excision/dilation for iSGS does not appear to significantly lengthen the intraluminal stenosis.
• The distance of the stenosis from the glottis remains largely unchanged despite repeated endoscopic interventions.
• Current endoscopic techniques are effective in managing iSGS without causing detrimental physical progression of the stenosis.