Adult-acquired laryngeal stenosis: a study of prognostic factors

We reviewed cases of adult-acquired laryngeal stenosis treated at the Health Sciences Centre in Winnipeg, Manitoba, over a 15-year period. We studied the influence of various factors on the final outcome including age, sex, etiology, associated conditions, length and diameter of the stenotic segment, as well as its anatomic site. We found a total of 32 patients ranging in age from 16 to 73 years. Fifty-five percent were caused by intubation and 16% by external trauma. Other causes included inflammatory diseases, irradiation, and burns. The subglottis was involved in 82% of the total number of cases reviewed. We studied the probability of decanulation over time by using the Kaplan-Meier survival curves. We then identified the independent factors affecting the probability and time of decanulation by using the Cox Proportional Hazards model. External trauma was found to have the best outcome when compared to other etiologies. The anatomic site of stenosis and its length were independent determinants of outcome, while its diameter was not. Involvement of the glottis in subglottic stenosis led to a significantly poorer outcome. We recommend the use of the length and site of stenosis as primary prognostic factors in the assessment of acquired laryngeal stenosis in the adult population.