Vocal fold fixation due to proximal stenosis progression complicating idiopathic subglottic stenosis
Vocal fold fixation due to proximal stenosis progression complicating idiopathic subglottic stenosis
PURPOSE: This study examined the incidence and risk factors for vocal fold fixation due to proximal progression of idiopathic subglottic stenosis (ISS) over the course of serial treatments.
METHODS: Records of 22 consecutive patients with ISS treated between 2004 and 2016 were retrospectively reviewed. Patient, stenosis, and treatment details were recorded. Cox regression was used to identify independent predictors of vocal fold fixation.
RESULTS: All patients were female and mean age at diagnosis was 46 ± 7 years. In five patients, the stenosis was within 15 mm of the glottis at first treatment. Vocal fold fixation due to proximal stenosis progression occurred in seven (32%) patients. It led to permanent hoarseness due to unilateral vocal fold fixation in two patients and caused airway compromise due to bilateral vocal fixation in two other patients. No airway-related deaths occurred and no patient required a tracheostomy. Stenosis incision using coblation or potassium titanyl phosphate laser, and an initial glottis-to-stenosis (GtS) distance < 15 mm significantly increased the risk of proximal stenosis progression on univariable analysis.
CONCLUSION: Vocal fold fixation due to proximal stenosis progression is a significant complication of idiopathic subglottic stenosis and causes permanent voice and/or airway sequelae. It should be actively looked for and documented every time a patient is assessed. If a reduction in the GtS distance is observed, definitive surgery should be promptly considered before proximal stenosis progression compromises the efficacy and safety of definitive treatment or, worse, causes vocal fold fixation.
Adult, Constriction, Pathologic/surgery, Disease Progression, Female, Glottis/surgery, Hoarseness/etiology, Humans, Laryngostenosis/complications, Lasers, Solid-State, Male, Middle Aged, Reconstructive Surgical Procedures, Retrospective Studies, Risk Factors, Vocal Cords/pathology
2293-2300
Nouraei, S.A.R.
f09047ee-ed51-495d-a257-11837e74c2b3
Dorman, E.B.
ee9d9f87-f517-4975-9df3-bd3905270eb1
Johnston, J.
e3393f80-1193-44fd-818d-0cf8df5e4068
Vokes, D.E.
6a087d98-6c6f-4acd-ab0c-0601e700810c
August 2019
Nouraei, S.A.R.
f09047ee-ed51-495d-a257-11837e74c2b3
Dorman, E.B.
ee9d9f87-f517-4975-9df3-bd3905270eb1
Johnston, J.
e3393f80-1193-44fd-818d-0cf8df5e4068
Vokes, D.E.
6a087d98-6c6f-4acd-ab0c-0601e700810c
Nouraei, S.A.R., Dorman, E.B., Johnston, J. and Vokes, D.E.
(2019)
Vocal fold fixation due to proximal stenosis progression complicating idiopathic subglottic stenosis.
European Archives of Oto-Rhino-Laryngology, 276 (8), .
(doi:10.1007/s00405-019-05494-6).
Abstract
PURPOSE: This study examined the incidence and risk factors for vocal fold fixation due to proximal progression of idiopathic subglottic stenosis (ISS) over the course of serial treatments.
METHODS: Records of 22 consecutive patients with ISS treated between 2004 and 2016 were retrospectively reviewed. Patient, stenosis, and treatment details were recorded. Cox regression was used to identify independent predictors of vocal fold fixation.
RESULTS: All patients were female and mean age at diagnosis was 46 ± 7 years. In five patients, the stenosis was within 15 mm of the glottis at first treatment. Vocal fold fixation due to proximal stenosis progression occurred in seven (32%) patients. It led to permanent hoarseness due to unilateral vocal fold fixation in two patients and caused airway compromise due to bilateral vocal fixation in two other patients. No airway-related deaths occurred and no patient required a tracheostomy. Stenosis incision using coblation or potassium titanyl phosphate laser, and an initial glottis-to-stenosis (GtS) distance < 15 mm significantly increased the risk of proximal stenosis progression on univariable analysis.
CONCLUSION: Vocal fold fixation due to proximal stenosis progression is a significant complication of idiopathic subglottic stenosis and causes permanent voice and/or airway sequelae. It should be actively looked for and documented every time a patient is assessed. If a reduction in the GtS distance is observed, definitive surgery should be promptly considered before proximal stenosis progression compromises the efficacy and safety of definitive treatment or, worse, causes vocal fold fixation.
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Nouraei2019_Article_VocalFoldFixationDueToProximal
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More information
Accepted/In Press date: 9 April 2019
e-pub ahead of print date: 11 June 2019
Published date: August 2019
Keywords:
Adult, Constriction, Pathologic/surgery, Disease Progression, Female, Glottis/surgery, Hoarseness/etiology, Humans, Laryngostenosis/complications, Lasers, Solid-State, Male, Middle Aged, Reconstructive Surgical Procedures, Retrospective Studies, Risk Factors, Vocal Cords/pathology
Identifiers
Local EPrints ID: 438315
URI: http://eprints.soton.ac.uk/id/eprint/438315
ISSN: 0937-4477
PURE UUID: 408a3bf3-bd88-41fa-93c9-4bb46e23388b
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Date deposited: 04 Mar 2020 17:34
Last modified: 16 Mar 2024 06:47
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Contributors
Author:
S.A.R. Nouraei
Author:
E.B. Dorman
Author:
J. Johnston
Author:
D.E. Vokes
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