Endoscopic Surgical Management of Subglottic Stenosis Still a Challenge

How effective is endoscopic surgical management of adult subglottic stenosis, and what are the treatment outcomes?

Background: Although patients often experience symptomatic improvement of benign subglottic stenosis after endoscopic dilation, recurrence rates remain at 40% to 70% over months/years. Currently, there is no gold standard algorithm for managing subglottic stenosis. In 2002, Eliachar and colleagues published a protocol for subglottic stenosis treatment in patients with granulomatosis with polyangiitis (GPA) at the Cleveland Clinic Foundation. This study assesses outcomes over a 10-year period.

Study design: Ten-year retrospective review of adult patients with subglottic stenosis.

Setting: Cleveland Clinic Foundation, Cleveland.

Synopsis: Ninety-two adults (23 male, 69 female) with subglottic stenosis underwent 247 endoscopic dilations between January 1, 2001, and December 31, 2010. Patients were examined for etiology of stenosis, stenosis grade, and surgical dates. Of the 92 patients, 39 had a GPA diagnosis, 23 had a prior history of prolonged intubation or a tracheotomy, and 30 were categorized with idiopathic stenosis. Forty-one patients needed a single procedure, while 51 needed multiple surgeries. Of the 51 multiple-surgery patients, the mean time interval between surgeries was 13.7 months. There were few complications reported; the most common was transient post-operative hoarseness. Eight of the 92 patients required a later open procedure; six of the eight needed repeated dilations after open surgery. A Kaplan-Meier analysis estimated that at one year, 36.3% of patients would require an additional surgery; at two years, the estimate rose to 57.8%. Stenosis etiology did not affect a patient’s overall need for additional surgery. Limitations included a limited number of subjects and treatment at other institutions for some patients.

Bottom line: Although patients are often symptomatically improved after endoscopic dilation, recurrence rates remain high.

Citation: Hseu AF, Benninger MS, Haffey TM, Lorenz R. Subglottic stenosis: a ten-year review of treatment outcomes. Laryngoscope. 2014;124:736-741.