How heterogenous is laryngotracheal stenosis (LTS) with regard to etiology, natural history, and clinical outcome?
Background: LTS is an umbrella term for luminal compromise at the larynx, subglottis, or trachea. Diagnosis is frequently delayed as patients rapidly transition from acute inpatient care to outpatient facilities, and the fact that many specialists initially interact with this population makes it difficult to establish the disease’s natural history, define universal disease outcome predictors, and create cogent personalized care plans.
Study design: Retrospective cohort study of 150 consecutive adult tracheal stenosis patients from 1998 to 2013.
Setting: Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston.
Synopsis: The most common etiology was iatrogenic, followed by idiopathic, autoimmune, and traumatic. The traumatic group was significantly younger at presentation than all others. The idiopathic group had a significantly higher percentage of females than autoimmune, iatrogenic, or traumatic. Cardiovascular comorbidities and diabetes mellitus type 2 were significantly more prevalent in iatrogenic than in other etiologies. Idiopathic LTS involved less of the tracheal lumen than autoimmune or iatrogenic. There was no difference in number of surgeries per year of follow-up or surgery type performed by etiologic strata. Significantly more patients in the iatrogenic and autoimmune groups were tracheostomy-dependent at last follow-up compared to those in the traumatic or idiopathic groups. Patients with iatrogenic injuries had a significantly higher rate of tracheomalacia observed on bronchoscopic evaluation. The limits of retrospective review prevent direct objective data comparison on reflux episode frequency and severity between individuals and subgroups, and limited out-of-network medical record access prevented exploring the relationship between intubation length or tracheostomy procedure type and the ultimate injury severity or treatment outcome.
Bottom line: Laryngotracheal stenosis is not homogeneous, but has multiple distinct etiologies that demonstrate disparate rates of long-term tracheostomy dependence.
Citation: Gelbard A, Francis DO, Sandulache VC, Simmons JC, Donovan DT, Ongkasuwan J. Causes and consequences of adult laryngotracheal stenosis. Laryngoscope. 2015;125:-11431137.
—Reviewed by Amy Hamaker