Smoking History and ANCA Testing Correlate with Nonmechanical LTS

Which tests, if any, lead clinicians to the etiology of laryngotracheal stenosis (LTS) in serologic testing in a large cohort of nonmechanical LTS patients?

Bottom line
The finding of a more significant smoking history in the autoimmune LTS (aLTS) group than in the idiopathic LTS (iLTS) group suggests an inflammatory effect of smoking cigarettes and an association with autoimmune disease. GPA patients with positive antineutrophil cytoplasmic antibody (ANCA) were the only significant cohort of patients in this study found to have positive serological testing correlated with a diagnosable condition responsible for LTS.

Background: Although mechanical (traumatic) causes of LTS are often easily identified based on patient history, aLTS and iLTS are more difficult to differentiate—specifically, there is not a consensus on what diagnostic testing should be performed following stenosis identification.

Study design: Retrospective chart review of 92 nonmechanical LTS patients (69 with iLTS and 23 with aLTS) seen at a tertiary medical center from 2007 to 2014.

Setting: Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix.

Synopsis: The iLTS cohort consisted primarily of middle-aged, Caucasian, and female participants; the aLTS cohort also consisted predominately of middle-aged and Caucasian patients, but was less female predominate. Among comorbid conditions considered (diabetes mellitus, asthma, chronic obstructive pulmonary disease, obstructive sleep apnea, GERD), there were no significant differences between groups. There was a significant difference in tobacco usage (never smoked: iLTS 91.3%, aLTS 68.3%; former smokers: iLTS 5.8%, aLTS 31.8%; current smokers; iLTS 2.9%, aLTS 0%). In comparing serology, antineutrophil cytoplasmic antibody (ANCA) was the only significantly different result between the two groups. The ANCA test was negative in all of the 24 iLTS patients tested. Eleven aLTS patients tested for ANCA were positive; all 11 patients were diagnosed with granulomatosis with polyangiitis (GPA). Limitations included non-standardized data collection and recording, and the rarity of iLTS and aLTS, making it difficult to achieve enough power to determine small differences.

Citation: Hall SR, Allen CT, Merati AL, Mayerhoff RM. Evaluating the utility of serological testing in laryngotracheal stenosis. Laryngoscope. 2017;127:1408–1412.