Idiopathic subglottic stenosis: pre-treatment, surgical procedures and voice outcome in a series of 23 consecutive patients

Background:

Idiopathic subglottic stenosis is a rare disease characterize by a slow, progressive scarring of the subglottic space leading to dyspnea and stridor. Usually, the initial treatment consists of endoscopic procedures such as laser ablation and dilation. However, only surgical treatment leads to long-term recurrence free survival.

Material and method:

From December 2013 to February 2019, 23 patients with idiopathic subglottic stenosis received laryngotracheal surgery at our institution. They were treated with cricotracheal resection (CTR), extended cricotracheal resection (eCTR) or laryngotracheal reconstruction with rip cartilage (SSLTR). The objective outcome was recorded using the RBH score and the Dysphonia Severity Index (DSI). In addition, a subset of patients was questioned regarding their subjective outcome using the Sandhu Score.

Result:

The cohort consisted of women (100%) with a mean age at the time of surgery of 55.13 years (26 – 77). 6 (26.1%) patients were without and 17 (73.9%) with endoscopic pretreatment. The mean number of endoscopic pretreatment was 4.59 procedures (range 1 – 14). At referral for surgery, 22 (95.7%) patients were graded as Cotton-Myer III°. 6 (26.1%) patients had a cricotracheal resection (CTR) and 13 (56.5%) received extended cricotracheal resection (eCTR). In 4 patients a complex reconstruction with insertion of a rip cartilage (SSLTR) was necessary to achieve a satisfactory result. The preoperative DSI (n = 13) changed from 3.01 (range -2.22 – 9.05) to -1.18 (range -33.35 – 7.09) post-operatively. The RBH score (n = 18) increased from R = 0.95, B = 0.58 and H = 0.95 to postoperative R = 1.78, B = 0.94 and H = 1.78. The self-reported postoperative quality of life measured by the Sandhu score (n = 8) revealed an excellent result regarding dyspnea (1.25) and slight limitation regarding voice (2.38).

Conclusion:

In experienced centers, the surgical treatment of idiopathic subglottic stenosis results in a very good functional outcome quantified by objective and perceptive parameters. Although the respiratory function can be fully restored, patients need to be aware of a measurable decrease of the quality of voice.