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The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology

Published online by Cambridge University Press:  27 April 2016

M Wierzbicka ,
M Tokarski ,
M Puszczewicz  and
W Szyfter
M Wierzbicka*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poland
M Tokarski
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poland
M Puszczewicz
Affiliation:
Department of Rheumatology and Internal Medicine, Poznan University of Medical Sciences, Poland
W Szyfter
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poland
*
Address for correspondence: Dr Małgorzata Wierzbicka, Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Przybyszewskiego Str. 49, 60-356 Poznań, Poland E-mail: [email protected]
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Abstract

Objective:

To determine the long-term efficacy of submucosal corticosteroid injection plus dilatation for subglottic stenosis as a single modality treatment in granulomatosis with polyangiitis and relapsing polychondritis, as compared with idiopathic subglottic stenosis and traumatic subglottic stenosis.

Method:

Patients who underwent dilatation for autoimmune causes were identified. Corticosteroid injection into the submucosa of a stenotic segment was followed by serial dilatation. Definitive improvement was defined as good airway patency for more than 24 months with no further procedures needed. Clinical, demographic and procedural data were recorded.

Results:

Patients (n = 45) were divided into three subglottic stenosis groups: traumatic (n = 24), idiopathic (n = 9) and autoimmune (n = 12). Patients were treated with dilatations, with a median follow-up time of 76 months. Six patients were tracheostomy-dependent. There were no statistical differences in the number of final improvements between autoimmune, idiopathic and traumatic groups, with values of 75, 56 and 71 per cent, respectively. There was no statistical difference between granulomatosis with polyangiitis plus relapsing polychondritis and idiopathic subglottic stenosis in terms of decannulation rates.

Conclusion:

Granulomatosis with polyangiitis and relapsing polychondritis patients have better improvement rates than patients with other subglottic stenosis types.

Keywords

Acquired Subglottic StenosisRelapsing PolychondritisGranulomatosis With PolyangiitisDilatationIntralesional Injections
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 7 , July 2016 , pp. 674 - 679
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1Gelbard, A, Francis, DO, Sandulache, VC, Simmons, JC, Donovan, DT, Ongkasuwan, J.Causes and consequences of adult laryngotracheal stenosis. Laryngoscope 2015;125:1137–43CrossRefGoogle ScholarPubMed
2Pagnoux, C, Stubbe, M, Lifermann, F, Decaux, O, Pavic, M, Bérezné, A et al. Wegener's granulomatosis strictly and persistently localized to one organ is rare: assessment of 16 patients from the French Vasculitis Study Group database. J Rheumatol 2011;38:475–8CrossRefGoogle ScholarPubMed
3Holle, JU, Gross, WL, Holl-Ulrich, K, Ambrosch, P, Noelle, B, Both, M et al. Prospective long-term follow-up of patients with localised Wegener's granulomatosis: does it occur as persistent disease stage? Ann Rheum Dis 2010;69:1934–9CrossRefGoogle ScholarPubMed
4Langford, CA, Sneller, MC, Hallahan, CW, Hoffman, GS, Kammerer, WA, Talar-Williams, C et al. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis. Arthritis Rheum 1996;39:1754–60CrossRefGoogle ScholarPubMed
5Holle, JU, Dubrau, C, Herlyn, K, Heller, M, Ambrosch, P, Noelle, B et al. Rituximab for refractory granulomatosis with polyangiitis (Wegener's granulomatosis): comparison of efficacy in granulomatous versus vasculitic manifestations. Ann Rheum Dis 2012;71:327–33CrossRefGoogle ScholarPubMed
6Aries, PM, Hellmich, B, Voswinkel, J, Both, M, Nölle, B, Holl-Ulrich, K et al. Lack of efficacy of rituximab in Wegener's granulomatosis with refractory granulomatous manifestations. Ann Rheum Dis 2006;65:853–8CrossRefGoogle ScholarPubMed
7Hong, G, Kim, H.Clinical characteristics and treatment outcomes of patients with relapsing polychondritis with airway involvement. Clin Rheumatol 2013;32:1329–35CrossRefGoogle ScholarPubMed
8Watters, K, Russell, J.Subglottic stenosis in Wegener's granulomatosis and the nitinol stent. Laryngoscope 2003;113:2222–4CrossRefGoogle ScholarPubMed
9Wolter, NE, Ooi, EH, Witterick, IJ.Intralesional corticosteroid injection and dilatation provides effective management of subglottic stenosis in Wegener's granulomatosis. Laryngoscope 2010;120:2452–5CrossRefGoogle ScholarPubMed
10Arebro, J, Henriksson, G, Macchiarini, P, Juto, JE.New treatment of subglottic stenosis due to Wegener's granulomatosis. Acta Otolaryngol 2012;132:995–1001CrossRefGoogle ScholarPubMed
11Martinez Del Pero, M, Jayne, D, Chaudhry, A, Sivasothy, P, Jani, P.Long-term outcome of airway stenosis in granulomatosis with polyangiitis (Wegener granulomatosis): an observational study. JAMA Otolaryngol Head Neck Surg 2014;140:1038–44CrossRefGoogle ScholarPubMed
12Halmos, GB, Schuiringa, FS, Pálinkó, D, van der Laan, TP, Dikkers, FG.Finding balance between minimally invasive surgery and laryngotracheal resection in the management of adult laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2014;271:1967–71CrossRefGoogle ScholarPubMed
13Taylor, SC, Clayburgh, DR, Rosenbaum, JT, Schindler, JS.Clinical manifestations and treatment of idiopathic and Wegener granulomatosis-associated subglottic stenosis. JAMA Otolaryngol Head Neck Surg 2013;139:76–81CrossRefGoogle ScholarPubMed
14Gluth, MB, Shinners, PA, Kasperbauer, JL.Subglottic stenosis associated with Wegener's granulomatosis. Laryngoscope 2003;113:1304–7CrossRefGoogle ScholarPubMed
15Schokkenbroek, AA, Franssen, CF, Dikkers, FG.Dilatation tracheoscopy for laryngeal and tracheal stenosis in patients with Wegener's granulomatosis. Eur Arch Otorhinolaryngol 2008;265:549–55CrossRefGoogle ScholarPubMed
16Solans-Laqué, R, Bosch-Gil, J, Canela, M, Lorente, J, Pallisa, E, Vilardell-Tarrés, M.Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis. Lupus 2008;17:832–6CrossRefGoogle ScholarPubMed
17Hoffman, GS, Thomas-Golbanov, CK, Chan, J, Akst, LM, Eliachar, I.Treatment of subglottic stenosis, due to Wegener's granulomatosis, with intralesional corticosteroids and dilation. J Rheumatol 2003;30:1017–21Google ScholarPubMed
18Bakhos, D, Lescanne, E, Diot, E, Beutter, P, Morinière, S.Subglottic stenosis in Wegener's granulomatosis [in French]. Ann Otolaryngol Chir Cervicofac 2008;125:35–9CrossRefGoogle ScholarPubMed
19Nouraei, SA, Obholzer, R, Ind, PW, Salama, AD, Pusey, CD, Porter, F et al. Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis. Thorax 2008;63:49–52CrossRefGoogle ScholarPubMed
20Hseu, AF, Benninger, MS, Haffey, TM, Lorenz, R.Subglottic stenosis: a ten-year review of treatment outcomes. Laryngoscope 2014;124:736–41CrossRefGoogle ScholarPubMed
21Peters, JE, Salama, AD, Ind, PW.Wegener's granulomatosis presenting as acute systemic vasculitis following 20 years of limited tracheobronchial disease. J Laryngol Otol 2009;123:1375–7CrossRefGoogle ScholarPubMed
22Fowler, NM, Beach, JM, Krakovitz, P, Spalding, SJ.Airway manifestations in childhood granulomatosis with polyangiitis (Wegener's). Arthritis Care Res (Hoboken) 2012;64:434–40CrossRefGoogle ScholarPubMed
23Kent, PD, Michet, CJ Jr, Luthra, HS.Relapsing polychondritis. Curr Opin Rheumatol 2004;16:56–61CrossRefGoogle ScholarPubMed
24Ernst, A, Rafeq, S, Boiselle, P, Sung, A, Reddy, C, Michaud, G et al. Relapsing polychondritis and airway involvement. Chest 2009;135:1024–30CrossRefGoogle ScholarPubMed
25Holle, JU, Gross, WL, Latza, U, Nölle, B, Ambrosch, P, Heller, M et al. Improved outcome in 445 patients with Wegener's granulomatosis in a German vasculitis center over four decades. Arthritis Rheum 2011;63:257–66CrossRefGoogle Scholar
26Jordan, NP, Verma, H, Siddiqui, A, Morrison, GA, D'Cruz, DP.Morbidity and mortality associated with subglottic laryngotracheal stenosis in granulomatosis with polyangiitis (Wegener's granulomatosis): a single-centre experience in the United Kingdom. J Laryngol Otol 2014;128:831–7CrossRefGoogle ScholarPubMed
27Wester, JL, Clayburgh, DR, Stott, WJ, Schindler, JS, Andersen, PE, Gross, ND.Airway reconstruction in Wegener's granulomatosis-associated laryngotracheal stenosis. Laryngoscope 2011;121:2566–71CrossRefGoogle ScholarPubMed
28Xie, C, Shah, N, Shah, PL, Sandhu, G.Laryngotracheal reconstruction for relapsing polychondritis: case report and review of the literature. J Laryngol Otol 2013;127:932–5CrossRefGoogle ScholarPubMed
29Nouraei, SA, Sandhu, GS.Outcome of a multimodality approach to the management of idiopathic subglottic stenosis. Laryngoscope 2013;123:2474–84CrossRefGoogle Scholar
30Allen, CT, Lee, CJ, Meyer, TK, Hillel, AD, Merati, AL.Risk stratification in endoscopic airway surgery: is inpatient observation necessary? Am J Otolaryngol 2014;35:747–52CrossRefGoogle ScholarPubMed