Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T07:31:12.774Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk factors for adult acquired subglottic stenosis

Published online by Cambridge University Press:  23 December 2016

E A Nicolli ,
R M Carey ,
D Farquhar ,
S Haft ,
K P Alfonso  and
N Mirza
E A Nicolli
Affiliation:
Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA Department of Otolaryngology: Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
R M Carey*
Affiliation:
Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA
D Farquhar
Affiliation:
Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA Department of Otolaryngology: Head and Neck Surgery, University of North Carolina, Chapel Hill, USA
S Haft
Affiliation:
Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA Division of Otolaryngology, University of California, San Diego, USA
K P Alfonso
Affiliation:
Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA Department of Otolaryngology: Head and Neck Surgery, University of Kentucky, Lexington, USA
N Mirza
Affiliation:
Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA
*
Address for correspondence: Dr Ryan Carey, Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, 5 Ravdin, Philadelphia, PA 19104, USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aetiology and outcomes for patients with acquired subglottic stenosis are highly variable. This study aimed to identify risk factors for subglottic stenosis and patient characteristics that predict long-term clinical outcomes.

Methods:

A retrospective review was performed on 63 patients with subglottic stenosis and 63 age-matched controls. Patient demographics and clinical characteristics were compared. Subglottic stenosis patients were further grouped according to tracheostomy status (i.e. tracheostomy never required, tracheostomy initially required but patient eventually decannulated, and tracheostomy-dependent). Patient factors from these three groups were then compared to evaluate risk factors for long-term tracheostomy dependence.

Results:

Compared to controls, patients with subglottic stenosis had a significantly higher body mass index (30.8 vs 26.0 kg/m2; p < 0.001) and were more likely to have diabetes (23.8 per cent vs 7.94 per cent; p = 0.01). Comparing tracheostomy outcomes within the subglottic stenosis group, body mass index trended towards significance (p = 0.08). Age, gender, socio-economic status, subglottic stenosis aetiology and other co-morbidities did not correlate with outcome.

Conclusion:

Obesity and diabetes are significant risk factors for acquiring subglottic stenosis. Further investigations are required to determine if obesity is also a predictor for failed tracheostomy decannulation in subglottic stenosis.

Keywords

LaryngostenosisInflammationObesityTracheostomyDiabetes Mellitus
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 3 , March 2017 , pp. 264 - 267
Copyright
Copyright © JLO (1984) Limited 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at the American Broncho-Esophagological Association Annual Meeting, 14–15 May 2014, Las Vegas, Nevada, USA.

References

1 Lorenz, RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg 2003;11:467–72CrossRefGoogle ScholarPubMed
2 Nouraei, SA, Ma, E, Patel, A, Howard, DJ, Sandhu, GS. Estimating the population incidence of adult post-intubation laryngotracheal stenosis. Clin Otolaryngol 2007;32:411–12Google Scholar
3 Zias, N, Chroneou, A, Tabba, MK, Gonzalez, AV, Gray, AW, Lamb, CR et al. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med 2008;8:18 Google Scholar
4 Herrington, HC, Weber, SM, Andersen, PE. Modern management of laryngotracheal stenosis. Laryngoscope 2006;116:1553–7CrossRefGoogle ScholarPubMed
5 Hseu, AF, Benninger, MS, Haffey, TM, Lorenz, R. Subglottic stenosis: a ten-year review of treatment outcomes. Laryngoscope 2014;124:736–41CrossRefGoogle ScholarPubMed
6 Melkane, AE, Matar, NE, Haddad, AC, Nassar, MN, Almoutran, HG, Rohayem, Z et al. Management of postintubation tracheal stenosis: appropriate indications make outcome differences. Respiration 2010;79:395–401 Google Scholar
7 Hirshoren, N, Eliashar, R. Wound-healing modulation in upper airway stenosis--myths and facts. Head Neck 2009;31:111–26Google Scholar
8 Branski, RC, Sandulache, VC, Dohar, JE, Hebda, PA. Mucosal wound healing in a rabbit model of subglottic stenosis: biochemical analysis of secretions. Arch Otolaryngol Head Neck Surg 2005;131:153–7CrossRefGoogle Scholar
9 Coker, RK, Laurent, GJ, Shahzeidi, S, Lympany, PA, du Bois, RM, Jeffery, PK et al. Transforming growth factors-beta 1, -beta 2, and -beta 3 stimulate fibroblast procollagen production in vitro but are differentially expressed during bleomycin-induced lung fibrosis. Am J Pathol 1997;150:981–91Google Scholar
10 Branski, RC, Rosen, CA, Verdolini, K, Hebda, PA. Markers of wound healing in vocal fold secretions from patients with laryngeal pathology. Ann Otol Rhinol Laryngol 2004;113:23–9CrossRefGoogle ScholarPubMed
11 Ghosh, A, Philiponis, G, Lee, JY, Leahy, KP, Singhal, S, Cohen, NA et al. Pulse steroid therapy inhibits murine subglottic granulation. Otolaryngol Head Neck Surg 2013;148:284–90Google Scholar
12 Haft, S, Lee, JY, Ghosh, A, Philiponis, G, Malaisrie, N, Leahy, KP et al. Inflammatory protein expression in human subglottic stenosis tissue mirrors that in a murine model. Ann Otol Rhinol Laryngol 2014;123:65–70 CrossRefGoogle ScholarPubMed
13 Puyo, CA, Dahms, TE. Innate immunity mediating inflammation secondary to endotracheal intubation. Arch Otolaryngol Head Neck Surg 2012;138:854–8CrossRefGoogle ScholarPubMed
14 Wisse, BE. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol 2004;15:2792–800CrossRefGoogle ScholarPubMed
15 Pickup, JC, Crook, MA. Is type II diabetes mellitus a disease of the innate immune system? Diabetologia 1998;41:1241–8CrossRefGoogle ScholarPubMed
16 Ettema, SL, Loerhl, TA, Toohill, RJ, Merati, AL. The prevalence of diabetes in a series of patients with subglottic stenosis. Ear Nose Throat J 2007;86:687–90CrossRefGoogle Scholar
17 Sinacori, JT, Taliercio, SJ, Duong, E, Benson, C. Modalities of treatment for laryngotracheal stenosis: the EVMS experience. Laryngoscope 2013;123:3131–6CrossRefGoogle ScholarPubMed
18 Tawfik, KO, Houlton, JJ, Compton, W, Ying, J, Khosla, SM. Laryngotracheal reconstruction: a ten-year review of risk factors for decannulation failure. Laryngoscope 2015;125:674–9Google Scholar
19 Blumin, JH, Johnston, N. Evidence of extraesophageal reflux in idiopathic subglottic stenosis. Laryngoscope 2011;121:1266–73CrossRefGoogle ScholarPubMed
20 Maronian, NC, Azadeh, H, Waugh, P, Hillel, A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol 2001;110:606–12CrossRefGoogle ScholarPubMed
21 Walner, DL, Stern, Y, Gerber, ME, Rudolph, C, Baldwin, CY, Cotton, RT. Gastroesophageal reflux in patients with subglottic stenosis. Arch Otolaryngol Head Neck Surg 1998;124:551–5Google Scholar