Clinical Profile of Patients with Laryngotracheal Stenosis in a Tertiary Government Hospital

Abstract

Objective: To describe the clinical profile of patients with laryngotracheal stenosis over a 7-year period and discuss strategies for its prevention.
 Methods: 
 Study Design: Retrospective Case Series
 Setting: Tertiary Government Hospital
 Participants: Patients with laryngotracheal stenosis confirmed by laryngoscopy and/or bronchoscopy
 Results: Twenty-one patients were evaluated for laryngotracheal stenosis from January 2008 to June 2015, but only 13 with complete data were included in this study. Of the 13 patients, nine (69.2%) belonged to the pediatric age group. Ten (77%) were males and three (23%) were females. Laryngotracheal stenosis following endotracheal tube (ET) intubation was seen in 11 (84.6%) while 2 had thyroid masses and no history of prior ET intubation. Presenting symptoms or reasons for referral were wheezing (n=4), stridor (n=4), failure to decannulate the tracheostomy tube (n=3), and dyspnea (n=2). Duration of ET intubation was four to 60 days. The highest frequency of ET re-intubation was 5 times. Among those intubated, stenosis was glottic in one, subglottic in five and tracheal in five patients. Three had Cotton-Myer grade I stenosis, two had grade II, three had grade III and three had grade IV stenosis. Those with thyroid masses had tracheal stenosis.
 Conclusion: Strategies for prevention of laryngotracheal stenosis should include routine airway endoscopy for patients with longstanding neck masses and for those with prolonged ET intubation, for whom the option of early prophylactic tracheostomy is worth considering. Otherwise, immediate post-extubation endoscopy may facilitate documentation and appropriate intervention.
 Keywords: acquired laryngeal stenosis; tracheal stenosis; endoscopy; intubation, intratracheal; tracheostomy