Idiopathic Subglottic Stenosis: Factors Affecting Outcome After Single-Stage Repair

Abstract

Idiopathic subglottic stenosis is a rare inflammatory condition affecting the subglottic larynx. We have treated 263 patients (only 2 were male) with this condition. The purpose of this study is to determine factors affecting outcome and predisposing to complications. Information was gathered from chart reviews, surveys, and a prospective database. Median time from diagnosis to surgery was 24 months. Antinuclear antibodies when measured were positive in 76 patients (47%). Prior tracheal procedures were done in 58 patients (22%), and 184 patients (70%) had prior endoscopic procedures. Resection of the posterior cricoid mucosa with tracheal membranous wall flap was done in 150 patients (57%). Tailored cricoplasty was performed in 105 patients (40%). Extubation in the operating room was achieved in 247 patients (94%). Steroid therapy for edema was required in 63 patients (24%). Anastomotic complications occurred in 30 patients, 17 granulations and 7 subcutaneous air. Twenty-three patients (8.7%) have recurrence (14 mild, 9 recalcitrant) requiring dilation. Risk factors for anastomotic complications and recurrence were edema requiring steroids, use of mitomycin C, and prior tracheostomy, stents, and vocal cord involvement. Follow-up was available for 227 patients. Follow-up survey of 180 patients revealed, on a 10-point scale, effectiveness 9.4, satisfaction 9.4, and symptom improvement 9.4. A normal voice was present in 82 patients (45%); 96 patients (54%) had change in voice; and 121 patients (67%) had difficulty projecting their voice. Single-stage reconstructive surgery resulted in 96% good-to-excellent results. Recalcitrant stenosis developed in 4% of patients. Stents, postoperative edema, mitomycin use, and vocal cord involvement are risks for recurrence. Recurrence was related to reactivation of disease in 14 patients and to technical problems in 6 patients.