Idiopathic Laryngotracheal Stenosis Research Articles

Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes.

Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency. Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit. 129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only. This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study. 3 Laryngoscope, 133:908-913, 2023.

Pregnancy-associated idiopathic laryngotracheal stenosis: presentation, management and results of surgical treatment.

Idiopathic laryngotracheal stenosis (ILTS) is an uncommon problem arising mostly in women. In some, it arises during or is exacerbated by pregnancy. Experience with management of patients with this rare association is limited. This study seeks to evaluate the management of patients with pregnancy-associated ILTS and compare outcomes to cases not associated with pregnancy. Retrospective review of 15 patients undergoing surgical treatment of pregnancy-associated ILTS from 1971 to 2013. Variables of interest and airway outcomes were compared to patients with non-pregnancy-associated ILTS. Pregnancy-associated ILTS was observed in 15/263 (5.7%) patients. Symptoms developed during their first pregnancy. When compared to non-pregnancy patients, these patients were younger (37 vs 47 years; P = 0.0003), had more prior tracheostomies (26.7% vs 10.9%; P = 0.085) and had more preoperative airway dilatations (86.7% vs 57.7%; P = 0.030). All patients completed pregnancy without complications and ultimately underwent laryngotracheal resection. The expression of hormonal receptors in the surgical specimens was similar in both groups (oestrogen receptors: 100% vs 75% and progesterone receptors: 71.4% vs 72.1%, in pregnancy and non-pregnancy patients, respectively). Airway outcomes were good/excellent in 13 (86.7%) patients with pregnancy-associated ILTS and 225 (90.7%) patients without pregnancy association (P = 0.642), and did not change when adjusting for other risk factors. Pregnancy-associated ILTS is rare. The pathophysiology is unclear, but appearance of symptoms during pregnancy may suggest hormonal factors. To minimize foetal risk, dilatation during pregnancy followed by laryngotracheal resection after delivery is the preferred treatment. Pregnancy association does not seem to affect outcomes with expected satisfactory results in most patients.

IDIOPATHIC LARYNOTRACHEAL STENOSIS AND LOW ALPHA-ONE ANTITRYPSIN LEVELS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Idiopathic laryngotracheal stenosis (ILS) is an inflammatory condition resulting in the narrowing of the airway. (1) To date, in the literature, there has been no clear association between ILS and low alpha-one antitrypsin (A1AT) levels. We report a case in which a patient had both abnormalities and we postulate mechanisms through which low A1AT levels could cause airway stenosis. CASE PRESENTATION: A 57-year-old lady with a past medical history of Parkinson's disease was sent for a second opinion for shortness of breath and wheezing. She had been erroneously diagnosed with A1AT deficiency and was started on augmentation therapy. Physical examination demonstrated a hoarse voice and diffuse expiratory wheeze, but no stridor, emanating from the upper airway. Her A1AT level was 79 mg/dl (normal 80-220 mg/dl) and her A1AT phenotype was PI*MZ. Pulmonary function testing showed the following: FVC: 87%, FEV1: 82%, FEV1/FVC: 93% and DLCO: 91%. The flow-volume loop suggested a fixed airway obstruction. Chest and neck tomography showed a scant amount of secretions involving the superior aspect of the trachea inferior to the vocal cord. She underwent bronchoscopy, which revealed tracheal narrowing to 5mm in diameter approximately 3 cm below the vocal cords. There was a thick fibrous band on the left side and a few smaller webs tethering the trachea. There was also a tracheal diverticulum present on the left side of the thick fibrous band. The rest of the tracheobronchial tree was normal. Initially, endobronchial scissors and a YAG laser were used to cut the webs and the trachea partially unfolded. The trachea was then dilated from 10 to 15 mm in diameter. Complete tracheal patency was achieved. DISCUSSION: ILS is rare and is most commonly seen in post-menopausal women. Proposed mechanisms are related to estrogen, disruption of blood supply, gastroesophageal reflux, and unremitting cough. (2) Secondary causes of laryngotracheal stenosis include prolonged endotracheal intubation and autoimmune diseases such as granulomatosis with polyangiitis and sarcoidosis. (1) There is no clear evidence showing an association between low A1AT levels and ILS. A1AT is a potent inhibitor of proteases and is crucial in conserving the integrity of connective tissue. In patients with low A1AT levels, these proteolytic enzymes can lead to fibrosis and scarring. Though most commonly associated with emphysema, low levels of A1AT have also been associated with arterial fibromuscular dysplasia with evidence of altered extracellular matrix and connective tissue abnormalities. (3) Although causation is impossible to establish in this case, we speculate that low A1AT levels may have led to connective tissue dysregulation and stenotic lesions of the trachea. CONCLUSIONS: This case is the first report of ILS occurring in the setting of low levels of A1AT. We speculate that there may be a pathobiologic link between the two entities. Reference #1: Gelbard A, Francis DO, Sandulache VC, Simmons JC, Donovan DT, Ongkasuwan J. Causes and consequences of adult laryngotracheal stenosis.Laryngoscope.2015 May;125(5):1137-43. https://doi.org/10.1002/lary.24956. Epub 2014 Oct 7. Reference #2: Damrose EJ. On the development of idiopathic subglottic stenosis. Med Hypotheses. 2008;71(1):122-5. https://doi.org/10.1016/j.mehy.2007.12.017. Epub 2008 Mar 4. Reference #3: Schievink WI, Björnsson J, Parisi JE, Prakash UB. Arterial fibromuscular dysplasia associated with severe alpha 1-antitrypsin deficiency. Mayo Clin Proc. 1994 Nov;69(11):1040-3. DISCLOSURES: No relevant relationships by Hamzah Alfahel, source=Web Response No relevant relationships by Anthony Cucci, source=Web Response No relevant relationships by Ahmad JABRI, source=Web Response No relevant relationships by Sanjiv Tewari, source=Web Response No relevant relationships by Elizabeth Verghese, source=Web Response

Evaluating the utility of serological testing in laryngotracheal stenosis

Whereas mechanical (traumatic) causes of laryngotracheal stenosis (LTS) are identified based on history, autoimmune laryngotracheal stenosis (aLTS) and idiopathic laryngotracheal stenosis (iLTS) are often more difficult to differentiate. The objective of this study was to evaluate serologic testing in a large cohort of nonmechanical LTS patients to determine which tests, if any, lead clinicians to the etiology of the LTS. Retrospective chart review. This study reviewed nonmechanical LTS patients seen at a tertiary medical center from 2007 to 2014. Data were obtained on patient demographics, associated preexisting autoimmune conditions, comorbidities, intubation history, and serologic testing. Ninety-two records were reviewed. Twenty-three (25%) patients were found to have autoimmune disease; 69 (75%) met criteria for iLTS. A history of cigarette smoking was more significant in the aLTS group than the iLTS group (P < .001). Antineutrophil cytoplasmic antibody (ANCA) was positive only in patients with known granulomatosis with polyangiitis (GPA). All other serological testing was equivocal between the two cohorts. Differentiating iLTS from aLTS has proven difficult. The lack of information about the two entities has resulted in variability in the diagnostic workup to distinguish them. This study's finding of a more significant smoking history in the aLTS group correlates with the literature, which suggests an inflammatory effect of smoking cigarettes and an association with autoimmune disease. The only significant cohort of patients in this study found to have positive serological testing correlated with a diagnosable condition responsible for LTS was GPA patients with positive ANCA. 4. Laryngoscope, 127:1408-1412, 2017.

Complications after tracheal resection and reconstruction: prevention and treatment.

Tracheal resection and reconstruction (TRR) and laryngotracheal resection and reconstruction (LTRR) is commonly performed for post-intubation tracheal stenosis, tracheal tumor, idiopathic laryngotracheal stenosis (ILTS), and tracheoesophageal fistula (TEF). Ninety-five percent of patients have a good result from surgery. Complications occur in ~20% of patients, of which half are anastomotic complications. Complications include granulation tissue formation, restenosis of the trachea, anastomotic separation, TEF and tracheoinnominate fistula (TIF), wound infection, laryngeal edema, and glottic dysfunction. Risk factors for anastomotic complication include diabetes, reoperation, previous tracheal appliance, and long-segment tracheal resection. Bronchoscopy should be part of the diagnostic workup when a complication is suspected. Anastomotic separation-the most feared complication of tracheal surgery-may present subtly with stridor and wound infection, or with respiratory distress and extremis. Prompt management is required to prevent devastating consequences. The airway should be secured, bronchoscopy should be performed to address the degree of separation, and the anastomosis should be revised if needed, usually with the addition of t-tube or tracheostomy. Anastomotic complications that are managed aggressively typically yield good results. More than half of such patients will eventually have a satisfactory airway. However, an anastomotic complication is associated with a thirteen-fold increase in the risk of death following tracheal resection.

Idiopathic laryngotracheal stenosis.

Idiopathic laryngotracheal stenosis (ILTS) is a rare inflammatory disease of unknown etiology. Infectious, traumatic and immunologic processes must first be excluded. The majority of patients affected are female who present with progressive symptoms of upper airway obstruction, which can extend over a number of years. ILTS is characterized by short segment, circumferential stenotic lesions, located particularly at the level of the cricoid. Bronchoscopic evaluation is essential for establishing the diagnosis and operative planning. Various temporizing interventions have historically been utilized, including dilation and laser ablation, for symptomatic management. However these interventions have demonstrated diminishing returns and poor long-term outcomes. Patients with ILTS should be considered early for definitive surgical intervention to minimize complications and optimize outcomes. Laryngotracheal resection and reconstruction is a viable intervention, which has demonstrated good long-term results and low recurrence rates for this patient population.

Effects of Balloon Dilation for Idiopathic Laryngotracheal Stenosis on Voice Production.

To evaluate the effects of balloon dilation for idiopathic laryngotracheal stenosis on voice production. Retrospective review of 10 female patients with idiopathic laryngotracheal stenosis undergoing balloon dilation. Voice outcomes were evaluated by comparing pre- and posttreatment patient-reported, perceptual, aerodynamic, and acoustic parameters. Complete data sets were not available for all subjects; sample size for each parameter is reported with the corresponding result. Total Voice Handicap Index (VHI) decreased significantly (22.9 ± 13.5 to 6.8 ± 6.5; n = 8; p = .015), as did glottal function index (7.2 ± 4.9 to 1.5 ± 2.0; n = 6; p = .022). No changes were observed in the GRBAS (grade, roughness, breathiness, asthenia, strain) scale. Changes in aerodynamic parameters were not statistically significant. Percent jitter decreased (1.32 ± 1.37 to 0.60 ± 0.29; n = 7; P = .078), and fundamental frequency range was preserved (507 ± 325 to 612 ± 281; n = 7; P = .309). Our sample of patients with idiopathic laryngotracheal stenosis had a mild-moderate dysphonia that improved with balloon dilation. Importantly, adverse effects on voice that can occur with open procedures were not observed. Patient perception of dysphonia improved while fundamental frequency range was maintained and aerodynamic parameters remained within or moved toward the normal range. Larger prospective studies are warranted to further evaluate changes in voice production associated with balloon dilation.

Single-stage subchordal resection and reconstruction of idiopathic laryngotracheal stenosis in a male patient

Single-stage subchordal resection and reconstruction of idiopathic laryngotracheal stenosis in a male patient

Treatment of Idiopathic Laryngotracheal Stenosis

Idiopathic laryngotracheal stenosis is a very rare condition characterized by an inflammatory cicatricial stenosis at the level of the cricoid cartilage and proximal trachea. Treatment options range from conservative short-term solutions to definitive surgical resection and reconstruction.

Treatment of idiopathic laryngotracheal stenosis with laryngotracheal reconstruction

We evaluated the efficacy of laryngotracheal reconstruction with costal cartilage grafting for the treatment of idiopathic laryngotracheal stenosis. From January 2001 to December 2005, 129 patients with laryngotracheal stenosis were treated at our hospital. Of these patients, five (4 per cent) female patients whose ages ranged from 14 to 34 years were identified as having idiopathic laryngotracheal stenosis. These patients were treated with a modified laryngotracheal reconstruction with anterior costal cartilage grafting. A Montgomery T-tube remained in place for 12 to 22 months. Three patients presented with grade three and two with grade two stenosis. Three patients were decannulated after one procedure, with normal respiratory function and good exercise tolerance; one patient was decannulated after two procedures. One patient failed decannulation. The mean time to decannulation was 13 months. Laryngotracheal reconstruction with anterior costal cartilage grafting is a safe and effective method, and provides an alternative treatment for idiopathic laryngotracheal stenosis.

Przyczyny zwężeń krtaniowo-tchawiczych na podstawie przeglądu literatury i doświadczeń własnych

Laryngo-tracheal stenosis (LTS) is a relatively rare disease, caused usually by iatrogenic reasons (intubation, tracheotomy, radiotherapy and surgery of the larynx and trachea) or by trauma. However they may be caused by another rare diseases effecting the wall of the larynx and trachea (primary stenosis) or by compression of pathological process near by (secondary stenosis). Among the primary stenosis except iatrogenic and posttraumatic there are also: congenital, postinfective (tuberculosis, syphilis, scleroma, diphtheria, histoplasmosis and the other), in connective tissue diseases (Wegener's granulomatosis, relapsing polychondritis), in blister diseases (pemphigoid cicarticans, epidermolysis bullosa hereditaria), in amyloidosis, in sarcoidosis and tracheobronchopathia osteochondroplastica. Secondary stenosis may be effected by thyroid diseases, diseases of the big blood vessels of the thorax, hypertrophic thymus, enlargement of the lymph nodes near by the trachea, tumors and cysts of the neck and mediastinium, retrotracheal abscess and cold abscess in vertebral column tuberculosis. If the reason of stenosis is unknown, the stenosis is called idiopathic. In this publication basing on the literature review the reasons of LTS were described in details. We also present our clinical experience concerning 124 patients. The authors underline, that in most of patients the reason of LTS can be find after taking the history of a patient. However, in the cases, when the reason is not clear, a lot of specific examination should be done to find another rare reason, and only after exclusion it the diagnosis of idiopathic LTS can be established.

Idiopathic Tracheal Stenosis: Successful Outcome With Antigastroesophageal Reflux Disease Therapy

There is controversial evidence that gastroesophageal reflux disease (GERD) is an etiologic factor for idiopathic laryngotracheal stenosis. We present the case of a 44-year-old woman with symptomatic tracheal stenosis managed as idiopathic stenosis. She underwent six endoscopic dilations during 1 year, and before surgery she underwent 24-hour esophageal pH monitoring that documented GERD. Anti-GERD treatment was started, which was confirmed as effective with 24-hour esophageal pH monitoring 3 months later. At 2-year follow-up the patient remained free of symptoms and no additional airway procedure was necessary. A close relationship between anti-GERD therapy and clinical outcome was noted.

How does Cricotracheal Resection Affect the Female Voice?

We measured the effects of cricotracheal resection on the adult female voice. Voice recordings of 14 women (mean age, 53 years; range, 35 to 69 years) who underwent cricotracheal resection for chronic airway obstruction associated with idiopathic laryngotracheal stenosis were acquired before and after surgery. The recordings were analyzed with voice analysis software. The measures included the mean fundamental frequency of a sustained vowel at a comfortable pitch and loudness (F0), the mean F0 of connected speech (ie, speaking F0), the pitch range (F0 range), and the maximum phonation time. Self-assessment measures of the Voice Handicap Index were taken. The mean speaking F0 lowered significantly, by 21 Hz, from 186 Hz to 165 Hz (p = .04). In 7 patients, the speaking F0 was below 160 Hz after the operation. The mean sustained vowel frequency also dropped by 32 Hz (p = .03). The F0 range was reduced by an average of 5.9 semitones, from 21.5 to 15.6 (p = .05). The maximum phonation time did not change significantly. The postoperative mean Voice Handicap Index score was 21.9. Cricotracheal resection can significantly impact the adult female voice. It often lowers the pitch of the speaking voice into the male range and reduces the pitch range of the voice. The change in voice that potentially accompanies this procedure should be discussed with patients in preoperative counseling.

Total Idiopathic Laryngotracheal Stenosis. Treatment With Mitomycin C

This case report involves a 69-year-old woman who presented idiopathic laryngotracheal stenosis with total obstruction of the airway. Seven surgical procedures involving open field and endoscopy techniques had to be performed due to repeated re-obstructions. The novelty in this case is that success was finally obtained with the use of mitomycin C. The drug action is well known, but is interesting to report a case in which success was only obtained when we used mitomycin C.

Balloon Dilatation of the Trachea as Treatment for Idiopathic Laryngotracheal Stenosis

The treatment of choice for idiopathic tracheal stenosis is tracheal resection and anastomosis, although some authors prefer more conservative management. Between January 1, 1996 and January 1, 2005, 8 patients-all women-with idiopathic tracheal stenosis were treated in the chest surgery department of the Hospital Universitario La Fe in Valencia, Spain. One case was treated by means of surgery and so was excluded from this study. The remaining 7 women were treated by tracheal balloon dilatation; 4 required just 1 dilatation (and remained asymptomatic), 2 required 2 dilatations, and 1 required 4 dilatations. The median symptom-free interval was 25.5 months, and there was no associated mortality or morbidity. We conclude that balloon dilatation, which was not associated with mortality or morbidity, is a suitable treatment option for idiopathic tracheal stenosis.

Anastomotic complications after tracheal resection: Prognostic factors and management

ObjectiveWe sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients.MethodsThis was a single-institution, retrospective review of 901 patients who underwent tracheal resection.ResultsThe indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P = .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P = .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P = .002), lengthy (≥4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P = .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P = .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P = .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P = .04).ConclusionsTracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation. We sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients. This was a single-institution, retrospective review of 901 patients who underwent tracheal resection. The indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P = .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P = .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P = .002), lengthy (≥4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P = .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P = .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P = .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P = .04). Tracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation.

Anastomotic complications after tracheal resection: Prognostic factors and management

We sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients. This was a single-institution, retrospective review of 901 patients who underwent tracheal resection. The indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P = .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P = .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P = .002), lengthy (> or =4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P = .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P = .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P = .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P = .04). Tracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation.

Idiopathic laryngotracheal stenosis: Effective definitive treatment with laryngotracheal resection

Objective Little was known about idiopathic laryngotracheal stenosis when it was first described. We have operated on 73 patients with idiopathic laryngotracheal stenosis, have confirmed its mode of presentation and response to surgical therapy, and have established long-term follow-up. Methods Charts of 73 patients treated surgically for idiopathic laryngotracheal stenosis between 1971 and 2002 were retrospectively reviewed. Results All patients were treated with a single-staged laryngotracheal resection, with (36/73) and without (37/73) a posterior membranous tracheal wall flap. Nearly all were women (71/73), with a mean age of 46 years (range, 13-74 years). Twenty-eight (38%) of 73 had undergone a previous procedure with laser, dilation, tracheostomy, T-tube, or laryngotracheal operations. After laryngotracheal resection, the majority of patients (67/73) were extubated in the operating room, and 7 required temporary tracheostomies, only 1 of whom was among the last 30 patients. All were successfully decannulated. There was no perioperative mortality. Principal morbidity was alteration of voice quality, which was mild and tended to improve with time. Sixty-seven (91%) of 73 patients had good to excellent long-term results with voice and breathing quality and do not require further intervention for their idiopathic laryngotracheal stenosis. Conclusion Idiopathic laryngotracheal stenosis is an entity that occurs almost exclusively in women and is without a known cause. It is not a progressive process, but the timing of the operation is crucial. Single-staged laryngotracheal resection is successful in restoring the airway while preserving voice quality in more than 90% of patients. Protective tracheostomy is now rarely required (1/30). Long-term follow-up shows a stable airway and improvement in voice quality.

Successful treatment of idiopathic laryngotracheal stenosis by resection and primary anastomosis.

We studied the early and long-term response of idiopathic laryngotracheal stenosis (ILTS) to treatment by 1-stage laryngotracheal or tracheal resection and reconstruction in 73 patients. Nineteen of the 72 (26%) noted no difference in their voices or any difficulty in breathing after reconstruction. Forty-seven (64%) described loss of ability to project their voices as loudly as before or noted some difficulty in singing as well as they did before. Five (7%) had various degrees of dyspnea or stridor on effort. One needed continued dilation. The median follow-up was 8 years. Surgical treatment gave good or excellent results in 90% of these patients with ILTS. Recurrence or progression of stenosis was not evident.

Idiopathic laryngotracheal stenosis: radiologic findings.

Acquired nonneoplastic laryngotracheal stenosis can be either focal or diffuse. Diffuse tracheal stenosis is caused by sarcoidosis, tuberculosis, histoplasmosis, relapsing polychondritis, tracheopathia osteoplastica, and Wegener's granulomatosis. Focal tracheal stenosis, on the other hand, usually results from placement of an endotracheal or tracheostomy tube or from previous neck trauma. At our institution, since 1971, we have seen 49 cases of focal laryngotracheal stenosis that could not be attributed clinically or histologically to any one of the aforementioned causes. The purpose of this study was to study the radiologic features of these idiopathic laryngotracheal stenoses. A retrospective review of records showed that radiologic studies were still available in only 15 of the 49 patients with idiopathic laryngotracheal stenoses. All 15 patients had radiographs and plain tomograms, and one patient had a CT scan of the neck. Three radiologists reviewed all the images. The radiologic appearance was variable: the stenoses were from 2 to 4 cm long with a lumen between 3 and 5 mm in diameter at the narrowest portion. The narrowing was concentric and shaped like an hourglass in eight patients (53%) and was eccentric in the other seven (47%). The margins of the stenosis were smooth in nine patients (60%) and irregular and lobulated in six patients (40%). A dominant mass measuring approximately 1 cm in diameter was present in two patients (13%). No evidence of calcification or ossification was seen. Idiopathic laryngotracheal stenosis produces focal stenosis of the cervical part of the trachea, 2 to 4 cm long. The lumen is severely compromised, measuring no more than 5 mm in diameter at its narrowest portion. The stenosis can be concentric or eccentric and can have either smooth or lobulated margins. Special attention should be paid to the airways when chest radiographs of patients with a history of prolonged dyspnea and wheezing are reviewed. The prevalence of focal stenosis of the larynx and the upper part of the trachea due to tracheal intubation has declined since the introduction of low-pressure, high-volume retention cuffs. Therefore, idiopathic laryngotracheal stenosis should be considered in the differential diagnosis in patients with focal narrowing of the airway.