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Original Investigation |

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis ONLINE FIRST

Idris Samad, MB, BCh1; Lee Akst, MD1; Selmin Karataylı-Özgürsoy, MD1; Kristine Teets, MA, CCC-SLP1; Marissa Simpson, MS, CCC-SLP1; Ashwyn Sharma, BS1; Simon R. A. Best, MD1; Alexander T. Hillel, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. Published online August 11, 2016. doi:10.1001/jamaoto.2016.2029
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Importance  Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response.

Objective  To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery.

Design, Setting, and Participants  This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery.

Main Outcomes and Measures  The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed.

Results  Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, −20.3; 95% CI, −27.9 to −12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, −2.2; 95% CI, −3.4 to −0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, −27.5 cm H2O/L/s; 95% CI, −44.8 to −10.3 cm H2O/L/s) postoperatively.

Conclusions and Relevance  Patients demonstrate statistically and clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons’ regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.

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Figure.
Treatment of Subglottic Stenosis (SGS) in a Representative Patient

A, Endolaryngeal view of SGS in situ before balloon dilation. B, Endolaryngeal view of SGS in situ with cold excision using the cryoprobe. C, Endolaryngeal view of SGS with a pulmonary balloon dilator. The balloon was inflated in situ. D, Endolaryngeal view of SGS in situ following balloon dilation.

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