PMID- 28988454
OWN - NLM
STAT- MEDLINE
DCOM- 20181009
LR  - 20220410
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Linking)
VI  - 128
IP  - 3
DP  - 2018 Mar
TI  - Awake serial intralesional steroid injections without surgery as a novel targeted 
      treatment for idiopathic subglottic stenosis.
PG  - 610-617
LID - 10.1002/lary.26874 [doi]
AB  - OBJECTIVES/HYPOTHESIS: The fibrotic/erythematous appearance of the subglottis in 
      idiopathic subglottic stenosis (iSGS) hints that it might respond to repeated 
      intralesional steroid treatment similar to keloids. STUDY DESIGN: Retrospective 
      cohort study. METHODS: Thirteen iSGS subjects (six treated in-office with serial 
      intralesional steroid injections [SILSI] versus seven treated endoscopically in 
      the operating room [OR] followed by awake SILSI) between October 2011 and April 
      2017. Forced spirometry was performed before injections and at each follow-up 
      visit (peak expiratory flow [%PEF] and peak inspiratory flow). Steroids were 
      injected via transcricothyroid or transnasal routes. Injections were grouped into 
      rounds of four to six injections separated by 3 to 5 weeks. RESULTS: Thirteen 
      subjects with a mean follow-up of 3 years (3.3 years for SILSI and 2.7 years for 
      OR). Awake-only SILSI subjects had a mean improvement/round of 23.1% %PEF (range, 
      65.4%-88.6%), whereas the OR-treated subjects had a mean %PEF improvement/round 
      of 25.1% (range, 57.4%-82.5%). Both groups had improved breathing, and the 
      improvements were statistically equal (P = .569). SILSI subjects underwent 5.3 
      injections/round in 1.3 rounds, whereas OR subjects had 5.9 injections/round over 
      2.1 rounds. Statistically significant improvement was seen in %PEF for both 
      groups (SILSI P = .007, OR P = .002). Overall, SILSI achieved sustained %PEF 
      above 80% in 83% (5/6) and OR + SILSI 86% (6/7). CONCLUSIONS: SILSI in the awake 
      outpatient setting can improve the airway caliber in iSGS and is equivalent to 
      endoscopic OR treatment. We believe iSGS can be viewed as a chronic 
      scarring/inflammatory condition that can benefit from steroid scar-modification 
      therapy. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:610-617, 2018.
CI  - (c) 2017 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Franco, Ramon A Jr
AU  - Franco RA Jr
AUID- ORCID: 0000-0002-4549-6017
AD  - Division of Laryngology, Department of Otolaryngology, Harvard Medical School and 
      Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
FAU - Husain, Inna
AU  - Husain I
AD  - Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, 
      U.S.A.
FAU - Reder, Lindsay
AU  - Reder L
AD  - Department of Otolaryngology, University of Southern California, Los Angeles, 
      California, U.S.A.
FAU - Paddle, Paul
AU  - Paddle P
AD  - Monash Health and Alfred Health, Victoria, Melbourne, Australia.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20171008
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
RN  - 0 (Steroids)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Glottis
MH  - Humans
MH  - Injections, Intralesional
MH  - Laryngostenosis/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Peak Expiratory Flow Rate
MH  - Retrospective Studies
MH  - Spirometry
MH  - Steroids/*administration & dosage
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Airway stenosis
OT  - idiopathic subglottic stenosis
OT  - in-office treatment
OT  - reconstruction
OT  - steroid injection
EDAT- 2017/10/11 06:00
MHDA- 2018/10/10 06:00
CRDT- 2017/10/09 06:00
PHST- 2016/12/29 00:00 [received]
PHST- 2017/07/15 00:00 [revised]
PHST- 2017/07/26 00:00 [accepted]
PHST- 2017/10/11 06:00 [pubmed]
PHST- 2018/10/10 06:00 [medline]
PHST- 2017/10/09 06:00 [entrez]
AID - 10.1002/lary.26874 [doi]
PST - ppublish
SO  - Laryngoscope. 2018 Mar;128(3):610-617. doi: 10.1002/lary.26874. Epub 2017 Oct 8.