PMID- 34117778 OWN - NLM STAT- MEDLINE DCOM- 20211124 LR - 20220302 IS - 1531-4995 (Electronic) IS - 0023-852X (Print) IS - 0023-852X (Linking) VI - 131 IP - 12 DP - 2021 Dec TI - Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis. PG - E2880-E2886 LID - 10.1002/lary.29675 [doi] AB - OBJECTIVES/HYPOTHESIS: Adjuvant medications including proton pump inhibitors (PPI), antibiotics (trimethoprim/sulfamethoxazole [TMP-SMX]), and inhaled corticosteroids (ICS) may be prescribed for patients with idiopathic subglottic stenosis (iSGS). We describe medication use with endoscopic dilation (ED) or endoscopic resection with medical treatment (ERMT) and evaluate impact on outcomes. STUDY DESIGN: International, prospective, 3-year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. METHODS: Post hoc secondary analysis of prospectively collected North American Airway Collaborative data on outcomes linked with adjuvant medication utilization. Primary outcome was time to recurrent operation, evaluated using Kaplan-Meier curves and Cox regression analysis. Secondary outcomes of change in peak expiratory flow (PEF) and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score over 12 months were compared. RESULTS: Sixty-one of 129 patients undergoing ED received PPI (47%), and 10/143 patients undergoing ED received ICS (7%). TMP-SMX was used by 87/115 patients (76%) undergoing EMRT. PPI use in the ED group did not affect time to recurrence (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.53-1.88; P = .99) or 12-month change in PEF (L/min) (median [interquartile range], 12.0 [10.7-12.2] vs. 8.7 [-5.1 to 24.9]; P = .59), but was associated with 12-month change in CCQ (-0.05 [-0.97 to 0.75] vs. -0.50 [-1.60 to 0.20]; P = .04). ICS did not affect outcome measures. TMP-SMX use in ERMT did not affect time to recurrence (HR = 0.842, 95% CI: 0.2345-3.023; P = .79), PEF at 12 months (75 [68-89] vs. 81 [68-89]; P = .92), or 12-month change in CCQ (0.20 [-1.05 to 0.47] vs. -0.30 [-1.00 to 0.10]; P = .45). CONCLUSION: There is no standard practice for prescribing adjuvant medications. These data do not support that adjuvant medications prolong time to recurrence or increase PEF. Patients with iSGS and gastroesophageal reflux disease may experience some symptom benefit with PPI. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2880-E2886, 2021. CI - (c) 2021 The American Laryngological, Rhinological and Otological Society, Inc.. FAU - Hoffman, Matthew R AU - Hoffman MR AUID- ORCID: 0000-0002-1923-0039 AD - Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama, U.S.A. AD - Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A. FAU - Patro, Ankita AU - Patro A AUID- ORCID: 0000-0001-8370-9071 AD - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. FAU - Huang, Li-Ching AU - Huang LC AD - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, U.S.A. FAU - Chen, Sheau-Chiann AU - Chen SC AD - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, U.S.A. FAU - Berry, Lynn D AU - Berry LD AD - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, U.S.A. FAU - Gelbard, Alexander AU - Gelbard A AUID- ORCID: 0000-0003-0078-1305 AD - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. FAU - Francis, David O AU - Francis DO AD - Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A. CN - North American Airway Collaborative LA - eng GR - R01 CA251566/CA/NCI NIH HHS/United States GR - 1409-22214/Patient Centered Outcomes Research Institute/ GR - R21016724-01/National Institute for Deafness and Communication Disorders/ GR - R01 HL146401/HL/NHLBI NIH HHS/United States GR - R01CA251566-01/CA/NCI NIH HHS/United States GR - R01HL146401-01/HL/NHLBI NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20210612 PL - United States TA - Laryngoscope JT - The Laryngoscope JID - 8607378 RN - 0 (Anti-Bacterial Agents) RN - 0 (Anti-Inflammatory Agents) RN - 0 (Proton Pump Inhibitors) SB - IM MH - Adult MH - Anti-Bacterial Agents/*therapeutic use MH - Anti-Inflammatory Agents/*therapeutic use MH - Combined Modality Therapy MH - Dilatation/*methods/statistics & numerical data MH - Female MH - Humans MH - Laryngoscopy/*methods/statistics & numerical data MH - Laryngostenosis/*therapy MH - Male MH - Middle Aged MH - Prospective Studies MH - Proton Pump Inhibitors/*therapeutic use MH - Recurrence MH - Time Factors MH - Treatment Outcome PMC - PMC8762605 MID - NIHMS1768363 OTO - NOTNLM OT - Idiopathic subglottic stenosis OT - adjuvant medical treatment OT - endoscopic dilation OT - endoscopic resection with medical therapy OT - inhaled corticosteroid OT - proton pump inhibitor OT - trimethoprim-sulfamethoxazole COIS- Conflicts of Interest: None. FIR - Anderson, Catherine IR - Anderson C FIR - Amin, Milan R IR - Amin MR FIR - Benninger, Michael S IR - Benninger MS FIR - Blumin, Joel H IR - Blumin JH FIR - Bock, Jonathan M IR - Bock JM FIR - Bryson, Paul C IR - Bryson PC FIR - Castellanos, Paul F IR - Castellanos PF FIR - Clary, Matthew S IR - Clary MS FIR - Cohen, Seth M IR - Cohen SM FIR - Crawley, Brianna K IR - Crawley BK FIR - Dailey, Seth H IR - Dailey SH FIR - Daniero, James J IR - Daniero JJ FIR - de Alarcon, Alessandro IR - de Alarcon A FIR - Donovan, Donald T IR - Donovan DT FIR - Edell, Eric S IR - Edell ES FIR - Ekbom, Dale C IR - Ekbom DC FIR - Fink, Daniel S IR - Fink DS FIR - Franco, Ramon A IR - Franco RA FIR - Garrett, C Gaelyn IR - Garrett CG FIR - Guardiani, Elizabeth A IR - Guardiani EA FIR - Hillel, Alexander T IR - Hillel AT FIR - Hoffman, Henry T IR - Hoffman HT FIR - Hogikyan, Norman D IR - Hogikyan ND FIR - Howell, Rebecca J IR - Howell RJ FIR - Johns, Michael M IR - Johns MM FIR - Kasperbauer, Jan L IR - Kasperbauer JL FIR - Khosla, Sid M IR - Khosla SM FIR - Kinnard, Cheryl IR - Kinnard C FIR - Kupfer, Robbi A IR - Kupfer RA FIR - Langerman, Alexander J IR - Langerman AJ FIR - Lentz, Robert J IR - Lentz RJ FIR - Lorenz, Robert R IR - Lorenz RR FIR - Lott, David G IR - Lott DG FIR - Makani, Samir S IR - Makani SS FIR - Maldonado, Fabien IR - Maldonado F FIR - Mannion, Kyle IR - Mannion K FIR - Matrka, Laura IR - Matrka L FIR - McWhorter, Andrew J IR - McWhorter AJ FIR - Merati, Albert L IR - Merati AL FIR - Mori, Matthew IR - Mori M FIR - Netterville, James L IR - Netterville JL FIR - O'Dell, Karla IR - O'Dell K FIR - Ongkasuwan, Julina IR - Ongkasuwan J FIR - Postma, Gregory N IR - Postma GN FIR - Reder, Lindsay S IR - Reder LS FIR - Rohde, Sarah L IR - Rohde SL FIR - Richardson, Brent E IR - Richardson BE FIR - Rickman, Otis B IR - Rickman OB FIR - Rosen, Clark A IR - Rosen CA FIR - Rutter, Michael J IR - Rutter MJ FIR - Sandhu, Guri S IR - Sandhu GS FIR - Schindler, Joshua S IR - Schindler JS FIR - Schneider, G Todd T IR - Schneider GTT FIR - Shah, Rupali N IR - Shah RN FIR - Sikora, Andrew G IR - Sikora AG FIR - Sinard, Robert J IR - Sinard RJ FIR - Smith, Marshall E IR - Smith ME FIR - Smith, Libby J IR - Smith LJ FIR - Soliman, Ahmed Ms IR - Soliman AM FIR - Sveinsdottir, Sigriethur IR - Sveinsdottir S FIR - Van Daele, Douglas J IR - Van Daele DJ FIR - Veivers, David IR - Veivers D FIR - Mepi IR - Mepi FIR - Verma, Sunil P IR - Verma SP FIR - Weinberger, Paul M IR - Weinberger PM FIR - Weissbrod, Philip A IR - Weissbrod PA FIR - Wootten, Christopher T IR - Wootten CT FIR - Shyr, Yu IR - Shyr Y EDAT- 2021/06/13 06:00 MHDA- 2021/11/25 06:00 PMCR- 2022/03/01 CRDT- 2021/06/12 08:35 PHST- 2021/05/20 00:00 [revised] PHST- 2021/03/01 00:00 [received] PHST- 2021/05/27 00:00 [accepted] PHST- 2021/06/13 06:00 [pubmed] PHST- 2021/11/25 06:00 [medline] PHST- 2021/06/12 08:35 [entrez] PHST- 2022/03/01 00:00 [pmc-release] AID - 10.1002/lary.29675 [doi] PST - ppublish SO - Laryngoscope. 2021 Dec;131(12):E2880-E2886. doi: 10.1002/lary.29675. Epub 2021 Jun 12.