Citations 2
Characterizing Disease Severity Through Surgical Recurrence Rates in Idiopathic Subglottic Stenosis
Bowen, Andrew J. , Awadallah, Andrew S. , McCalla, Monet, Roitman, Ariel , Ali, Hawa M. , Leverson, Glen, Khalil, Yousuf H. , Ring, Sydney , Edell, Eric S. , Xie, Katherine , Francis, David O. , Ekbom, Dale C. , Dailey, Seth H. , Bowen, Andrew Jay , Awadallah, Andrew , Ali, Hawa , Edell, Eric, Koster, Matthew, Xie, Katherine Z , Davis, Ruth , Francis, David O , Ekbom, Dale , Dailey, Seth H , Koster, Matthew J. , Bayan, Semirra L.
The Laryngoscope | May 21, 2025 | Volume: 135 | Issue: 10 | Pages: 3766-3773
ABSTRACTObjectiveThere is currently not a marker of disease severity in idiopathic subglottic stenosis (iSGS). Our objective was to characterize iSGS patients' disease severity using endoscopic surgery rates.MethodsThis was a two‐center retrospective analysis of iSGS patients with a minimum of 4 years of follow up following an initial endoscopic procedure (laser wedge excision (LWE) or endoscopic dilation (ED)). Disease severity was classified into Groups A–C, based on whether patients had fewer (Group A), the same number (Group B), or more surgeries (Group C) in years 3–5 compared to years 1 and 2. Disease severity proportions were compared across institutions using chi‐square analysis. Nonparametric testing compared clinical characteristics such as age, BMI, and GERD across severity groups.ResultsThere were 104 patients from institution 1 and 53 patients from institution 2 that were all female and predominantly Caucasian. Both institutions had clinically and statistically similar proportions of patients in Group A (64% vs. 62%), Group B (20% vs. 19%), and Group C (16% vs. 19%) disease (p > 0.05). No clinical characteristic (e.g., age, sex, race, BMI, GERD) was associated with disease severity.ConclusionAcross tertiary care institutions there is a consistent proportion of iSGS patients who either demonstrate nonrecurrent/decelerating (Group A), stable but persistent (Group B), or rapidly recurring disease (Group C). Two‐year surgery rates appear to be an important timepoint for providing expectations to patients on the likelihood of possessing severe disease.Level of Evidence4
Surgical Recurrence Across Endoscopic Surgical Techniques in Idiopathic Subglottic Stenosis
Bowen, Andrew J. , Awadallah, Andrew S. , Ali, Hawa M. , McCalla, Monet, Roitman, Ariel , Leverson, Glen, Khalil, Yousuf H. , Ring, Sydney , Edell, Eric S. , Xie, Katherine , Francis, David O. , Dailey, Seth H. , Ekbom, Dale C. , Bowen, Andrew Jay , Ali, Hawa , Edell, Eric, Koster, Matthew, Xie, Katherine Z , Davis, Ruth , Francis, David O , Dailey, Seth H , Ekbom, Dale , Awadallah, Andrew , Bayan, Semirra L. , Koster, Matthew J.
The Laryngoscope | April 15, 2025 | Volume: 135 | Issue: 9 | Pages: 3280-3286
ABSTRACTObjectiveWhile endoscopic laser wedge excision (LWE) for iSGS demonstrated lower surgical recurrence rates compared to endoscopic dilation (ED), ED remains the primary technique employed. Additionally, serial intralesional steroid injections (SILSIs) also demonstrate benefits in controlling disease. We aimed to compare surgical recurrence rates following ED, ED + SILSI, and LWE following a patient's first operation.MethodsThis was a two‐center retrospective analysis of iSGS patients who underwent either ED, ED + SILSI, or LWE. Patients were followed to their last follow‐up date or reoperation. Kaplan–Meier analysis and Cox proportional hazards were used to evaluate the recurrence times across the different surgical groups with additional stratification by age, compliance to medical adjuvant therapy, and percentage of stenosis rated at reoperation.ResultsA total of 126 patients from Institution 1 underwent LWE, while at Institution 2, ED and ED + SILSI were performed on 32 and 23 patients, respectively. One‐year recurrence estimates were 9%, 53%, and 0% for LWE, ED, and ED + SILSI, respectively, while 5‐year recurrence estimates were 45%, 90%, and 19%, respectively. Adjusted Cox‐proportional hazard ratios demonstrated a greater risk of surgical recurrence with ED compared to LWE (2.25; 95% confidence interval [CI]: 1.31–3.88) and no difference between ED + SILSI and LWE (0.84; 95% CI: 0.32–2.25).ConclusionLWE demonstrates reduced recurrence times compared to ED when controlling for surgery number, age, triple therapy compliance, and percentage of stenosis at reoperation. The application of postoperative SILSI appears to similarly reduce recurrence rates comparable to LWE and warrants further investigation.