Alexander Gelbard
Last active: 7/30/2020

Causes and consequences of adult laryngotracheal stenosis.

Gelbard A, Francis DO, Sandulache VC, Simmons JC, Donovan DT, Ongkasuwan J
Laryngoscope. 2015 125 (5): 1137-43

PMID: 25290987 · PMCID: PMC4562418 · DOI:10.1002/lary.24956

OBJECTIVES/HYPOTHESIS - Laryngotracheal stenosis (LTS) is largely considered a structural entity, defined on anatomic terms (i.e., percent stenosis, distance from vocal folds, overall length). This has significant implications for identifying at-risk populations, devising systems-based preventive strategies, and promoting patient-centered treatment. The present study was undertaken to test the hypothesis that LTS is heterogeneous with regard to etiology, natural history, and clinical outcome.

STUDY DESIGN - Retrospective cohort study of consecutive adult tracheal stenosis patients from 1998 to 2013.

METHODS - Subjects diagnosed with laryngotracheal stenosis (ICD-9: 478.74, 519.19) between January 1, 1998, and January 1, 2013, were identified. Patient characteristics (age, gender, race, follow-up duration) and comorbidities were extracted. Records were reviewed for etiology of stenosis, treatment approach, and surgical dates. Stenosis morphology was derived from intraoperative measurements. The presence of tracheostomy at last follow-up was recorded.

RESULTS - One hundred and fifty patients met inclusion criteria. A total of 54.7% had an iatrogenic etiology, followed by idiopathic (18.5%), autoimmune (18.5%), and traumatic (8%). Tracheostomy dependence differed based on etiology (P < 0.001). Significantly more patients with iatrogenic (66%) and autoimmune (54%) etiologies remained tracheostomy-dependent compared to traumatic (33%) or idiopathic (0%) groups. On multivariate regression analysis, each additional point on Charlson Comorbidity Index was associated with a 67% increased odds of tracheostomy dependence (odds ratio 1.67; 95% confidence interval 1.04-2.69; P = 0.04).

CONCLUSIONS - Laryngotracheal stenosis is not a homogeneous clinical entity. It has multiple distinct etiologies that demonstrate disparate rates of long-term tracheostomy dependence. Understanding the mechanism of injury and contribution of comorbid illnesses is critical to systems-based preventive strategies and patient-centered treatment.

LEVEL OF EVIDENCE - 4.

© 2014 The American Laryngological, Rhinological and Otological Society, Inc.

MeSH Terms (14)

Adult Diagnosis, Differential Female Follow-Up Studies Humans Laryngostenosis Male Middle Aged Prognosis Retrospective Studies Severity of Illness Index Tracheal Stenosis Tracheostomy Young Adult

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