Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary; Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2021 Feb;131(2):366-369. doi: 10.1002/lary.29059. Epub 2020 Sep 9.
Serial intralesional steroid injection (SILSI) is an emerging treatment for idiopathic subglottic stenosis (ISGS), providing improvement in both subjective symptoms and objective airflow parameters. Little is known about how this airway remodeling affects the voice. This project analyzes subjective voice changes after SILSI and correlates these with airflow parameters.
An ISGS database containing voice-related quality of life (V-RQOL) and spirometry (peak expiratory flow percentage [%PEF]) was retrospectively queried. Included were ISGS patients from 2009 to 2019 who had at least one SILSI treatment. Encounters without complete data were excluded. Differences between preprocedure and postprocedure metrics were calculated. Correlations and nonparametric bivariate analysis were performed.
Six hundred and seventeen steroid injections were performed in 55 patients, with an average of 3.5 years of follow-up. The average V-RQOL for all patient encounters, both pre- and postprocedure, showed little subjective dysphonia (83.5 of 100, 95% confidence interval [CI] 81.6 to 85.4). Considering SILSI-only treatments, there were 143 encounters with full data; of these, V-RQOL improved in 70 (49.0%), did not change in 40 (28.0%), and worsened in 33 (23.0%). Average V-RQOL improvement for the entire cohort was 1.9 points (95% CI: 0.7 to 3.2), which was small but significant (P = .0003). Across all data, there was a weak but significant correlation between PEF% and V-RQOL (ρ = 0.22, P = .0043).
SILSI was associated with improvement in subjective voice ratings in about half of patients, and the improvement correlated with improved airflow measurements. This research adds to the growing body of data regarding SILSI and suggests that further work on functional changes to the larynx with airway remodeling is imperative.
4 Laryngoscope, 131:366-369, 2021.
腔内类固醇注射（SILSI）是一种新兴的特发性声门下狭窄（ISGS）治疗方法，可改善主观症状和客观气流参数。对于这种气道重塑如何影响声音，我们知之甚少。本项目分析了 SILSI 后主观声音变化，并将这些变化与气流参数相关联。
回顾性查询包含嗓音相关生活质量（V-RQOL）和肺活量测定（呼气峰流速百分比 [%PEF]）的 ISGS 数据库。纳入 2009 年至 2019 年至少接受一次 SILSI 治疗的 ISGS 患者。排除无完整数据的病例。计算术前和术后指标的差异。进行相关性和非参数双变量分析。
55 例患者共进行了 617 次类固醇注射，平均随访 3.5 年。所有患者的 V-RQOL 平均值（术前和术后）均显示出轻微的主观发音困难（83.5 分，95%置信区间 [CI] 81.6 至 85.4）。考虑到仅 SILSI 治疗的情况，有 143 次就诊有完整数据；其中，70 次（49.0%）V-RQOL 改善，40 次（28.0%）无变化，33 次（23.0%）恶化。整个队列的平均 V-RQOL 改善为 1.9 分（95%CI：0.7 至 3.2），虽小但有统计学意义（P =.0003）。在所有数据中，PEF%与 V-RQOL 之间存在微弱但显著的相关性（ρ=0.22，P=.0043）。
SILSI 与大约一半患者的主观嗓音评分改善相关，改善与气流测量改善相关。这项研究增加了关于 SILSI 的不断增长的数据，并表明需要进一步研究气道重塑对喉功能的变化。
4 Laryngoscope，131：366-369，2021。
