Wehbi Nader, Gleadhill Claire M E, Ahmadian David, Skirko Jonathan R, Yip Helena T
University of Arizona College of Medicine-Phoenix Phoenix Arizona USA.
Department of Otolaryngology University of Arizona College of Medicine-Tucson Tucson Arizona USA.
World J Otorhinolaryngol Head Neck Surg. 2024 Feb 8;11(1):17-22. doi: 10.1002/wjo2.159. eCollection 2025 Mar.
Subglottic stenosis (SGS) is commonly treated with endoscopic dilations or tracheal resection. Since office-based serial intralesional steroid injections (SILSI) were first reported in 2017, they have been established as an effective, less invasive treatment alternative or adjunct. The aim of this study is to add to the literature investigating the efficacy of office-based SILSIs for idiopathic and post-intubation SGS patients, specifically studying surgery-free intervals (SFIs) and discussing our experience with SILSI treatment order and stenosis grade.
This study is a retrospective case series of 14 patients with subglottic stenosis treated with in-office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.
Of seven patients with calculable SFI, a mean SFI increase of 481.28 days was observed following SILSI treatment ( = 0.042). Ten patients in our cohort presented with idiopathic or post-intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI. Two patients with post-intubation grade 1 SGS were managed successfully with SILSI as their primary treatment. Two patients with post-intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.
We have found that SFI significantly increased following SILSI initiation. Although statistical power was limited given the small sample size, our findings suggest that SILSI may be an effective primary treatment in low-grade stenosis. SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate-grade stenosis. SILSI may not be effective in high-grade stenosis patients who failed prior endoscopic treatment.
声门下狭窄（SGS）通常采用内镜扩张或气管切除术治疗。自2017年首次报道门诊连续病灶内注射类固醇（SILSI）以来，它已成为一种有效、侵入性较小的治疗选择或辅助治疗方法。本研究的目的是补充有关门诊SILSI治疗特发性和插管后SGS患者疗效的文献，具体研究无手术间隔期（SFI），并讨论我们在SILSI治疗顺序和狭窄分级方面的经验。
本研究是一项回顾性病例系列研究，对2018年至2022年在一家学术三级医疗中心接受门诊连续病灶内注射类固醇作为主要或辅助治疗的14例声门下狭窄患者进行研究。
在7例可计算SFI的患者中，SILSI治疗后SFI平均增加481.28天（=0.042）。我们队列中的10例患者表现为特发性或插管后2级SGS，通过内镜扩张和SILSI联合治疗成功治愈。2例插管后1级SGS患者以SILSI作为主要治疗方法成功治愈。2例插管后3级SGS患者需要进行气管切除术，未从SILSI中获益。
我们发现开始SILSI治疗后SFI显著增加。尽管由于样本量小，统计效力有限，但我们的研究结果表明，SILSI可能是低度狭窄的有效主要治疗方法。SILSI作为内镜扩张的辅助治疗在中度狭窄中可能最有效。SILSI对先前内镜治疗失败的高度狭窄患者可能无效。
