Evaluating the utility of serological testing in laryngotracheal stenosis. (12th November 2016)

• Record Type: Journal Article
• Authors: Hall, S. Ryan; Allen, Clint T.; Merati, Albert L.; Mayerhoff, Ross M.
• Is Part Of: Laryngoscope. Volume 127:Number 6(2017)
• Page Start: 1408
• Page End: 1412
• Publication Date: 2016-11-12
• Subjects: Laryngotracheal stenosis -- granulomatosis with polyangiitis -- autoimmune laryngotracheal stenosis -- idiopathic laryngotracheal stenosis; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.26385
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: Whereas mechanical (traumatic) causes of laryngotracheal stenosis (LTS) are identified based on history, autoimmune laryngotracheal stenosis (aLTS) and idiopathic laryngotracheal stenosis (iLTS) are often more difficult to differentiate. The objective of this study was to evaluate serologic testing in a large cohort of nonmechanical LTS patients to determine which tests, if any, lead clinicians to the etiology of the LTS. Study Design: Retrospective chart review. Methods: This study reviewed nonmechanical LTS patients seen at a tertiary medical center from 2007 to 2014. Data were obtained on patient demographics, associated preexisting autoimmune conditions, comorbidities, intubation history, and serologic testing. Results: Ninety‐two records were reviewed. Twenty‐three (25%) patients were found to have autoimmune disease; 69 (75%) met criteria for iLTS. A history of cigarette smoking was more significant in the aLTS group than the iLTS group ( P < .001). Antineutrophil cytoplasmic antibody (ANCA) was positive only in patients with known granulomatosis with polyangiitis (GPA). All other serological testing was equivocal between the two cohorts. Conclusions: Differentiating iLTS from aLTS has proven difficult. The lack of information about the two entities has resulted in variability in the diagnostic workup to distinguish them. This study's finding of a more significant smoking history in the aLTS group correlates with the literature, which suggests an inflammatory effect of smoking cigarettes and an association with autoimmune disease. The only significant cohort of patients in this study found to have positive serological testing correlated with a diagnosable condition responsible for LTS was GPA patients with positive ANCA. Level of Evidence: 4. Laryngoscope, 127:1408–1412, 2017