Office-Based Steroid Injections for Idiopathic Subglottic Stenosis: Patient-Reported Outcomes, Effect on Stenosis, and Side Effects. (April 2020)

• Record Type: Journal Article
• Authors: Hoffman, Matthew R.; Francis, David O.; Mai, Johnny P.; Dailey, Seth H.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 129:Number 4(2020)
• Page Start: 361
• Page End: 368
• Publication Date: 2020-04
• Subjects: idiopathic subglottic stenosis -- steroid injection -- dyspnea index -- modified medical research council dyspnea scale -- voice handicap index; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489419889066
• Languages: English
• ISSNs: 0003-4894

Abstract

Objective: Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects. Methods: Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t -tests compared values at baseline versus follow-up tracheoscopy. Results: DI decreased ( t = 3.938, P = 0.0013), as did MMRC ( t = 2.179, P = 0.0457). There was no change in VHI-10 ( t = 1.354; P = 0.1957) scores. Airway stenosis decreased ( t = 4.331; P = 0.0006); this was not correlated with change in DI ( r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2). Conclusion: Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis.