Affiliation:
1. Department of Otolaryngology–Head and Neck Surgery Head and Neck Institute, Cleveland Clinic Ohio Cleveland USA
2. Department of Neurology Neurologic Institute, Cleveland Clinic Ohio Cleveland USA
3. Department of Quantitative Health Sciences Lerner Research Institute, Cleveland Clinic Ohio Cleveland USA
Abstract
AbstractObjectiveEndoscopic management of subglottic stenosis (SGS) includes a wide range of techniques. This 17‐year review compares treatment outcomes between carbon dioxide (CO2) laser and cold steel.Study DesignRetrospective chart review.SettingSingle tertiary care center.MethodsA chart review was performed for all patients undergoing endoscopic treatment of SGS at Cleveland Clinic between July 12, 2000 and September 1, 2017. Data collected included demographics, stenosis etiology, stenosis severity, comorbidities, treatment modality, and airway procedure history. The primary endpoint was repeated treatment‐free survival (RTFS) within 2 years using a Kaplan‐Meier analysis and Cox proportional hazard model.ResultsA total of 139 patients (median [interquartile range] aged 48.7 [37.8, 57.0] years; 83.4% female) were included in the analysis, with etiologies including idiopathic (56.8%), granulomatosis with polyangiitis (25.2%), and intubation (16.5%). All patients underwent either cold steel (107 patients) or CO2 laser (32 patients) lysis of stenosis with concurrent dilation. RTFS within 2 years was 50.2% for CO2 laser and 31.9% for cold steel (hazard ratio [HR] and 95% confidence interval [CI]: 1.69, 0.96‐2.97, P = .07). In patients with no prior airway procedures, there was no difference in RTFS between laser and cold knife (P = .41). However, in patients with prior airway procedures, RTFS was significantly greater in the laser group, even after adjusting for age, smoking history, and stenosis etiology (50.0% vs 16.8%, adjusted HR and CI: 2.82, 1.14‐6.98, P = .025).ConclusionEndoscopic lysis of SGS with CO2 laser should be considered in revision cases.