Risk Factors for Adult Laryngotracheal Stenosis: A Review of 74 Cases

Abstract

Objectives: We sought to identify risk factors for and review our experience in the management of adult acquired laryngotracheal stenosis (LTS) at an academic urban medical center. Methods: A retrospective review of all patients given a diagnosis of acquired LTS between 1997 and 2005 was performed. Seventy-four patients with LTS were identified. Demographic information, medical and surgical history, surgical procedures performed, and outcomes were collected. A control group of 106 patients admitted over the same time period with respiratory distress but without LTS was identified. The data collected for both groups were analyzed by Fisher's exact test and logistic regression analysis. Results: Demographically, the control group was not significantly different from the LTS group. Patients who had a previous tracheostomy were 10.99 times more likely to develop LTS than control patients (95% confidence interval [CI], 4.68 to 25.80). Patients irradiated for carcinomas of the oropharynx and larynx were 5.95 times more likely to develop LTS than control patients (95% CI, 1.87 to 18.91). Those previously intubated for more than 48 hours were 3.91 times more likely to develop LTS than control patients (95% CI, 1.91 to 8.02). Finally, patients who were intubated for any non-airway surgery were found to be 2.07 times more likely to develop LTS (95% CI, 1.09 to 3.93). Conclusions: Prolonged intubation, tracheostomy, previous non-airway surgery, and irradiation for oropharyngeal and laryngeal tumors are risk factors for LTS. Multiple surgical procedures are often required for treatment. Mitomycin C did not significantly improve decannulation rates.