Endoscopic Management of Idiopathic Subglottic Stenosis in Twenty-Five Patients

Introduction While multiple causes exist for the development of subglottic stenosis, the mechanism responsible for idiopathic subglottic stenosis (ISS) remains unknown. Proposed etiologies include gastro-esophageal reflux (GERD) related exposure, telescoping of the first tracheal ring under the cricoid cartilage, a hormonal cause, and the possibility of an unidentified autoimmune process (1,3,6,8,12,18,19). As ISS represents a rare disease of yet unknown etiology, the optimal management remains to be defined. The treatment options range from endoscopic management, which is less invasive but tends to show recurrence to open tracheal resection with anastomosis for those patients in whom endoscopic techniques are ineffective or have shown a high recurrence rate (5). Endoscopic management is an outpatient procedure, which shows limited voice alteration. In contrast, open resection requires a hospital stay, can be associated with changes in voice, and is reserved for centers with significant expertise due to the demanding nature of the procedure (11,15). However, the procedure results in complete removal of the inflamed and stenotic area (2,10). The available literature shows limited reports for endoscopic management of ISS in more than twenty patients. This study sought to add to the current literature by reporting the experience at one institution, with a large number of patients during a relatively condensed time frame over which surgical technique has not varied. Specific areas of evaluation in this work include the presence of circumferential/cicatricial scarring which previously has indicated that endoscopic management would not be successful, as well as the goal for endoscopic management as the sole technique rather than a temporizing measure for open intervention. This study also sought to identify any characteristics related to interval of recurrence, which would help identify the patient population in which endoscopic intervention would be a favorable option