Quantitative assessment of the upper airway in infants and children with subglottic stenosis (original) (raw)
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RETRACTED: Development and Validation of a New Outcome Score in Subglottic Stenosis
The Annals of Thoracic Surgery, 2012
Background. We prospectively evaluated a clinical and endoscopic score, the tracheal endoscopic clinical score (TECS), developed as a disease-specified outcome measure in adult patients undergoing operation for subglottic stenosis. We also performed a retrospective chart review to identify preoperative and intraoperative risk factors for worse TECS. Methods. The TECS includes endoscopic (vocal cord and glottic function, anastomotic healing, and patency) and interview (respiration, voice, swallow) variables, and was administered at 6-month follow-up. Endoscopic and subjective domains were weighted to obtain a continuous TECS index ranging from 0 (best) to 1 (worse). The TECS and preoperative variables relationships were evaluated by univariate and multivariate analysis. Results. We collected data (January 2009 to December 2010) from 30 patients (mean age, 48.3 ؎ 19 years) undergoing subglottic resection and primary reconstruction. Stenosis etiology was postintubation (n ؍ 8), idio-pathic (n ؍ 2), tracheostomy (n ؍ 18), and malignant (n ؍ 2). Surgery included Pearson operation with (n ؍ 7) or without (n ؍ 23) a Liberman-Mathisen cricoplasty. Mean length of resected trachea was 30.5 ؎ 13.5 mm, and mean hospital stay was 7.4 days. Mortality rate was 1 patient (3.3%). The univariate analysis showed positive correlation between 6-month TECS and degree of stenosis (McCaffrey and Cotton scale 0 to 4) stage 4, tracheostomy or T-tube at surgery, bottleneck-type transition stenosis, and resection length. At multivariate analysis, the presence of tracheostomy, bottleneck-type transition stenosis and resection length were indicators of worse postoperative functional result. Conclusions. The TECS seems to be a valid and simple instrument to identify preoperative variables predicting worse results and to assess postoperative outcome. Validation on larger series is necessary.
The Role of Spirometry and Dyspnea Index in the Management of Subglottic Stenosis
The Laryngoscope, 2019
Objectives: We aimed to assess the role of spirometry measures and Dyspnea Index (DI) in response to treatment of subglottic stenosis (SGS) and ability to predict need for surgery. We also assessed correlations between spirometry measures, DI, and physical SGS parameters. Methods: Thirty-seven adult female SGS patients were prospectively enrolled. Spirometry data and DI were obtained at serial clinic visits; physical SGS parameters were obtained intraoperatively. PIFR, PEFR, EDI, FEV1/FVC, and DI were compared preoperatively to postoperatively for patients who underwent operative intervention. Spirometry data, DI, and physical SGS parameters were analyzed for correlations, and receiver operating characteristic (ROC) curves were created for spirometry measures and DI to determine optimal cutoffs for recommending surgery. Results: Means of all measured spirometry measures changed significantly from preoperative to postoperative visits (P < .05). Mean DIs changed significantly between preoperative (27.5, n = 13, SD = 8.6) and postoperative visits (8.6, n = 13, SD = 5.5, P < 5 × 10-5). All Pearson correlations were negligible to moderate. The area under the curve (AUC) for peak inspiratory flow rate (PIFR) was 0.903 (95% CI, 0.832-0.974) with cutoff at 2.10 L/s; the AUC for DI was 0.874 (95% CI, 0.791-0.956) with cutoff between 22-25; the AUC for peak expiratory flow rate (PEFR) was 0.806 (95% CI, 0.702-0.910) with cutoff at 2.5 L/s; all other ROC curves were less than good. Conclusion: PIFR, PEFR, EDI, FEV1/FVC, and DIs significantly improve after treatment for SGS. No strong correlations exist between spirometry measures, DI, and physical SGS parameters. PIFR was the most sensitive and specific for predicting timing of operative intervention in our cohort.
Reliability of peak expiratory flow percentage compared to endoscopic grading in subglottic stenosis
Laryngoscope Investigative Otolaryngology, 2020
ObjectiveTo determine the reliability of pulmonary function testing compared to endoscopic grading in the assessment of subglottic stenosis.MethodsConsecutively treated patients with subglottic stenosis at a tertiary care specialty hospital from 2009 to 2019 were identified. Two fellowship‐trained laryngologists and two otolaryngologists blinded to clinical history reviewed laryngo tracheoscopic examinations and assessed the degree of stenosis using the Cotton‐Myer grading system (% stenosis). Nine full flow‐volume loops were performed at the time of each exam.ResultsThe endoscopic images of 45 subjects were graded for degree of stenosis and the spirometry data were analyzed. The kappa values for Cotton‐Myer grade overall was 0.37, grade I was −0.103, grade II was 0.052, and grade III was 0.045. The overall intraclass correlation of the physician grading of estimated percent obstruction (% stenosis) was 0.712 (P < .01) whereas the overall intraclass correlation for PEF% was 0.96 ...
BMJ open, 2018
Idiopathic subglottic stenosis (iSGS) is an unexplained progressive obstruction of the upper airway that occurs almost exclusively in adult, Caucasian women. The disease is characterised by mucosal inflammation and localised fibrosis resulting in life-threatening blockage of the upper airway. Because of high recurrence rates, patients with iSGS will frequently require multiple procedures following their initial diagnosis. Both the disease and its therapies profoundly affect patients' ability to breathe, communicate and swallow. A variety of treatments have been advanced to manage this condition. However, comparative data on effectiveness and side effects of the unique approaches have never been systematically evaluated. This study will create an international, multi-institutional prospective cohort of patients with iSGS. It will compare three surgical approaches to determine how well the most commonly used treatments in iSGS 'work' and what quality of life (QOL) trade-of...
Use of flow volume curve to evaluate large airway obstruction
Monaldi Archives for Chest Disease
The flow volume loop (FVL) is a graphic display of airflow against lung volumes at different levels obtained during the maximum inspiratory and expiratory maneuver. It is a simple and reproducible method of lung function assessment. A narrative review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, EMBASE, Ovid MEDLINE and CINAHL databases were queried and reviewed for studies pertinent to the various FVLs abnormalities and their mechanisms from January 2020 to December 2020. We used the following search terms; flow-volume loop, upper airway obstruction, Obstructive airway disease, and spirometry. Assessing the shape of the flow-volume loop is particularly helpful in diagnosing and localizing upper airway obstruction. They are also helpful in identifying bronchodilator response to treatment. Characteristic FVLs is also seen in patients with obstructive or restrictive lung disorders. Spirometry should be ...
Thorax, 2008
Rationale: The prevalence of airway obstruction varies widely with the definition used. Objectives: To study differences in the prevalence of airway obstruction when applying four international guidelines to three population samples using four regression equations. Methods: We collected predicted values for FEV 1 /FVC and its lower limit of normal (LLN) from the literature. FEV 1 /FVC from 40,646 adults (including 13,136 asymptomatic, neversmokers) aged 17-90+ years were available from American, English, and Dutch populationbased surveys. The prevalence of airway obstruction was determined by the LLN for FEV 1 /FVC, and by using the GOLD, ATS/ERS, or BTS guidelines, initially in the healthy subgroup and then the entire population. Results: The LLN for FEV 1 /FVC varied between prediction equations (57 available for men and 55 for women), and demonstrated marked negative age dependency. The median age at which the LLN fell below 0.70 in healthy subjects was 42 and 48 years in men and women respectively. When applying the reference equations (Health Survey for England 1995-1996, NHANESIII, ECCS/ERS and a Dutch population study) to the selected population samples, the prevalence of airway obstruction in healthy never-smokers aged over 60 years varied for each guideline: 17-45% of men and 7-26% of women for GOLD; 0-18% of men and 0-16% of women for ATS/ERS; 0-9% of men and 0-11% of women for BTS. GOLD guidelines caused false positive rates of up to 60% when applied to entire populations. Conclusions: Airway obstruction should be defined by FEV 1 /FVC and FEV 1 being below the LLN using appropriate reference equations.
International journal of pediatric otorhinolaryngology, 2009
Creation of a patent subglottic airway after partial cricotracheal resection (PCTR) may not always result in successful decannulation due to associated parameters such as co-morbidity and/or glottic involvement. We classified patients after incorporating these additional parameters into the original Myer-Cotton classification to assess whether this could better predict the outcome measures after PCTR. One hundred children with Myer-Cotton grade III or IV subglottic stenosis who underwent PCTR between 1978 and 2008 were identified from a prospectively collected database. The patients were classified into four groups based on the association of co-morbidity and/or glottic involvement. Delay in decannulation, revision open surgery and rates of decannulation were the outcome measures compared between the groups. There were 68 children with Myer-Cotton grade III and 32 children with grade IV stenosis. Based on the new classification, there were 36 children with isolated SGS, 31 with asso...