Office-Based Serial Intralesional Steroid Injections in Benign Subglottic Stenosis-First Results.

Abstract

Objective: Serial intralesional steroid injections (SILSI) are increasingly used in the treatment of idiopathic subglottic stenosis (iSGS) and auto-immune related subglottic stenosis (SGS), which are both known for their high rate of recurrences. SILSI could potentially prolong the time to re-intervention. We evaluated the effects of adjuvant SILSI in iSGS and auto-immune related SGS-patients on time to reintervention and spirometry results.

Methods: A total of 16 consecutive subjects undergoing SILSI from 07/2018 were included in this consecutive case-series. All patients were treated with surgical endoscopic dilatation (ED) followed by SILSI (ED + SILSI). A subgroup of patients (no. 7/16) were previously also treated with solely ED. In this subgroup, outcome measures could be compared before and after adding SILSI within the same patient. Outcome measures included time to reintervention, side effects, and spirometry results expressed in Δarea under the curve_total/forced vital capicity (AUC).

Results: Of all patients, 8/16 (50%) underwent at least one reintervention post ED + SILSI after a mean time of 14 months. In the subgroup, the median of the mean time to reintervention improved from 12 (interquartile range = 6) months post ED to 18 months (IQR = 8) post ED + SILSI. The median difference in AUC was 1.27 (P = 0.022; 95% CI: 0.51-3.05). No patients developed serious side effects during SILSI.

Conclusion: Adjuvant SILSI after ED potentially prolongs time to reintervention in iSGS and auto-immune SGS patients. It is, however, still unclear which patients benefit most. The decision to incorporate this adjuvant treatment should be made in shared decision making between surgeon and patient.

Level of evidence: 4: