In-Office Balloon Dilation for Idiopathic Subglottic Stenosis: A Pilot Study.

Abstract

ImportanceIdiopathic subglottic stenosis is a debilitating and recurrent disease, often requiring reintervention. Balloon dilation is a well-recognized, minimally invasive treatment to alleviate symptoms, and is typically performed in the operating room. In-office balloon dilation in the awake patient has rarely been reported, and may obviate the need for general anesthesia in this patient population.ObjectiveThis study aims to detail the safety and efficacy of in-office balloon dilation for mild to moderate subglottic stenosis.DesignMixed-methods study.SettingSingle tertiary-care institution in Montreal, Canada.Participants and InterventionAll adult patients with Cotton-Myer Grade I-II idiopathic subglottic stenosis undergoing in-office balloon dilation between June 1, 2022 and August 1, 2023 were prospectively recruited.Main Outcome MeasuresPre- and post-procedure validated dyspnea and voice scales, airway diameter and spirometry values were obtained. Patient- and physician-reported adverse events were thoroughly documented.ResultsEleven patients underwent in-office balloon dilation during the study period (F:M 10:1, mean age 55.8 years). The median Dyspnea Index and voice handicap index-10 scores both significantly decreased following the procedure. In-office balloon dilation improved airway patency, with an estimated median of 40% to 10% stenosis (median difference -25%, 95% CI (-45, -15), P = .003). The normalized peak expiratory flow percentage significantly increased from a median of 62% to 99% (median difference 27%, 95% CI (19, 40), P = .004). The median time to regular activities was one day. Six patients having previously undergone the procedure under general anesthesia indicated a preference for in-office dilation. There were no severe adverse events.Conclusion and RelevanceIn-office balloon dilation is a safe and effective option for the management of mild-moderate idiopathic subglottic stenosis, with demonstrated improvement in both patient-reported outcomes and objective measures.