Office based steroid injections for subglottic stenosis

Abstract

Serial Intralesional Steroid Injection (SILSI) has been gaining popularity among patients and physicians as a first-line treatment for idiopathic subglottic stenosis. Patients are followed by in-office and at-home spirometry to assess the peak inspiratory flow (PIF), peak expiratory flow (PEF) and the PEF% values, along with quality-of-life instruments such as the RAND36, EQ5D and the new subglottic stenosis-specific, iSGS6. The initial procedure can be performed in the operating room using balloons and cold instruments to remove the subglottic scarring with injection of triamcinolone acetate 40 mg/cc into the subglottis. Subsequent injections are performed in the awake-office setting at 3-week intervals until reaching a total of 6 injections (1 at surgery + 5 in-office). This single-surgeon experience with SILSI at Mass Eye and Ear now spans 13+ years, 95 patients and over 1,000 injections. A total of 58% (55/95) of patients have only required one SILSI Round (4 to 6 injections) while we have an overall success rate of 96% (91/95). A total of 95% of subjects (90/95) tolerated awake SILSI. The 52 patients with greater than 2 years of follow-up have an average follow-up of 68 months. As a group they started at a PEF% of 55% and ended their SILSI at a PEF% of 93%. Their most recent PEF% is 92% reflecting the lasting efficacy SILSI offers. As a group they underwent an average of 7 steroid injections and 1.6 surgeries resulting in an average of 36 months between interventions. A total of 29% of patients (15/52) in the Long-Term group have not had recurrences in the 53 months they have been followed. They have a group PEF% of 94% highlighting the durable SILSI effects allowing them to breath without restriction. SILSI is a safe and reliable method to treat airway stenosis that is rooted in many years of clinical success. These patients have excellent quality of life and can maintain a high level of breathing for much longer than those treated with balloon dilation (36 months vs. 12 months).