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Monitoring Adult Subglottic Stenosis With Spirometry and Dyspnea Index: A Novel Approach
Örebro University, School of Medical Sciences. Department of Ear Nose and Throat.ORCID iD: 0000-0001-6065-9016
Örebro University, School of Medical Sciences. Department of Respiratory Medicine.ORCID iD: 0000-0003-1926-8464
Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-2610-6992
2022 (English)In: Otolaryngology and head and neck surgery, ISSN 0194-5998, E-ISSN 1097-6817, Vol. 167, no 3, p. 517-523Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects.

STUDY DESIGN: Prospective cohort study.

SETTING: Tertiary referral center.

METHOD: Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements.

RESULTS: The Cotton-Myer classification correlated weakly with peak expiratory flow (r = -0.35, P = .012), expiratory disproportion index (r = 0.32, P = .022), peak inspiratory flow (r = -0.32, P = .022), and total peak flow (r = -0.36, P = .01). The DI showed an excellent area under the curve (0.99, P < .001), and among PFTs, the expiratory disproportion index demonstrated the best area under the curve (0.89, P < .001), followed by total peak flow (0.88, P < .001), peak expiratory flow (0.87, P < .001), and peak inspiratory flow (0.84, P < .001). Patients treated endoscopically with balloon dilatation showed a 53% decrease in expiratory disproportion index (95% CI, 41%-66%; P < .001) and a 37% improvement in peak expiratory flow (95% CI, 31%-43%; P < .001).

CONCLUSION: Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI.

Place, publisher, year, edition, pages
Sage Publications, 2022. Vol. 167, no 3, p. 517-523
Keywords [en]
Dyspnea index, expiratory disproportion index, functional assessment, peak expiratory flow, subglottic stenosis
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-95568DOI: 10.1177/01945998211060817ISI: 000727325400001PubMedID: 34813409Scopus ID: 2-s2.0-85120574186OAI: oai:DiVA.org:oru-95568DiVA, id: diva2:1615764
Note

Funding agency:

Örebro County Council

Available from: 2021-12-01 Created: 2021-12-01 Last updated: 2024-01-02Bibliographically approved
In thesis
1. Subglottic stenosis: Diagnostics, endoscopic treatment and follow-up
Open this publication in new window or tab >>Subglottic stenosis: Diagnostics, endoscopic treatment and follow-up
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Subglottic stenosis (SGS) is a rare condition of upper airway obstruction transforming tracheal mucosa below the vocal folds into scar tissue. It is primarily caused by laryngotracheal trauma and infrequent autoimmune conditions ofsystemic inflammation. Cases without an evident cause despite a comprehensive investigation are classified as idiopathic. SGS’s unspecific clinical presentation and the underrated findings from conventional spirometry, conceal the diagnosis. Hence, the role of spirometry in the preoperative evaluation and the postoperative monitoring of patients with SGS is unclear. The goal of treatment is to maintain a patent airway while recurrence is part of the natural course of the condition.

This thesis focuses on the diagnosis, preoperative functional and self-reported assessment, choice of endoscopic treatment and the postoperative follow-up of patients with SGS.

Dyspnea Index (DI), a 10-item, 5-point Likert questionnaire with scores ranging from 0 to 40, specifically developed for patients with upper airway obstruction, is now translated and validated in Swedish. The expiratory disproportion index (EDI), which is the ratio of forced expiratory volume in 1 second divided by the peak expiratory flow (PEF), is the spirometry measurement of choice to diagnose patients with SGS from those with obstructive lung disease, when found above 0.39. The percent deterioration of the EDI or PEF ( ) from each patient’s best achieved values correlates with a percent deterioration of the DI and thus, it could be used to monitor treatment effects indicating a disease recurrence. Furthermore, a DI score over 14 refines the diagnostic value of crude spirometry measurements and could be helpful to detect recurrence in patients treated for SGS. Finally, balloon dilatation was found more favorable regarding short-term disease recurrence compared to CO2 laser treatment and patients with a younger age of SGS onset, overweight or obesity showed an increased risk for restenosis

Place, publisher, year, edition, pages
Örebro: Örebro University, 2023. p. 83
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 279
Keywords
Subglottic stenosis, Dyspnea Index, spirometry, Expiratory Disproportion Index, balloon dilatation, endoscopic treatment
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-104731 (URN)9789175294971 (ISBN)
Public defence
2023-06-02, Örebro universitet, Campus USÖ, hörsal X3, Södra Grev Rosengatan 32, Örebro, 12:30 (Swedish)
Opponent
Supervisors
Available from: 2023-03-07 Created: 2023-03-07 Last updated: 2024-01-02Bibliographically approved

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Ntouniadakis, EleftheriosSundh, Josefin

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