title: Treatment for adult idiopathic and Wegener-associated subglottic stenosis.
abstract: The aim of the study is to present the results of combination treatment for adult non-traumatic subglottic stenosis (SGS). This is a retrospective chart review of 12 female patients (age range 32-76 years) with idiopathic SGS (eight patients) and Wegener's granulomatosis. All patients had a hard and 11 a short (less than 1 cm) stenosis. Eleven patients were treated with endoscopic CO(2) laser, one with Nd-YAG laser. Topical triamcinolone was applied to all. In 10 patients, topical mitomycin C (MMC) was additionally applied. Symptom severity and airway resistance (AR) were evaluated pre- and post-interventionally. Postoperatively, oral steroids (and/or methotrexate) and proton pump inhibitors (PPI) were prescribed. Follow-up period ranged between 7 and 115 months. All patients reported a significant improvement in obstructive symptoms. Average AR preoperatively was 1.004 kPa/(L/s) and postoperatively 0.526 kPa/(L/s). Three patients underwent surgery once, 2 required a second surgery, 5 were operated 3 times, one 5 times, and one 7 times. The latter two patients had not received local MMC treatment. Endoscopic laser surgery combined with local MMC and triamcinolone application and postoperative oral steroid/methotrexate and PPI therapy provides a treatment option that results in prolongation of the symptom-free time intervals and avoidance of open surgery in patients with idiopathic and Wegener-associated hard and short SGS.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University of Mainz Medical Center, Langenbeckstr. 1, 55101, Mainz, Germany. hagouve@yahoo.de
authors.forename: Haralampos
authors.initials: H
authors.lastname: Gouveris
authors.forename: Niki
authors.initials: N
authors.lastname: Karaiskaki
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Koutsimpelas
authors.forename: Cheerasook
authors.initials: C
authors.lastname: Chongolwatana
authors.forename: Wolf
authors.initials: W
authors.lastname: Mann
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000150:complications*; D006801:Humans; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000209:etiology / Q000628:therapy*; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D014221:Triamcinolone / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D019384:Nucleic Acid Synthesis Inhibitors; D014221:Triamcinolone; D016685:Mitomycin