title: Voice quality in laryngotracheal stenosis: impact of dilation and level of stenosis.
abstract: OBJECTIVE
  To assess the impact of suspension microlaryngoscopy with balloon dilation on voice-related quality of life (V-RQOL) in laryngotracheal stenosis (LTS).
  
  
  METHODS
  Retrospective chart review of LTS patients dilated at a tertiary-care academic hospital from 2010 to 2013. Data were obtained and then analyzed. LTS was stratified by (1) subglottic or tracheal stenosis and (2) multilevel stenosis (MLS; glottic and subglottic/tracheal). Pre- and postoperative V-RQOL and grade, roughness, breathiness, asthenia, strain (GRBAS) scores were compared. The number and frequency of balloon dilation procedures over the lifetime were secondary outcome variables.
  
  
  RESULTS
  Thirty-eight patients were identified: 26 subglottic/tracheal and 12 multilevel. Of these, 71.4% required multiple dilations, with greatest dilations/patient for multilevel stenosis (4.8). V-RQOL improved in the 27 patients with completed pre- and postoperative scores from a mean of 70.4 to 80 (P=.025). Pre/postoperative V-RQOLs for tracheal/subglottic (mean, 82.8/93.8) were significantly higher (P=.0001/.0001) than multilevel stenosis (48/55.3). Voice quality-of-life improvement was significant for the subglottic/tracheal cohort (P=.036) but not for the MLS group. GRBAS was performed pre- and postoperatively in 10 patients with improvement in all domains except breathiness.
  
  
  CONCLUSIONS
  Laryngotracheal stenosis is associated with dysphonia. Patients with glottic involvement have significantly worse voice quality of life than those with tracheal/subglottic stenosis. Endoscopic balloon dilation improves V-RQOL in patients with subglottic/tracheal stenosis.
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Selmin
authors.initials: S
authors.lastname: Karatayli-Ozgursoy
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Benke
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Best
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Paulette
authors.initials: P
authors.lastname: Pacheco-Lopez
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Teets
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Starmer
authors.affiliation: Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA LAKST1@jhmi.edu.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
mesh_terms: D000328:Adult; D004106:Dilatation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007829:Laryngostenosis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome; D014833:Voice Quality
keywords: airway disorders; laryngology; laryngotracheal stenosis; larynx; otolaryngology; upper trachea; voice outcomes