title: The use of propranolol in the treatment of subglottic hemangiomas: A literature review and meta-analysis.
abstract: OBJECTIVE
  1) Describe the origins of the use of propranolol in the treatment of subglottic hemangiomas, 2) Perform meta-analysis of all case reports and series in which propranolol was used to treat subglottic hemangiomas.
  
  
  METHODS
  Literature review and meta-analysis.
  
  
  METHODS
  A total of 61 cases were identified from 19 scholarly articles. Cases were assessed by parameters including age at diagnosis, presence of other hemangiomas, percent airway obstructed, dose of propranolol, treatment duration, age at therapy termination, use of steroids, and treatment failure. Treatment failure was defined as: 1) Need for surgery after initiation of propranolol, 2) Return of symptoms, or 3) Endoscopic worsening/recurrence of hemangioma. All data was subjected to comprehensive statistical analysis.
  
  
  RESULTS
  Though not statistically significant, a trend was noted towards a decreased treatment failure rate with increasing doses of propranolol (p = 0.0563). The use of concurrent steroids was associated with a higher failure rate (p = 0.0487). Notably, no associations were observed between the presence of additional hemangiomas, prior surgery, or increased initial percent airway obstruction with treatment failure.
  
  
  CONCLUSIONS
  Propranolol is rapidly becoming the standard of care in the treatment of subglottic hemangiomas. Despite widespread adoption, the rarity of this condition has limited previous studies to case reports and small series. No evidence-based guidelines exist for proper dosing of propranolol. The results of this meta-analysis suggest a benefit to higher doses of propranolol (3 mg/kg/day), though further investigation is needed.
authors.affiliation: Virginia Commonwealth University, Dept. of Otolaryngology, Richmond, VA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Hardison
authors.affiliation: Virginia Commonwealth University, Dept. of Biostatistics, Richmond, VA, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Wan
authors.affiliation: Virginia Commonwealth University, Dept. of Otolaryngology, Richmond, VA, USA. Electronic address: kelley.dodson@vcuhealth.org.
authors.forename: Kelley M
authors.initials: KM
authors.lastname: Dodson
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000402:Airway Obstruction / Q000188:drug therapy*; D004724:Endoscopy; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007822:Laryngeal Neoplasms / Q000188:drug therapy*; D007828:Laryngoscopy / Q000706:statistics & numerical data; D011379:Prognosis; D011433:Propranolol / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000319:Adrenergic beta-Antagonists; D011433:Propranolol
keywords: 3a; Hemangiomas; Propranolol; Subglottic obstruction