(270) In-Office Balloon Dilation: A Novel Protocol for Idiopathic Subglottic Stenosis

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Has Audio

Presenting Author(s)

Roy F. Catherine, MD

Dr
McGill University Health Centre - Montreal, QC
Montreal, Quebec, Canada

Co-Author(s)

AL

Antonia Lagos-Villasceca, MD

Dr
Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile, United States
JS

Jennifer Silver, PGY4 OTL-HNS

McGill University, USA
EL

Eli Layous, MD

Dr
Department of Otolaryngology – Head and Neck Surgery, McGill University Health Center, Montreal, Canada, United States
JY

Jonathan Young, MD, FRCS

MD
McGill University
Montreal, Quebec, Canada
AG

Anne V Gonzales, MD MSc

Dr
Department of Respiratory Medicine, McGill University Health Center, Montreal, Canada, United States

Senior Author(s)

Karen M. Kost, MD, FRCS

Professor of Otolaryngology-Head and Neck Surgery, Director of the Voice and Dysphagia Laboratory, McGill University
McGill University Health Center
Westmount, QC, Canada

Disclosure(s):

Roy F. Catherine, MD: No relevant relationships to disclose.

Introduction: Idiopathic subglottic stenosis is a debilitating condition, which often recurs and may require frequent interventions. Endoscopic balloon dilation is a well-recognized, minimally invasive treatment to alleviate symptoms, and is typically performed in the operating room. We herein describe in-office balloon dilation in the awake patient as a novel approach, allowing safe, effective and timely treatment while mitigating the need for general anesthesia.

Methods: Adult patients with Cotton-Myer Grade I-II idiopathic subglottic stenosis undergoing in-office balloon dilation at the Voice Laboratory of the Royal Victoria Hospital between June 1, 2022 and July 1, 2023 were prospectively recruited. All patients completed pre- and post-procedure questionnaires including patient-reported outcomes and validated dyspnea and voice scales. Patient- and physician-reported adverse events were thoroughly documented. Pre- and post-procedure nasolaryngotracheoscopy recordings and spirometry were reviewed as objective measures of airflow obstruction.

Results: Eleven patients underwent in-office balloon dilation during the study period (F:M 10:1, mean age 56 (SD 12.3) years. The median (IQR: 25th-75th percentile) Dyspnea Index and Voice Handicap Index both showed a statistically significant decrease following the procedure: from 31 (26.5-32) to 6 (4-13) (P=0.003) and from 13 (6.5-23) to 5 (1.5-9.5) (P=0.02) respectively. In-office balloon dilation improved airway patency, with an estimated median (IQR) of 40% (30-55%) to 10% (5-17.5%) stenosis (P=0.004). The normalized peak expiratory flow percentage of predicted values significantly increased from a median (IQR) of 62% (55-98%) to 99% (88.5-109.5%) (P=0.004).

Conclusions: In-office balloon dilation is a safe and viable option for the management of mild-moderate idiopathic subglottic stenosis, with demonstrated improvement in both objective and patient-reported outcomes.