Can PROMS Distinguish Subglottic Stenosis From Bilateral Vocal Fold Paralysis?

Introduction: Patient-reported outcome measures (PROMs) are powerful tools that focus medical care on the patient experience. Subglottic stenosis (SGS) and bilateral vocal fold paralysis (BVFP) result in airway narrowing and present with similar symptoms. The objective of this study is to determine whether PROMS can be used to distinguish between these conditions.

Methods: A retrospective analysis of PROMs was performed in patients diagnosed with subglottic stenosis and bilateral vocal fold paralysis at an academic laryngology practice from March 2019 to September 2021. PROMs collected included the Voice Handicap Index-10 (VHI-10), Eating Assessment Tool (EAT-10), Dyspnea Index (DI), and Patient Reported Outcome Measurement Information System-10 Mental/Physical (PROMIS-10 Mental and Physical). Statistical analysis was performed in R. Linear regression was used to control for sex given the predominance of idiopathic subglottic stenosis among females.

Results: One-hundred and seventy-five patients were identified. Among 131 SGS patients, mean age was 51.6 years (SD of 13.50) 84% of patients reported female sex. Among 56 BVFP patients, mean age was 61.6 years (SD of 15.6) and 41.1% of patients reported female sex. Twelve patients were diagnosed with both SGS and BVFP.

Linear regression controlling for sex showed statistically significant differences between diagnoses for VHI-10 (SGS mean = 13.27, BVFP mean = 24.85, p < .001), DI (SGS mean = 18.81, BVFP mean = 13.89, p = .009), PROMIS-10 Physical (SGS mean = 50.09, BVFP mean = 45.34, p = .013). EAT-10 was statistically significant before controlling for sex (p = < .001) but not after (p = 0.109).

Conclusions: The results illustrate several differences between SGS and bilateral vocal fold paralysis. Patients with SGS reported worse breathing at initial visit and worse overall health status. Patients with BVFP reported greater difficulty with voice and swallowing.