Laser vs Cold Steel for Endoscopic Management of Subglottic Stenosis

Tuesday, October 3, 2023

3:48 PM - 3:54 PM East Coast USA Time

Location: 106BC

Presenting Author(s)

Kevin Y. Liang, MD

Resident Physician
Cleveland Clinic
Cleveland, OH, United States

Co-Author(s)

FS

Faez H. Syed, MD

Cleveland Clinic, USA
KM

Katherine M. Miller, MD,

Resident Physician
Cleveland Clinic Foundation
Cleveland, OH, United States
HL

Hong Li, MS

Cleveland Clinic, USA
MB

Michael S. Benninger, MD

Professor and Chair, Department of Otolaryngology-Head and Neck Surgery
Cleveland Clinic
Cleveland, OH, United States
PB

Paul C. Bryson, MD

Associate Professor
Head and Neck Institute, Cleveland Clinic
Cleveland, OH, United States

Senior Author(s)

Robert R. Lorenz, MD, MBA

3P Workgroup Co-Chair, Coordinator for Practice Affairs
AAO-HNS
Cleveland, Ohio, United States

Disclosure(s):

Katherine M. Miller, MD,: No relevant relationships to disclose.

Michael S. Benninger, MD: No relevant relationships to disclose.

Paul C. Bryson, MD, MBA: No relevant relationships to disclose.

Introduction: Endoscopic management of subglottic stenosis includes a wide range of techniques. This 18-year review compares treatment outcomes between carbon dioxide (CO2) laser and cold steel.

Methods: A retrospective chart review was performed for all patients undergoing endoscopic treatment of subglottic stenosis at Cleveland Clinic between July 12, 2000 and September 1, 2017. Data collected included demographics, stenosis etiology, stenosis severity, comorbidities, treatment modality, and airway procedure history. The primary endpoint was repeat treatment-free survival at 2 years using a Kaplan-Meier analysis and Cox proportional hazard model.

Results: A total of 139 patients (mean [standard deviation] age 46.4 [13.7] years; 83.4% female) were included in the analysis, with etiologies including idiopathic (79 [56.8%]), granulomatosis with polyangiitis (35 [25.2%]), and intubation (23 [16.5%]). All patients underwent either cold steel (107 patients) or CO2 laser (32 patients) lysis of stenosis with concurrent dilation. 2-year treatment-free survival was 50.2% for CO2 laser and 31.9% for cold steel (Hazard Ratio [HR] and 95% confidence interval [CI]: 1.69, 0.96-2.97, log-rank p-value=0.066). In patients with no prior airway procedures, there was no difference in treatment-free survival between laser and cold knife (p=0.42). However, in patients with history of prior airway procedures, 2-year treatment-free survival was significantly greater in the laser group (50.0% vs. 16.8%, HR and CI: 2.78, 1.11-6.93, p=0.029).

Conclusions: Endoscopic treatment of subglottic stenosis with CO2 laser should be considered in revision cases.