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Multicenter Study
. 2016 Mar;125(3):257-63.
doi: 10.1177/0003489415608867. Epub 2015 Oct 14.

Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study

Alexander T Hillel  1 , Selmin Karatayli-Ozgursoy  2 , Idris Samad  2 , Simon R A Best  2 , Vinciya Pandian  2 , Laureano Giraldez  3 , Jennifer Gross  3 , Christopher Wootten  4 , Alexander Gelbard  4 , Lee M Akst  2 , Michael M Johns  3 ; North American Airway Collaborative (NoAAC)
Affiliations
Multicenter Study

Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study

Alexander T Hillel et al. Ann Otol Rhinol Laryngol. 2016 Mar.

Abstract

Objective: To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients.

Methods: Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU).

Results: Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy.

Conclusion: Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.

Keywords: fibrosis; hospital safety; intubation; laryngotracheal stenosis; tracheostomy.

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Figures

Figure 1
Figure 1
Laryngoscopic images capture the evolution of posterior glottic stenosis. Initial mucosal ulceration and inflammation (A) progresses to posterior laryngeal granulation tissue (B) that ultimately contracts the arytenoids forcing the vocal folds into a bilateral midline position (C).
Figure 2
Figure 2
Average length of intubation was significantly greater for posterior glottic stenosis (PGS) patients than controls. Dot plot graph with mean (red line) of days intubated in posterior glottic stenosis (PGS) and control cohorts.
Figure 3
Figure 3
Comparison of endotracheal tube (ETT) size by gender and disease state. ETT distribution stratified by gender (A) demonstrating distinct shifts in distribution of ETT sizes used to intubate males and females. There was a significant difference between posterior glottic stenosis (PGS) and control patients in males intubated with size 8 ETT or larger (B).
Figure 4
Figure 4
PGS patients have a significantly higher risk of a tracheostomy. The outcome of tracheostomy was significantly higher for posterior glottic stenosis (PGS) patients than in controls (A). Tracheostomy at last follow-up visit was also significantly higher in the PGS cohort (B).
See this image and copyright information in PMC

References

    1. Whited RE. Posterior commissure stenosis post long-term intubation. Laryngoscope. 1983;93(10):1314–1318. - PubMed
    1. Bogdasarian RS, Olson NR. Posterior glottic laryngeal stenosis. Otolaryngol Head Neck Surg. 1980;88(6):765–772. - PubMed
    1. Gardner GM. Posterior glottic stenosis and bilateral vocal fold immobility: diagnosis and treatment. Otolaryngol Clin North Am. 2000;33(4):855–878. - PubMed
    1. Benjamin B, Holinger LD. Laryngeal complications of endotracheal intubation. Ann Otol Rhinol Laryngol. 2008;117(9Supp):1–20. - PubMed
    1. Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. 1984;94(3):367–377. - PubMed

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