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. 2022 Sep;167(3):517-523.
doi: 10.1177/01945998211060817. Epub 2021 Nov 23.

Monitoring Adult Subglottic Stenosis With Spirometry and Dyspnea Index: A Novel Approach

Eleftherios Ntouniadakis  1 , Josefin Sundh  2 , Mathias von Beckerath  1   3
Affiliations

Monitoring Adult Subglottic Stenosis With Spirometry and Dyspnea Index: A Novel Approach

Eleftherios Ntouniadakis et al. Otolaryngol Head Neck Surg. 2022 Sep.

Abstract

Objective: The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects.

Study design: Prospective cohort study.

Setting: Tertiary referral center.

Method: Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements.

Results: The Cotton-Myer classification correlated weakly with peak expiratory flow (r = -0.35, P = .012), expiratory disproportion index (r = 0.32, P = .022), peak inspiratory flow (r = -0.32, P = .022), and total peak flow (r = -0.36, P = .01). The DI showed an excellent area under the curve (0.99, P < .001), and among PFTs, the expiratory disproportion index demonstrated the best area under the curve (0.89, P < .001), followed by total peak flow (0.88, P < .001), peak expiratory flow (0.87, P < .001), and peak inspiratory flow (0.84, P < .001). Patients treated endoscopically with balloon dilatation showed a 53% decrease in expiratory disproportion index (95% CI, 41%-66%; P < .001) and a 37% improvement in peak expiratory flow (95% CI, 31%-43%; P < .001).

Conclusion: Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI.

Keywords: dyspnea index; expiratory disproportion index; functional assessment; peak expiratory flow; subglottic stenosis.

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Conflict of interest statement

Disclosures: Competing interests: None.

Sponsorships: None.

Funding source: This study was funded by Örebro County Council.

Figures

Figure 1.
Figure 1.
Receiver operating characteristic analysis, areas under the curve (AUCs), and cutoff values for the spirometry measures, DI, and VHI. DI, Dyspnea Index; EDI, expiratory disproportion index; FEV1, force expiratory volume in 1 second; FIV1, forced inspiratory volume in 1 second; PEF, peak expiratory flow; PIF, peak inspiratory flow; TPF, total peak flow; VHI, Voice Handicap Index.
Figure 2.
Figure 2.
Scatterplot pairing pre- and postoperative observations: (a) DI-PEF and (b) DI-EDI. DI, Dyspnea Index; EDI, expiratory disproportion index; PEF, peak expiratory flow.
See this image and copyright information in PMC

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