Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis
| Autor: | Idris Samad, Ashwyn Sharma, Alexander T. Hillel, Simon R. Best, Selmin Karatayli-Ozgursoy, Kristine Teets, Marissa Simpson, Lee M. Akst |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Vital capacity Preoperative care Article 030507 speech-language pathology & audiology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Quality of life Surveys and Questionnaires medicine Humans 030223 otorhinolaryngology Prospective cohort study Aged business.industry Endoscopy Laryngostenosis Middle Aged medicine.disease Surgery Stenosis Dyspnea Treatment Outcome Otorhinolaryngology Quality of Life Voice Balloon dilation Female Tracheal Stenosis 0305 other medical science Airway business Laryngotracheal stenosis |
| Zdroj: | JAMA Otolaryngology–Head & Neck Surgery. 142:1075 |
| ISSN: | 2168-6181 |
| Popis: | Importance Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. Objective To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. Design, Setting, and Participants This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. Main Outcomes and Measures The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. Results Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, −20.3; 95% CI, −27.9 to −12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, −2.2; 95% CI, −3.4 to −0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H 2 O/L/s (mean of difference, −27.5 cm H 2 O/L/s; 95% CI, −44.8 to −10.3 cm H 2 O/L/s) postoperatively. Conclusions and Relevance Patients demonstrate statistically and clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons’ regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS. |
| Databáze: | OpenAIRE |
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