Single intraoperative steroid injection improves outcomes of idiopathic subglottic stenosis: Study

A recent retrospective study published in The Laryngoscope journal found the patients with single intraoperative steroid injection experience shorter surgery-free interval in idiopathic subglottic stenosis (iSGS). This research was conducted over an 11-year period from January 1, 2012 to December 1, 2023 to evaluate how different treatment strategies impacted the surgery-free interval (SFI), which represents the duration between surgical interventions.

The study encompassed a total of 305 procedures involving 104 patients to compare the outcomes among different treatment protocols. The patients were divided into 4 main groups based on their treatment as endoscopic dilation (ED) alone, ED with a single intraoperative corticosteroid injection, ED followed by a single in-office intralesional steroid injection (ILSI), and ED with serial in-office steroid injection (SILSI) procedures postoperatively.

• Endoscopic Dilation Alone: This group consisted of 55 procedures and had a median SFI of 658 days (IQR: 595 days). It emerged as the treatment associated with the longest interval between surgeries.
• ED with Single Intraoperative Steroid Injection: This was the largest subgroup, with 102 procedures recorded. The median SFI here dropped notably to 395 days (IQR: 296 days) by indicating a statistically significant decrease in the surgery-free period when compared to ED alone (p = 0.001).
• ED Followed by Single Postoperative ILSI: This approach was applied in 27 procedures and resulted in a median SFI of 533 days (IQR: 351 days). Although longer than the intraoperative-only group, it still did not surpass the outcomes of ED alone.
• ED with Serial SILSI Procedures: This method comprised of 15 procedures and showed a median SFI of 585 days (IQR: 338 days). Despite the introduction of regular, serial steroid injections, the increase in SFI was not significantly different from the ED-alone group.

The study highlighted a critical insight, where the use of a single intraoperative steroid injection correlated with a significantly reduced SFI when compared to using endoscopic dilation alone. This outcome points to the potential limitations of single-use steroid injections in extending the time between surgical interventions.

The patients managed with ED followed by serial SILSI procedures did not experience significant improvements in SFI when compared to the ones who only underwent dilation. This finding suggests that while serial steroid injections might offer some benefits, their impact may not be substantial enough to alter the surgical interval significantly within this patient population. Overall, the outcomes of this research reinforces the importance of treatment selection in managing iSGS by emphasizing that while steroids are a common adjunct to surgical procedures, their long-term efficacy in extending SFI warrants further exploration.

Reference:

Ramazani, F., Bosch, J. D., & Randall, D. R. (2024). Comparing Intraoperative and In‐Office Steroid Injections for Management of Subglottic Stenosis. In The Laryngoscope. Wiley. https://doi.org/10.1002/lary.31903