2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Fig. 4. This is a scatterplot of 90 separate %PEF data points, by subject, over time (in months) for group 1 subjects. Each subject encoun- ter in the outpatient setting, during which the handheld spirometer was used, is a separate data point. The first four to six values represent the %PEF values during the active treatment with SILSI, whereas all subsequent values were obtained during the observation phase. %PEF values above 80% are considered to be in the normal range. Five of the six subjects had %PEF values that stabilized above 80%, whereas subject 4 was noted to fail and drop below the 80% line. She moved away and was lost to follow-up, explaining why there was no attempt to improve her breathing noted here. PEF 5 peak expiratory flow; SILSI 5 serial intralesional steroid injections.

in %PEF 5 45%). Only subject 4 was unable to remain above the 80% threshold. She rose initially from 50% to 81% while undergoing six injections over 6 months. She slid from 81% to 57% over the ensuing 10 months when we stopped injecting her. She moved away and was lost to follow-up before we could improve her breathing. Overall, there was an 83% (5/6) success rate in group 1. OR 1 SILSI (group 2). Referring to Figure 5 and Table II, five subjects (subjects 7, 9, 10, 12, and 13) did well, with a mean follow-up of 32 months and mean %PEF improvement/round of 25.1%. Subject 7 recently fell to 76%, the first time in 4 years she has dipped below 80%. She continues competing in triathlons and 5 km races. Two subjects (subjects 8 and 11) have been a bit more problematic, with subject 11 being the worst per- former. Subject 8 underwent three rounds over 54 months. She initially responded going from 38% to 102% but drifted down to 60% 18 months later. An in-office CO 2 laser 1 SILSI treatment boosted her 87%, with five injections over 6 months, but then 6 months later she was at 64%. Her third round consisted of in-office SILSI (three times), and she went up to 100%. Her most recent reading was 93%. Subject 11 has proven herself to be a very difficult case with wide variability (Fig. 6). After her initial sur- gery she went from 61% to 77%, and despite four in- office steroid injections, she drifted to 45% over 10 weeks, prompting another trip to the OR that allowed

group 1 and group 2 were statistically similar ( P 5 .569). Figure 5 depicts the %PEF changes over time for all seven OR 1 SILSI subjects (140 data points). Tables I and II contain demographic information and the changes in the %PEF with treatment. None of the 13 patients had treatment complica- tions such as acute airway obstruction, hematoma, crepi- tus, or infection. DISCUSSION This is the first study to describe clinically and sta- tistically significant quantitative improvements in the airway caliber of iSGS subjects using only repeated SILSI to modify the airway stenosis in iSGS. Despite not undergoing operative interventions, these office-based SILSI subjects had improvement in their subjective (dys- pnea) and objective (%PEF, PEF, and PIF flow-volume loop morphology) measures similar to those who did have surgery. This opens the possibility that iSGS can be treated medically. Subgroup Analysis: Diving Into the Results SILSI alone (group 1). Looking at Figure 4 and Table II, there are two subjects who started and stayed above 90% (subjects 2 and 3). The remaining four sub- jects had an average starting %PEF of 47%. Three of four (subjects 1, 5, and 6) displayed long-term improve- ments (mean follow-up of 44 months, mean improvement

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Franco et al.: Intralesional Steroid Injections for iSGS

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