2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Fig. 5. This is a scatterplot of 140 separate %PEF data points, by subject, over time (in months) for group 2 subjects. Each subject encoun- ter in the outpatient setting, during which the handheld spirometer was used, is a separate data point. %PEF values above 80% are con- sidered to be in the normal range. Six of seven subjects had stabilization of the %PEF above the 80% line. Subject 7 was above 80% except for the most recent pulmonary function test where her %PEF was recorded as 78%. Subject 11 has had the most variability of any subject, requiring five separate rounds and is now in the mid-80% range. OR 5 operating room; PEF 5 peak expiratory flow; SILSI 5 serial intralesional steroid injections.

her to jump to 74%, rising to 78% after two in-office injections. She declined, and over 1 month (two injec- tions) she went to 67%, prompting an in-office balloon 1 - steroid treatment. She has since undergone two more in- office balloon 1 steroid treatments. Her most recent %PEF was 82%. Overall, she has undergone five rounds with five injections/round, and despite her picket-fence pattern, has managed to continue leading a busy life. Ultimately, there is good control in 6/7 (86%) in group 2. Scar modification with intralesional steroids has been used by dermatologists to treat skin scars (keloids) since the 1960s, with response rates from 50% to 100% and recurrence rates from 9% to 50%. 7 Steroids have well-known and potent abilities to decrease the inflam- mation known to cause scars to proliferate, decreasing collagen and glycosaminoglycan synthesis (inhibiting fibroblast growth and encouraging fibroblast degenera- tion), and increasing collagenase activity to modify the scar and make it less fibrous. 3,8–10 Steroids decrease the migration of inflammatory cells (monocytes and leuko- cytes), whose cytokines contribute to the activation of Rationale for Steroid Injections: How Do Steroids Modify Scars?

fibroblasts, have antimitotic activity directly inhibiting fibroblasts, which are the cells responsible for the creation and deposition of collagen. Steroids decrease the levels of transforming growth factor- b , interleukin (Il)-1, IL-10, and other potent inflammatory cytokines involved in scar crea- tion, and induce hypoxia through vasoconstriction, possibly contributing to scar volume reduction and softening through starving the scar of nutrients. There is degrada- tion of collagen through an increase in collagenase activ- ity. 11 The sum total of steroid action is beneficial for scar reduction: decreased inflammation and collagen deposition and increased collagen degradation. The Need for Repeated Injections Key to effecting a change with steroid injections is to deliver them into the scar on a regular schedule with repeated injections over time. 12 This differs significantly from the common practice of the singular injection of steroids at the end of an endoscopic procedure without follow-up injections. Keloids are injected every 2 to 5 weeks until there is good cosmetic effect, typically three to five times. We feel that the key to success using intralesional steroids is to adhere to a protocol that matches

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Franco et al.: Intralesional Steroid Injections for iSGS

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