Ballon-Dilatation subglottischer Stenosen insbesondere bei Granulomatose mit Polyangiitis

Zusammenfassung

Einleitung Subglottische Stenosen (SGS) sind Verengungen im Bereich unterhalb der Stimmlippen, die ein lebensbedrohliches Problem für die Betroffenen darstellen können. Ziel dieses Forschungsprojektes war es, herauszufinden, bei welcher Patientengruppe die Behandlung der SGS mittels Ballondilatation zu einem längerfristigen Erfolg führen kann.

Methoden 14 PatientInnen mit SGS wurden prospektiv (vor und bis zu 12 Monate nach Intervention) mittels Lungenfunktionstest, Laryngoskopien und zweier Fragebögen (Clinical Chronic Obstructive Pulmonary Disease Questionnaire), (modified Medical Research Council Dyspnoea Scale) zur Atemsituation untersucht. Zudem wurde die Anzahl der notwendigen Interventionen dokumentiert, der Stenosegrad gemessen und nach Myer Cotton bestimmt.

Ergebnisse Vier PatientInnen, die nur eine Intervention mit dem Ballon benötigten, zeigten eine bessere präinterventionelle Atemfunktion sowie eine höhere subjektive Belastung. Mittels Lungenfunktionstests und der Auswertung der Fragebögen konnte eine Verbesserung der Atemsituation und des Gesundheitszustandes aller 14 PatientInnen nach der initialen Intervention nachgewiesen werden. PatientInnen mit einem Stenosedurchmesser unter 4 mm benötigten nur eine Intervention. ProbandInnen mit 12-mm-Ballon-Eingriffen benötigten wiederholt Behandlungen.

Schlussfolgerungen ProbandInnen mit hohem Stenosegrad sowie tendenziell höherer subjektiver Belastung als auch geringerer objektiver Einschränkung der Atemsituation scheinen eine höhere Wahrscheinlichkeit für eine längerfristig erfolgreiche Behandlung mit dem Ballon zu haben. Die Wahl der Ballongröße scheint ein zusätzlich entscheidender Faktor für den Erfolg einer Intervention zu sein.

Abstract

Introduction Subglottic stenoses (SGS) are constrictions in the region below the vocal folds, that can pose a life-threatening problem for those affected. The aim of this research project was to identify the patient group for which the treatment of SGS by balloon dilatation can lead to long-term success.

Methods 14 patients with SGS were examined (before and up to12 months after intervention) using pulmonary function tests, laryngoscopies and two questionnaires (Clinical Chronic Obstructive Pulmonary Disease Questionnaire), (modified Medical Research Council Dyspnoea Scale) regarding the respiratory situation. Additionally, the number of necessary interventions, the degree of stenosis (according to Myer Cotton and measured in millimeters) were documented.

Results Four patients who required only one intervention with the balloon showed better pre-interventional respiratory function and a higher subjective stress level. Lung function tests and evaluation of the questionnaires showed an improvement in the respiratory situation and state of health of all 14 patients after the initial intervention. The degree of stenosis measured in millimeters shows that patients with a stenosis diameter of less than 4 mm only required one intervention. All patients who received an intervention using a 12-mm-balloon had to be treated several times.

Conclusions Patients with a high degree of stenosis and a tendency towards greater subjective stress and less objective restriction of the respiratory function appear to have a higher probability of long-term successful treatment with the balloon. Furthermore, the choice of balloon size seems to be an additional decisive factor for the success of an intervention.

Schlüsselwörter

Ballondilatation - subglottische Stenosen - Granulomatose mit Polyangiitis - idiopathische subglottische Stenosen - Spirometrie - CCQ-Fragebogen - mMRC-Fragebogen

Keywords

balloon dilatation - subglottic stenosis - granulomatosis with polyangiitis - Clinical Chronic Obstructive Pulmonary Disease Questionnaire - modified Medical Research Council Dyspnoea Scale - Spirometry

Publication History

Received: 04 February 2024

Accepted after revision: 28 June 2024

Article published online:
12 July 2024

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