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

• Literatur

• 1 Holle J, Röhl C, Laudien M. et al. THU0216 Subglottic stenosis and tracheobronchitis in granulomatosis with polyangiitis (GPA, wegener’s) are associated with a high burden of disease and damage. Ann Rheum Dis 2014; 71: 228.2-228
• 2 Blaivas AJ, Strauss W, Yudd M. Subglottic stenosis as a complication of Wegenerʼs granulomatosis. Prim Care Respir J 2008; 17: 114-116
• 3 Carnevale C, Arancibia-Tagle D, Sarría-Echegaray P. et al. Head and Neck Manifestations of Granulomatosis with Polyangiitis. A Retrospective analysis of 19 Patients and Review of the Literature. Int Arch Otorhinolaryngol 2019; 23: 165-171
• 4 Aravena C, Almeida FA, Mukhopadhyay S. et al. Idiopathic subglottic stenosis. A review. J Thorac Dis 1100-1111
• 5 Horta-Baas G, Hernández-Cabrera MF, Catana R. et al. Estenosis subglótica en granulomatosis con poliangitis (granulomatosis de Wegener). Presentación de 4 casos. Reumatol Clin 2016; 12: 267-273
• 6 Feinstein AJ, Goel A, Raghavan G. et al. Endoscopic Management of Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2017; 143: 500-505
• 7 Hellmich B, Sanchez-Alamo B, Schirmer JH. et al. EULAR recommendations for the management of ANCA-associated vasculitis. 2022 update. Ann Rheum Dis 2023;
• 8 Jethwa AR, Hasan W, Palme CE. et al. Cricotracheal resection for adult subglottic stenosis. Factors predicting treatment failure. Laryngoscope 2020; 130: 1634-1639
• 9 Bakthavachalam S, McClay JE. Endoscopic management of subglottic stenosis. Otolaryngol Head Neck Surg 2008; 139: 551-559
• 10 Hseu AF, Benninger MS, Haffey TM. et al. Subglottic stenosis. A ten-year review of treatment outcomes. Laryngoscope 736-741
• 11 Lavrysen E, Hens G, Delaere P. et al. Endoscopic Treatment of Idiopathic Subglottic Stenosis. A Systematic Review. Front Surg 2019; 6: 75
• 12 Breatnach E, Abbott GC, Fraser RG. Dimensions of the normal human trachea. AJR Am J Roentgenol 1984; 142: 903-906
• 13 Nouraei SAR, Randhawa PS, Koury EF. et al. Validation of the Clinical COPD Questionnaire as a psychophysical outcome measure in adult laryngotracheal stenosis. Clin Otolaryngol 2009; 34: 343-348
• 14 van der Molen T, Willemse BWM, Schokker S. et al. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes 2003; 1: 13
• 15 Zhou Z, Zhou A, Zhao Y. et al. Evaluating the Clinical COPD Questionnaire. A systematic review. Respirology 251-262
• 16 Vogelmeier C, Buhl R, Burghuber O. et al. Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 2018; 72: 253-308
• 17 Nouraei SAR, Nouraei SM, Randhawa PS. et al. Sensitivity and responsiveness of the Medical Research Council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis. Clin Otolaryngol 2008; 33: 575-580
• 18 Chen C, Ni W-H, Tian T-l. et al. The outcomes of endoscopic management in young children with subglottic stenosis. Int J Pediatr Otorhinolaryngol 2017; 99: 141-145
• 19 Ntouniadakis E, Sundh J, Magnuson A. et al. Balloon dilatation is superior to CO2 laser excision in the treatment of subglottic stenosis. Eur Arch Otorhinolaryngol 2023; 280: 3303-3311
• 20 Krol RM, Remmelts HHF, Klaasen R. et al. Systemic and Local Medical or Surgical Therapies for Ear, Nose and/or Throat Manifestations in ANCA-Associated Vasculitis. A Systematic Literature Review. J Clin Med 2023; 12
• 21 Shabani S, Hoffman MR, Brand WT. et al. Endoscopic Management of Idiopathic Subglottic Stenosis. Ann Otol Rhinol Laryngol 2017; 126: 96-102
• 22 Monnier P, Dikkers FG, Eckel H. et al. Preoperative assessment and classification of benign laryngotracheal stenosis. A consensus paper of the European Laryngological Society. Eur Arch Otorhinolaryngol 2015; 272: 2885-2896
• 23 Myer CM, OʼConnor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994; 103: 319-323
• 24 Czaja P, Soja J, Grzanka P. et al. Assessment of airway caliber in quantitative videobronchoscopy. Respiration 2007; 74: 432-438
• 25 Sharma GK, Foulad A, Verma SP. A novel device for measurement of subglottic stenosis in 3 dimensions during suspension laryngoscopy. JAMA Otolaryngol Head Neck Surg 2015; 141: 377-381
• 26 Song SA, Sandhu G, Franco RA. Should We Routinely Use Pulmonary Function Testing in the Management of Subglottic Stenosis?. Laryngoscope 2021; 131: 245-247
• 27 Kraft SM, Sykes K, Palmer A. et al. Using pulmonary function data to assess outcomes in the endoscopic management of subglottic stenosis. Ann Otol Rhinol Laryngol 2015; 124: 137-142
• 28 Alshareef W, Almutairi N, Sindi A. et al. Spirometry in laryngotracheal stenosis. A systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280: 4783-4792
• 29 Kimura K, Du L, Berry LD. et al. Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow. Laryngoscope 2021; 131: E2841-E2848
• 30 Abdullah A, Alrabiah A, Habib SS. et al. The Value of Spirometry in Subglottic Stenosis. Ear Nose Throat J 2019; 98: 98-101
• 31 Agustí A, Celli BR, Criner GJ. et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report. GOLD Executive Summary. Eur Respir J 2023; 61
• 32 Cazzola M, MacNee W, Martinez FJ. et al. Outcomes for COPD pharmacological trials. From lung function to biomarkers. Eur Respir J 2008; 31: 416-469
• 33 Oga T, Tsukino M, Hajiro T. et al. Analysis of longitudinal changes in dyspnea of patients with chronic obstructive pulmonary disease. An observational study. Respir Res 2012; 13: 85
• 34 Kon SSC, Dilaver D, Mittal M. et al. The Clinical COPD Questionnaire. Response to pulmonary rehabilitation and minimal clinically important difference. Thorax 2014; 69: 793-798
• 35 Nouraei SAR, Nouraei SM, Randhawa PS. et al. Sensitivity and responsiveness of the Medical Research Council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis. Clin Otolaryngol 575-580
• 36 Ammous O, Feki W, Lotfi T. et al. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2023; 1: CD013778
• 37 Paixão C, Rebelo P, Oliveira A. et al. Responsiveness and Minimal Clinically Important Difference of the Brief-BESTest in People With COPD After Pulmonary Rehabilitation. Phys Ther 2021; 101
• 38 Sharma SD, Gupta SL, Wyatt M. et al. Safe balloon sizing for endoscopic dilatation of subglottic stenosis in children. J Laryngol Otol 2017; 131: 268-272
• 39 Fiz I, Monnier P, Koelmel JC. et al. Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis. Laryngoscope 2020; 130: 1640-1645