Subglottic Stenosis Management
Mona Abaza, MD, MS, a professor of otolaryngology–head and neck surgery at the University of Colorado in Boulder, said that pulmonary function testing can be helpful in the management of subglottic stenosis.
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June 2022CT scans, which are “fairly useful” and easy to get, have been widely used by physicians to assess and monitor the condition, Dr. Abaza said. But they do have problems associated with them, she said.
“They can be pretty costly, and if you’re talking about a patient who’s having airway surgery every several months, the cumulative radiation dose can be a challenge as well,” she said. In addition, these measures often aren’t helpful in assessing the dynamics of the airway collapse. Also, visualization of the airway can have subjective aspects to it, she noted.
More recently, pulmonary function testing has emerged as a way to obtain objective measures “to allow us to really understand dynamic changes, as well as the efficiency and effectiveness of the myriad procedures that are used to treat subglottic stenosis,” Dr. Abaza said. In one study, with 32 patients and 271 patient encounters, peak expiratory flow (PEF) was found to significantly correlate with quality of life (Laryngoscope. 2018;128:1398-1402).
Care must be taken with interpretation of peak expiratory flow values, Dr. Abaza cautioned. Because they are dependent on age, height, body type, and gender, a value might be normal in one person but abnormal in another, she said.
Instead, a more useful measure is the percentage change from a given person’s normal PEF, she said. This can be used to assess changes over time clinically and to assess the effect of, and the need for, interventions. PEF is particularly useful because it can be done at home, she added, cautioning that because the tests are effort dependent, they might be of limited value in children or those with cognitive challenges.
“We can use PFTs to help define a patient’s breathing and dyspnea in a more objective manner,” Dr. Abaza said. “You can record them after changes to really begin to define how effective whatever procedure you performed is at improving the patient’s breathing. And you can noninvasively track patients, and they can track themselves.”
Intubation to Tracheostomy Transitions
Edward Damrose, MD, a professor of otolaryngology–head and neck surgery at Stanford University in Stanford, California, said the bulk of the evidence today shows that earlier transition from intubation to tracheostomy leads to the best outcomes.