Idiopathic subglottic stenosis (iSGS) is a narrowing of the trachea of unknown cause, usually affecting middle-aged Caucasian women. In-office intralesional steroid injection (SILSI) is a recent advance in minimally invasive treatment aiming to reduce inflammation and scarring. The authors of this study completed a systematic review of the existing literature to determine the patient- and clinician- reported outcomes of SILSI compared to other treatments – for example, endoscopic dilatation or open surgery. Inclusion criteria were studies of all designs reporting SILSI up to and including case series with clearly documented clinical outcomes. Studies based on an exclusively paediatric population or causes other than iSGS were excluded. Of the 383 articles screened, 14 met inclusion criteria, comprising 371 participants. Heterogeneity across the studies meant meta-analysis was not possible. Narrative results were reported. Only 11 studies reported sex, but of those 295 (93.5%) were women, and 98.1% were Caucasian. The most used steroid injection was Triamcinolone (10 studies). There were no adverse events reported and follow-up time ranged from 0.7–168 months. Study type included case series, cohort and retrospective cohort design. There was variation in dose, interval between injections and number of treatment sessions across the 14 studies. Improvements were reported across domains including voice-related outcomes, peak expiratory flow, dyspnoea index, degree of stenosis and surgery-free interval. The authors conclude that SILSI represents a useful adjunctive treatment for iSGS, but at present is not suitable as a standalone option due to the heterogeneity of the evidence. Future work needs to focus on standardising protocols and outcomes to better define a treatment plan.
Do in-office steroid injections help for idiopathic subglottic stenosis?
Reviewed by Gemma Clunie
In-Office Steroid Injections for Idiopathic Subglottic Stenosis: A Systematic Review.
CONTRIBUTOR
Gemma Clunie
BA (Hon), MSc, PhD, MRCSLT, Imperial College Healthcare NHS Trust; Honorary Research Fellow, Imperial College London, UK.
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