Use of oxygen reserve index during bronchoscopic balloon dilation for subglottic stenosis in a patient with left ventricular assist device implantation -a case report.

BACKGROUND: Monitoring the oxygenation status is crucial during general anesthesia to ensure patient safety. Although noninvasive pulse oximetry is commonly used to monitor percutaneous oxygen saturation (SpO2), it may not accurately reflect changes in oxygen partial pressure when the latter is excessively high or low. The oxygen reserve index (ORi) provides real-time information about the oxygen reserve status. CASE: We present a case of successful management of subglottic stenosis using balloon bronchoscopy in an infant with a left ventricular assist device implantation under ORi monitoring to predict hypoxemia during the surgical procedure. CONCLUSIONS: Utilizing ORi monitoring during anesthesia for procedures involving apnea in critically ill infants can help predict impending desaturation before a drop in SpO2 occurs, allowing anesthesiologists to effectively anticipate and manage the apnea period. Continuous ORi monitoring offers valuable insights during surgical procedures, especially in infants with compromised respiratory and cardiovascular functions.

Estenosis laringotraqueal recurrente asociada a Klebsiella pneumoniae subsp. rhinoscleromatis / Recurrent laryngotracheal stenosis associated with Klebsiella pneumoniae subsp. rhinoscleromatis

Introducción: Klebsiella rhinoscleromatis (KR) es una enterobacteria asociada con formación de granulomatosis crónica. Cuando este microorganismo afecta el tracto respiratorio se denomina escleroma, afectando principalmente la cavidad nasal; puede comprometer nasofaringe, laringe, tráquea y bronquios. Caso clínico: paciente femenina con antecedente de laringotraqueítis crónica con diagnóstico de estenosis traqueal y aislamiento en cultivos de Klebsiella pneumoniae ssp rhinoscleromatis multisensible, sin compromiso nasosinusal o extralaríngeo. Discusión: el escleroma puede afectar todo el tracto respiratorio y se deben tener presentes factores de riesgo asociados, como condiciones de hacinamiento, inmunosupresión y sexo femenino. El pilar del tratamiento es médico, basado en antibióticos; adicionalmente, se reserva manejo quirúrgico en la etapa esclerótica, donde hay ausencia del fenómeno inflamatorio. Conclusión: el escleroma es una patología rara con una evolución crónica y compromiso principalmente en cavidad nasal, que requiere alta sospecha diagnóstica para realizar manejo oportuno.

Introduction: Klebsiella rhinoscleromatis (KR) is an enterobacterium associated with the formation of chronic granulomatosis. When this microorganism affects the respiratory tract, it is called scleroma, the nasal cavity is the main one affected; additionally, it can involve nasopharynx, larynx, trachea, and bronchi. Clinical case: female patient with a history of chronic laryngotracheitis, with diagnosis of tra-cheal stenosis and isolation in cultures of multisensitive Klebsiella pneumoniae ssp rhinoscleromatis, without nasosinusal or extralaryngeal involvement. Discussion: scleroma can affect the entire respiratory tract, so associated risk factors should be taken into account, mainly overcrowding, immunosuppression, and female sex, in whom it is more common. The mainstay of treatment is medical, based on antibio-tics; additionally, surgical management is reserved for sclerotic stage, when there is no inflammatory phenomenon. Conclusion: scleroma is a rare pathology, with a chronic evolution, with involvement mainly in the nasal cavity, which requires a high diagnostic suspicion for its timely management.

Postintubation airway injury in the pediatric intensive care unit / Lesiones de la vía aérea postintubación en la unidad de terapia intensiva pediátrica

Introduction and objectives Airway injury caused by endotracheal intubation (ETI) is a common event in children who require ETI in the pediatric intensive care unit (PICU). The main aim of our study was to determine the incidence and the predisposing factors for the development of airway injury in PICU patients who need ETI. Secondary objectives were to evaluate the reasons for the request of airway endoscopy examination and the tracheostomy rate in this population. Materials and methods A retrospective, observational, descriptive study was conducted evaluating 1854 patients who were intubated in the PICU of a tertiary-care center between May 2015 and April 2019. Results The mean age of all intubated patients was 35.6 months and of those who required endoscopy 27.3 months (p = 0.04). Mean length of intubation was 7.2 days for all intubated patients and 23.5 days for those who required endoscopy (p = 0.0001). Extubation failure and stridor were significantly associated with the finding of airway injury (p = 0.0001 and p = 0.0006, respectively). Conclusions The incidence rate of ETI-related injury was 3%. Age younger than 27 months and intubation for more than 7 days were predisposing factors for the development of injury.The main indications for endoscopy were extubation failure and stridor, both related to the presence of injury. Tracheostomy rate in the PICU was 3.34%. (AU)

Introducción y objetivos Las lesiones de la vía aérea por intubación endotraqueal (IET) son procesos patológicos causados por el trauma de los tejidos durante dicha condición. El principal objetivo fue determinar la incidencia y los factores predisponentes para el desarrollo de lesión de la vía aérea en pacientes que requirieron IET en la Unidad de Terapia Intensiva Pediátrica (UTIP). Los objetivos secundarios fueron evaluar las indicaciones de endoscopía y el porcentaje de pacientes traqueostomizados en dicha población. Materiales y métodos Estudio retrospectivo, observacional y descriptivo, de 1854 pacientes intubados en un centro de tercer nivel de complejidad entre Mayo de 2015 y Abril de 2019.ResultadosLa media de edad de los pacientes intubados fue de 35,6 meses y la de los que requirieron endoscopía de la vía aérea fue de 27,3 meses (p = 0,04). El promedio de días de intubación de los pacientes intubados fue de 7,2 días y el de los que requirieron endoscopía fue de 23,5 días (p = 0,0001). El fallo de extubación programada y el estridor se relacionaron con la presencia lesión (p = 0,0001 y p = 0,0006, respectivamente). Conclusiones La incidencia de lesiones asociadas a la IET fue del 3%. La edad menor a 27 meses y la intubación por más de 7 días fueron los factores predisponentes para el desarrollo de lesiones. Las principales indicaciones de endoscopía fueron el fallo de extubación programada y el estridor; ambas se relacionaron con la presencia de lesión. El porcentaje de traqueostomías realizadas en la UTIP fue del 3,34%. (AU)

[A case report of primary extubation by partial cricotracheal resection for severe subglottic stenosis].

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.

Association between subglottic stenosis and endotracheal intubation in tracheostomized pediatric patients. / Asociación entre estenosis subglótica e intubación endotraqueal en pacientes pediátricos traqueostomizados.

OBJECTIVE: Considering that intubation time is the primary cause of subglottic stenosis, tracheostomy is suggested in adult patients following 10-15 days. The objective of this study was to analyze the association between intubation time and stenosis in pediatric patients, as well as to establish whether there is an adequate timing for tracheostomy in order to reduce the incidence of stenosis. MATERIALS AND METHODS: A retrospective study (2014-2019) of tracheostomized newborns and children after an intubation period was carried out. Endoscopic findings at tracheostomy were analyzed. RESULTS: Tracheostomy was conducted in 189 patients, 72 of whom met inclusion criteria. Mean age was 40 months (1 month - 16 years). The incidence of stenosis was 21%, with a mean age of 23 months and a mean intubation time of 30 days vs. 19 days in the non-stenosis group (p= 0.02). The incidence of stenosis increased by 7% five days following intubation, reaching 20% after one month. Patients under 6 months old had greater tolerance to intubation periods without stenosis (incidence < 6% after 40 days, and median time to stenosis of 56 days vs. 24 days in patients over 6 months old). CONCLUSIONS: In patients with long intubation periods, preventive measures should be taken in order to avoid laryngotracheal injuries, and early tracheostomy should be considered.

OBJETIVOS: Considerando el tiempo de intubación la principal causa de estenosis subglótica, en adultos se sugiere realizar una traqueostomía a los 10-15 días. Se buscó determinar la asociación entre tiempo de intubación y estenosis en pediatría y establecer si existe, un momento en el que realizar una traqueostomía reduciría la incidencia de estenosis. MATERIAL Y METODO: Estudio retrospectivo (2014-2019) de neonatos y niños traqueostomizados luego de un período de intubación. Se analizaron los hallazgos endoscópicos al realizar la traqueostomía. RESULTADOS: Se traqueostomizaron 189 pacientes y 72 cumplieron criterios de inclusión. La edad media fue de 40 meses (1 mes a 16 años). La incidencia de estenosis fue de 21%, con edad media de 23 meses e intubación media de 30 días versus en el grupo sin estenosis fue de 19 días (p= 0 ,02). La incidencia de estenosis aumentó un 7% a los cinco días de intubación alcanzando el 20% al mes. Los menores de 6 meses presentaron mayor tolerancia a períodos de intubación sin estenosis (incidencia < 6% luego de 40 días y mediana de tiempo hasta la estenosis de 56 días, versus 24 días en mayores de 6 meses). CONCLUSIONES: Los resultados favorables del tratamiento con sirolimus en nuestros pacientes parecen confirmar la efectividad y seguridad del fármaco en anomalías vasculares y lo posicionan como una opción terapéutica en pacientes pediátricos. Aun así, parece necesaria mayor investigación que trate de aclarar, entre otros, el régimen óptimo del tratamiento, la duración del mismo y los potenciales efectos adversos a largo plazo.

Asociación entre estenosis subglótica e intubación endotraqueal en pacientes pediátricos traqueostomizados / Association between subglottic stenosis and endotracheal intubation in tracheostomized pediatric patients

Objetivos: Considerando el tiempo de intubación la principal causade estenosis subglótica, en adultos se sugiere realizar una traqueostomíaa los 10-15 días. Se buscó determinar la asociación entre tiempo deintubación y estenosis en pediatría y establecer si existe, un momentoen el que realizar una traqueostomía reduciría la incidencia de estenosis. Material y métodos: Estudio retrospectivo (2014-2019) de neonatos y niños traqueostomizados luego de un período de intubación. Se analizaron los hallazgos endoscópicos al realizar la traqueostomía.Resultados: Se traqueostomizaron 189 pacientes y 72 cumplieroncriterios de inclusión. La edad media fue de 40 meses (1 mes a 16 años).La incidencia de estenosis fue de 21%, con edad media de 23 meses eintubación media de 30 días versus en el grupo sin estenosis fue de 19días (p= 0 ,02). La incidencia de estenosis aumentó un 7% a los cincodías de intubación alcanzando el 20% al mes. Los menores de 6 mesespresentaron mayor tolerancia a períodos de intubación sin estenosis(incidencia <6% luego de 40 días y mediana de tiempo hasta la estenosisde 56 días, versus 24 días en mayores de 6 meses). Conclusiones: En pacientes con intubación prolongada, se debentomar medidas preventivas para evitar el desarrollo de lesiones laringotraqueales incluyendo la consideración de una traqueostomía temprana.(AU)

Objective: Considering that intubation time is the primary cause ofsubglottic stenosis, tracheostomy is suggested in adult patients following10-15 days. The objective of this study was to analyze the association between intubation time and stenosis in pediatric patients, as well as toestablish whether there is an adequate timing for tracheostomy in orderto reduce the incidence of stenosis. Materials and methods: A retrospective study (2014-2019) oftracheostomized newborns and children after an intubation period wascarried out. Endoscopic findings at tracheostomy were analyzed.Results: Tracheostomy was conducted in 189 patients, 72 of whommet inclusion criteria. Mean age was 40 months (1 month - 16 years). The incidence of stenosis was 21%, with a mean age of 23 months anda mean intubation time of 30 days vs. 19 days in the non-stenosis group(p=0.02). The incidence of stenosis increased by 7% five days followingintubation, reaching 20% after one month. Patients under 6 months oldhad greater tolerance to intubation periods without stenosis (incidence<6% after 40 days, and median time to stenosis of 56 days vs. 24 daysin patients over 6 months old). Conclusions: In patients with long intubation periods, preventivemeasures should be taken in order to avoid laryngotracheal injuries, andearly tracheostomy should be considered.(AU)

Postintubation airway injury in the pediatric intensive care unit.

INTRODUCTION AND OBJECTIVES: Airway injury caused by endotracheal intubation (ETI) is a common event in children who require ETI in the pediatric intensive care unit (PICU). The main aim of our study was to determine the incidence and the predisposing factors for the development of airway injury in PICU patients who need ETI. Secondary objectives were to evaluate the reasons for the request of airway endoscopy examination and the tracheostomy rate in this population. MATERIALS AND METHODS: A retrospective, observational, descriptive study was conducted evaluating 1854 patients who were intubated in the PICU of a tertiary-care center between May 2015 and April 2019. RESULTS: The mean age of all intubated patients was 35.6 months and of those who required endoscopy 27.3 months (p = 0.04). Mean length of intubation was 7.2 days for all intubated patients and 23.5 days for those who required endoscopy (p = 0.0001). Extubation failure and stridor were significantly associated with the finding of airway injury (p = 0.0001 and p = 0.0006, respectively). CONCLUSIONS: The incidence rate of ETI-related injury was 3%. Age younger than 27 months and intubation for more than 7 days were predisposing factors for the development of injury. The main indications for endoscopy were extubation failure and stridor, both related to the presence of injury. Tracheostomy rate in the PICU was 3.34%.

Manifestaciones laríngeas de COVID-19 / Laryngeal manifestations of COVID-19

Introducción: la infección por COVID-19 afecta el tracto aerodigestivo superior a través de la enzima convertidora de angiotensina 2 (ECA2) y/o la proteasa transmembrana serina 2 (TMPRSS2). Sus manifestaciones agudas y secuelas han sido muy variadas y no todas están relacionadas con la intubación orotraqueal. El objetivo es describir las características sociodemográficas, clínicas y los hallazgos endoscópicos de los pacientes con síntomas laringofaríngeos posteriores a una infección por SARS-CoV-2 evaluados en el Hospital Militar Central y Hospital Universitario Clínica San Rafael entre marzo de 2020 y marzo de 2022. Materiales y métodos: estudio observacional de corte transversal con datos sociodemográficos, comorbilidades, necesidad de intubación orotraqueal, variedad de síntomas y sus hallazgos endoscópicos. Resultados: se recolectaron datos de 118 pacientes; la edad media fue de 51 años ± 14,4. El síntoma más frecuente fue la disfonía (69,5 %), seguido de la disnea (39,8 %). El 58,9 % requirió intubación orotraqueal y, de estos, la manifestación más frecuente fue disfonía por tensión muscular (DTM) y estenosis subglótica-traqueal. En el 41,1 % restante su hallazgo más frecuente fue la laringitis irritativa. Conclusiones: la COVID-19 tiene múltiples manifestaciones laringofaríngeas en relación con su mecanismo de infección e invasión en los tejidos de esta zona, de tipo inflamatorio y estructural, y no todos están relacionados con la intubación.

Introduction: COVID 19 infection affects the upper aerodigestive tract through angiotensin-converting enzyme 2 (ACE2) and/or Transmembrane serine protease 2 (TMPRSS2). Its acute manifestations and sequelae have been very varied, and not all of them are related to orotracheal intubation. The objective is to describe the sociodemographic and clinical characteristics and the endoscopic findings of patients with laryngopharyngeal symptoms after SARS-CoV-2 infection evaluated at the Hospital Militar Central and Hospital Universitario Clínica San Rafael between March 2020 and March 2022. Methods: Cross-sectional observational study, obtaining sociodemographic data, comorbidities, need for orotracheal intubation, variety of symptoms and their endoscopic findings. Results: 118 patients were collected; the mean age was 51 years ± 14.4. The most frequent symptom was dysphonia (69.5%), followed by dyspnea (39.8%). 58.9% required orotracheal intubation and of these the most frequent manifestation was muscular tension dysphonia (MTD) and subglottictracheal stenosis. In the remaining 41.1%, the most frequent finding was irritative laryngitis. Conclusions: COVID-19 has multiple laryngopharyngeal manifestations in relation to its mechanism of infection and invasion in the tissues of this area, as an inflammatory and structural type, and not all of them are related to intubation.

Management of unanticipated difficult airway in a patient with well-visualized vocal cords using video laryngoscopy - A case report.

BACKGROUND: Difficult airway occurs due to anatomical abnormalities of the airway that can be predicted through airway assessments; however, abnormalities beyond the vocal cord can be clinically asymptomatic and undetected until intubation failure to advance the endotracheal tube. CASE: We present a case of an unanticipated difficult airway in a stuporous 80-year-old female with a recent history of intracerebral hemorrhage and prolonged intubation. She required emergency ventriculo-peritoneal shunt surgery due to the progression of her hydrocephalus. Under anesthesia, facemask ventilation was easy and video laryngoscopy provided a full view of the glottis; however, endotracheal tube (ETT) entry failed. We suspected stenosis beyond the vocal cord, and a smaller diameter ETT was inserted and maintained for airway management during emergency surgery. Postoperative neck computed tomography findings revealed laryngotracheal stenosis (LTS). CONCLUSIONS: Anesthesiologists should be aware that LTS may be asymptomatic and consider difficult airway guidelines in patients with history of prolonged endotracheal intubation.

The Clinical Features and Risk Factors of Subglottic Cysts in Children: A Clinical Experience Using the Spontaneous Respiration Technique.

OBJECTIVES: Subglottic cysts (SGCs) are a rare cause of respiratory distress resulting from upper airway obstruction in infants and young children. Risk factors other than prematurity with a history of endotracheal intubation have not yet been well elucidated. Therefore, we aimed to describe the clinical features and analyze the risk factors of SGCs. METHODS: We conducted a retrospective review of medical records of pediatric patients who underwent marsupialization for SGCs between January 2017 and March 2022. These records were then compared with those of controls with a history of neonatal intubation, with a case-to-control ratio of 1:3. RESULTS: Eleven patients (eight boys and three girls) diagnosed with SGCs and 33 control patients (26 boys and seven girls) were included. All patients had a history of premature birth and neonatal intubation. Symptoms of SGCs appeared at a mean age of 8.2 months (range, 1-14 months) after extubation. The mean duration of intubation was 21.5 days (range, 2-90 days), and the intubation period was longer in patients with SGCs than in controls (21.5±24.8 days vs. 5.3±7.1 days; P<0.001). Furthermore, gestational age (28.3±4.2 weeks vs. 33.8±4.4 weeks; P=0.001) and birth weight (1,134.1±515.1 g vs. 2,178.2±910.1 g; P=0.001) were significantly lower in patients with SGCs than in controls. Multivariable analysis identified the intubation period as an independent risk factor. CONCLUSION: This study showed that gestational age, birth weight, and the intubation period were significantly associated with the development of SGCs. Pediatric patients presenting with progressive dyspnea who have the corresponding risk factors should undergo early laryngoscopy for the differential diagnosis of SGC.

Analysis of Clinical Treatment of Laryngeal Stenosis After Radiotherapy and Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy of Mid-stage and Advanced Laryngeal Cancer.

OBJECTIVE: To investigate the possible causes and treatment methods of laryngeal stenosis after radiotherapy following supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). METHODS: The data of seven patients with laryngeal stenosis after radiotherapy following SCPL-CHEP were analysed retrospectively. All patients were diagnosed with mid-stage or advanced laryngeal carcinoma before surgery, and the pathological type was squamous cell carcinoma. All patients met the requirements for SCPL-CHEP surgery. When laryngeal stenosis was found during the post-surgical follow-up period, patients were immediately given the appropriate treatment according to their conditions. RESULTS: All seven patients had laryngeal stenosis. One patient underwent granulation resection using a laryngoscope, four patients underwent granulation removal + low-temperature plasma ablation using a laryngoscope, and two patients underwent laryngeal dehiscence surgery + laryngotracheal T-tube placement. All patients recovered well after surgery, with patent airways. CONCLUSION: Laryngeal stenosis in patients with mid- and late-stage laryngeal carcinoma is one of the rare complications of SCPL-CHEP. Second-stage laryngeal dilatation can be selected according to the patient's laryngeal stenosis. Most patients with laryngeal stenosis can be extubated completely.

Prevalencia de estenosis subglótica posintubación en paciente pediátrico en un hospital de tercer nivel en Colombia entre 2017 y 2020 / Prevalence of pediatric postintubation subglottic stenosis in a third level hospital in Colombia between 2017 and 2020

Introducción: la intubación orotraqueal en pediatría aumenta la supervivencia en patologías graves; sin embargo, una consecuencia es el desarrollo de estenosis subglótica cuya población tiene más riesgo de desarrollarla por diferencias anatómicas con los adultos. La incidencia de estenosis subglótica posterior a intubación orotraqueal ha disminuido en el tiempo según lo reportado en la literatura. En este estudio se evaluó la prevalencia de la patología en nuestra población y su objetivo fue describir las características clínicas, demográficas y diagnósticas en población pediátrica, diagnosticados con estenosis subglótica en el Hospital San Vicente Fundación, posterior a intubación orotraqueal y evaluar la prevalencia del diagnóstico en el período mencionado. Materiales y métodos: se realizó un estudio retrospectivo mediante revisión de historias clínicas de pacientes con códigos CIE 10 de estenosis laríngea o subglótica secundaria a procedimientos y con código CUPS de intubación orotraqueal; se realiza un análisis descriptivo según la distribución de las variables. Resultados: la prevalencia de estenosis subglótica fue del 13 %. La mayoría fueron hombres, la causa principal de intubación fueron las infecciones respiratorias inferiores, principalmente bronquiolitis; las comorbilidades fueron prematuridad, trastorno de deglución y síndrome bronco-obstructivo. Hubo una mediana 19 días de intubación y las estenosis de bajo grado se diagnosticaron más frecuente. Conclusiones: la estenosis subglótica es una complicación de la intubación orotraqueal pediátrica, en este estudio con una prevalencia del 13 %. Los pacientes que desarrollan esta patología requieren la realización de uno o más procedimientos para obtener una vía aérea permeable con estancias hospitalarias prolongadas.

Introduction: Pediatric orotracheal intubation has increased survival rates in severe illnesses; however, one of the consequences maybe the development of subglottic stenosis. This population is at a higher risk of developing it due to anatomical diffe-rences compared to adults. The incidence of subglottic stenosis following orotracheal intubation has decreased over time as reported in the literature. This study aimed to assess the prevalence of this condition in our population and describe the clinical, demographic, and diagnostic characteristics in the pediatric population diagnosed with subglottic stenosis following orotracheal intubation at the San Vicente Fun-dación Hospital. Additionally, it aimed to evaluate the prevalence of this diagnosis during the mentioned period. Materials and Methods: A retrospective study was conducted by reviewing medical records of patients with ICD-10 codes for laryn-geal stenosis and for subglottic stenosis secondary to procedures. Also, the patients with the procedure code for orotracheal intubation were identified. A descriptive analysis was performed based on the distribution of variables. Results: The preva-lence of subglottic stenosis was 13%. There was a majority of male cases, and the primary cause of intubation was lower respiratory tract infection, mainly bronchio-litis. The most frequent comorbidities included prematurity, swallowing disorders, and broncho-obstructive syndrome. Median duration of intubation was 19 days, and lower-grade stenosis was more commonly encountered. Conclusions: Subglottic ste-nosis is a complication of pediatric orotracheal intubation, with a prevalence of 13% in this study. Patients who develop this condition require one or more procedures to establish a patent airway and often experience prolonged hospital stays.

A case report of primary extubation by partial cricotracheal resection for severe subglottic stenosis / 临床耳鼻咽喉头颈外科杂志

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

Abstract Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053-0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility.

Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant ( p = 0.064), complete BVFI on fiberoptic exam ( n = 47) was significantly associated with tracheostomy dependence both in the entire cohort ( p = 0.036) and in the 56 patients with tracheostomy ( p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053-0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

Voice outcomes and its impact on quality of life after open airway surgery in children.

INTRODUCTION: Open airway surgery is used to treat severe grades of laryngotracheal stenosis in children. Scarring of the airway following these procedures may lead to voice impairment and impact quality of life. This study was designed to characterize vocal outcome in children submitted reconstructive airway surgery and verify how this correlates to voice related quality of life in this population. MATERIAL AND METHODS: Children submitted to open airway surgery that had been decannulated for a minimum of 30 days and had functional speech were invited to participate. Pediatric Voice-Related Quality-of-Life survey (PVRQoL) was applied, consensus auditory perceptive of voice (CAPE-V) protocol was used for perceptual voice evaluation and acoustic analysis was performed using Praat software. RESULTS: Twenty children were enrolled in the study with an average age of 4 years and 8 months. Averages for PVRQoL exceeded normative values in 80% of the children. Half of the children had normal voice or mild dysphonia and half had moderate dysphonia, according to perceptual evaluation. Measures of F0, jitter and particularly shimmer were abnormal in most of the children. CONCLUSION: Voice quality varies from normal to moderately impaired in children following reconstructive airway surgery. Voice quality impacts quality of life in the majority of cases and the degree of dysphonia does not always correlate with voice related quality of life scores.

A novel treatment for supraglottic stenosis secondary to immunoglobulin G4-related disease.

Although immunoglobulin G4-related disease (IgG4-RD) has a predilection for the head and neck region, laryngeal pathology is rare. We report a case of supraglottic stenosis due to IgG4-RD together with a novel treatment strategy of employing a laryngeal stent. A 69-year-old man was referred with longstanding dyspnoea and worsening inspiratory stridor. Despite two supraglottic dilations over a 12-month period, his stenosis recurred and symptoms persisted. Serum investigations revealed elevated IgG4 levels (2.390g/l), with IgG4 infiltrate in laryngeal biopsies. The patient underwent endoscopic balloon dilation, intralesional Depo-Medrone® injection, CO2 laser therapy and insertion of a laryngeal stent to prevent re-stenosis. Rituximab and prednisolone were commenced postoperatively and the stent was removed at 6weeks. No stenosis recurrence was visualised over a further 12-month follow-up period. Sixteen cases of laryngeal lesions with confirmed IgG4 infiltrate in biopsies have been reported in the worldwide literature to date. Based on a literature review and our experience, we recommend that similar laryngeal pathologies undergo early IgG4 serological testing and biopsy immunohistochemistry. Prompt diagnostic confirmation may prevent unnecessary surgical interventions and optimise immunosuppression. Furthermore, the use of a laryngeal stent following laryngeal surgery may help reduce stenotic recurrence and promote healing.

Supraglottic stenosis as a late complication of radiotherapy: a case report

ABSTRACT Nasopharyngeal carcinoma is rare and affect mainly men between the fourth and sixth decades of life. The clinic is characterized to be nonspecific and the main complaints or findings related to this disease are: cervical mass, aural dysfunction, and headache. The basis of treatment is radiotherapy that involves a wide field of irradiation of normal tissues, which usually generates sequelae with direct implications for quality of life. We report a case of a nasopharyngeal carcinoma treated with radiotherapy and chemotherapy that evolved, after 8 years, into supraglottic stenosis. We emphasize the relevance of clinical follow-up after radiotherapy, particularly due to the late sequelae and the relevance of using radiotherapy devices with a more focal cancer field, in order to minimize complications.

Causas de estridor congénito / Causes of congenital stridor

INTRODUCTION. Airway abnormalities are rare but potentially fatal. Stridor is a res-piratory noise with greater predominance in the inspiratory phase. OBJECTIVE. To evaluate the etiology of stridor, determine its comorbidities and mortality. MATERIALS AND METHODS. Retrospective cross-sectional study. Population of 110 and sample of 33 data from the Medical Records of neonatal or infant patients who presented stri-dor at the Carlos Andrade Marín Specialties Hospital of Quito-Ecuador, from january 2009 to december 2020. RESULTS. The 51,51% (17; 33) of cases were men. The age of the first consultation for stridor was within the first month in 18,00% (6; 33) and 40,00% (13; 33) at 3 months. The most frequent congenital laryngeal patholo-gy was: laryngomalacia 81,82% (27; 33), followed by subglottic stenosis 9,09% (3; 33), bilateral chordal paralysis 6,06% (2; 33) and tracheal stenosis 3,03% (1; 33). The 51,51% (17; 33) presented comorbidities of causes: neurological, pulmonary and genetic among the main ones. Mortality was 18,20% (6; 33) related to the severity of comorbidities, except one secondary to tracheal stenosis. CONCLUSION. Laryn-gomalacia and subglottic stenosis were the predominant pathologies with congenital stridor. The comorbidities that occurred were neurological, pulmonary, genetic and caused mortality within 90 days after diagnosis.

INTRODUCCIÓN. Las anomalías de la vía aérea son poco frecuentes, pero potencialmente mortales. El estridor es un ruido respiratorio con mayor predominio en la fase inspiratoria. OBJETIVO. Evaluar la etiología del estridor, determinar sus comorbilidades y la mortalidad. MATERIALES Y MÉTODOS. Estudio transversal retrospectivo. Población de 110 y muestra de 33 datos de Historias Clínicas de pacientes neonatos o lactantes que presentaron estridor en el Hospital de Especialidades Carlos Andrade Marín de Quito - Ecuador, de enero 2009 a diciembre 2020. RESULTADOS. El 51,51% (17; 33) de casos fueron hombres. La edad de la primera consulta por estridor fue dentro del primer mes en el 18,00% (6; 33) y del 40,00% (13; 33) a los 3 meses. La patología congénita laríngea más frecuente fue: laringomalacia 81,82% (27; 33), seguida de estenosis subglótica 9,09% (3; 33), parálisis cordal bila-teral 6,06% (2; 33) y estenosis traqueal 3,03% (1; 33). El 51,51% (17; 33) presentaron comorbilidades de causas: neurológica, pulmonar y genética entre las principales. La mortalidad fue 18,20% (6; 33) relacionada con la severidad de las comorbilidades, excepto una secundaria a estenosis traqueal. CONCLUSIÓN. La laringomalacia y la estenosis subglótica fueron las patologías que predominaron con estridor congénito. Las comorbilidades que se presentaron fueron neurológica, pulmonar, genética y causaron mortalidad dentro de los 90 días posteriores al diagnóstico.

Office-Based Intralesional Steroid Injection for Treatment of Laryngeal Sarcoidosis.

OBJECTIVES: To report preliminary outcomes of a case series of in-office intralesional steroid injections for treatment of laryngeal sarcoidosis. METHODS: After diagnosis of laryngeal sarcoidosis, 3 patients were offered in-office steroid injections for primary or adjunctive treatment. Triamcinolone 40 was injected into supraglottic sarcoidosis lesions in the office using a channel laryngoscope. Response to treatment and need for further injections was determined based on patient symptoms and repeat flexible laryngoscopy. RESULTS: In-office intralesional steroid injections provided rapid symptom relief within days that lasted for months, thus decreasing the frequency of operative interventions. For one of the patients in this series, these injections even eliminated the need for tracheostomy. No complications were observed. CONCLUSIONS: In-office intralesional steroid injection is an emerging adjunctive treatment for laryngeal sarcoidosis. Prospective studies are required to determine efficacy and long-term risk profiles in relation to the current standard of operative management and systemic treatments.