Journal ArticleDOI
Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the expiratory disproportion index.
S. A. Reza Nouraei,S. Mahmoud Nouraei,Anil Kumar Patel,Kevin Murphy,Dino A. Giussani,Elias F. Koury,James Brown,P. Jeremy George,Andrew C. Cummins,Guri Sandhu +9 more
TLDR
The study's objective was to determine the utility of expiratory disproportion index (EDI), the ratio of forced expIRatory volume in 1 second to peak expiratories flow rate (PEFR), in differentiating between laryngotracheal stenosis (LTS) and other respiratory diagnoses.Abstract:
Objective/Hypothesis
The study's objective was to determine the utility of expiratory disproportion index (EDI), the ratio of forced expiratory volume in 1 second (FEV1) to peak expiratory flow rate (PEFR) (EDI = FEV1[L]/PEFR[L/s] × 100), in differentiating between laryngotracheal stenosis (LTS) and other respiratory diagnoses. LTS is an uncommon complication of mechanical ventilation or vasculitis or a manifestation of airway compression or malignancy. It frequently masquerades as asthma and evades timely diagnosis, causing prolonged morbidity and airway-related mortality.
Study Design
Observational study.
Methods
We compared spirometry results of 9,357 healthy subjects and nonstenosis pulmonary patients with 217 cases of LTS. Bootstrap analysis, receiver-operating characteristic (ROC) statistics, and Pearson correlation were used to assess the diagnostic utility of the EDI and its correlation with stenosis severity.
Results
Mean EDI values were 36 ± 7 in nonstenosis cases, 76 ± 17 in benign stenoses, and 69 ± 23 in tracheal cancer (P 50, EDI had a sensitivity of 95.9% and a specificity of 94.2% in differentiating between stenosis and nonstenosis cases.
Conclusions
EDI can reliably diagnose LTS using routine lung function data. Its simplicity and clinical utility, first recognized by Duncan Empey, are underpinned by a unique physiology whereby PEFR, being determined by total tracheobronchial tree resistance, falls disproportionately compared with FEV1, which is determined within small intrathoracic airways. EDI provides valuable information about the presence and extent of LTS particularly in nonspecialist clinical settings and its routine inclusion within standard lung function reports could prevent the prolonged morbidity and mortality that currently result from missed and delayed diagnoses.
Level of Evidence
3b. Laryngoscope, 123:3099–3104, 2013read more
Citations
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Journal ArticleDOI
Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society.
Cesare Piazza,Marta Filauro,Frederik G. Dikkers,S. A. Reza Nouraei,Kishore Sandu,Christian Sittel,Milan R. Amin,Guillermo Campos,Hans Edmund Eckel,Giorgio Peretti +9 more
TL;DR: The opinions of experts of the LARYngotracheal Stenosis Committee of the European Laryngological Society are gathered with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngo-esophageal stenosis (LTS) cases within referral specialist airway centers.
Journal ArticleDOI
A Prospective Study of Voice, Swallow, and Airway Outcomes Following Tracheostomy for COVID-19.
Maral J Rouhani,Gemma M. Clunie,Gerard Thong,Lindsay Lovell,Justin W. G. Roe,Margaret Ashcroft,Andrew Holroyd,Guri Sandhu,Chadwan Al Yaghchi +8 more
TL;DR: In this paper, the authors evaluated the effects of tracheostomy insertion on voice, swallow, and airway outcomes in COVID-19 patients following discharge from hospital discharge.
Journal ArticleDOI
Laryngeal pacing for bilateral vocal fold paralysis: Voice and respiratory aspects.
Andreas Mueller,Rudolf Hagen,Claus Pototschnig,Gerhard Foerster,Wilma Grossmann,Katrin Baumbusch,Markus Gugatschka,Tadeus Nawka +7 more
TL;DR: To evaluate the effects of neurostimulation with the laryngeal pacemaker (LP) system in patients with bilateral vocal fold paralysis in terms of voice quality and respiratory function.
Journal ArticleDOI
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis.
Delaney J. Carpenter,Sergio Ferrante,Stephen R Bakos,Matthew S. Clary,Alexander Gelbard,James J. Daniero +5 more
TL;DR: Evidence is provided supporting the use of PEF as a simple, efficient, and accessible way of monitoring progression of idiopathic subglottic stenosis and predicting receipt of surgical intervention and Sensitivity and specificity ofPEF were comparable to those of the more complex measures of TPF and EDI.
Journal ArticleDOI
Relationship between degree of obstruction and airflow limitation in subglottic stenosis.
TL;DR: It is hypothesize that airway resistance can be described by the Bernoulli Obstruction Theory, which predicts thatAirway resistance is inversely proportional to airspace CSA in cases of severe constriction.
References
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Journal ArticleDOI
Proposed grading system for subglottic stenosis based on endotracheal tube sizes
TL;DR: This work presents a conversion of tube size to the proposed grading scale: grade I up to 50% obstruction, grade II from 51% to 70%, and grade III above 70% with any detectable lumen, and an airway with no lumen is assigned to grade IV.
Journal ArticleDOI
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S. V. Dawson,E. A. Elliott +1 more
TL;DR: The theoretical approach to the "waterfall effect" leads to selection of the analogy of constricted open-channel flow to apply to the elastic network of airway tubes, and results are derived for the case of negligible friction by use of the Bernoulli principle.
Journal ArticleDOI
Adult laryngotracheal stenosis: etiology and surgical management.
TL;DR: Although promising work has been reported in the treatment of laryngotracheal stenosis, notably with primary resection and anastomosis, many questions remain to be answered, especially in the causes of this potentially life-threatening disease.
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Expiratory flow limitation.
TL;DR: A computational model of the maximal expiratory flow-volume (MEFV) curve has been developed and will require modeling of inhomogeneous emptying in diseased lungs, perfecting noninvasive techniques of estimating pertinent airway characteristics, and improving techniques for increasing the signal-to-noise ratio in MEFV curves.
Journal ArticleDOI
Tracheal stenosis: a flow dynamics study.
Mark Brouns,Santhosh Jayaraju,Chris Lacor,Johan De Mey,Marc Noppen,Walter Vincken,Sylvia Verbanck +6 more
TL;DR: Flow patterns and pressure drops over tracheal stenoses artificially inserted into a realistic three-dimensional upper airway model derived from multislice computed tomography images obtained in healthy men are assessed and a means of detecting stenosis at a precritical stage is suggested.