Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

Hagit Shoffel-Havakuk*, Yonatan Lahav, Yoni Shopen, Yonatan Reuven, Gideon Bachar, Yaniv Hamzany

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To describe the DISCO protocol (Dilation, Steroid injection, and post-operative Cough Exercise); a novel treatment for posterior glottic stenosis (PGS). Restoring glottic mobility in PGS is a major challenge. In orthopedic and plastic surgery, post-operative physical therapy is associated with improved motion range and flexibility; yet, this principle was never applied to laryngeal surgery. Methods: A retrospective cohort of PGS adult patients, treated by the DISCO protocol during 2018–2020. DISCO involves the following: scar release, glottic dilation, and steroid injection, followed by post-operative cough as glottic physical therapy. Maximal glottic opening angle (MGOA), relative glottic opening area (RGOA), and relative glottic insufficiency area (RGIA) were calculated before and post-operatively. Results: Seventeen patients were included; PGS etiology was post-intubation (n = 10), post-irradiation (n = 3), both (n = 1) and joint sclerosis (n = 3). Six patients also had additional airway disorders. Sixteen patients were tracheostomy-dependent. 2 (12%), 8 (47%) and 7 (41%) patients had type II, III and IV stenosis, respectively. Surgery included scar release, dilation and steroid injection alone in 7 patients; and additional unilateral sub-mucosal arytenoidectomy in 10. The mean follow-up was 17.5 months. There were no major complications. Successful outcomes (e.g., decannulation or permanent capping) were achieved in 14 (82%) patients with some restoration of joint movement. None had a persistent voice or swallowing complaints. Both MGOA and RGOA increased in all patients (p < 0.001). RGIA remained unchanged (p = 0.878). Conclusions: The DISCO protocol is a novel, effective and safe approach for PGS correction that can be easily applied. It can restore vocal fold mobility and may expand the glottic airway without causing glottic insufficiency. Level of Evidence: 4 Laryngoscope, 133:883–889, 2023.

Original languageEnglish
Pages (from-to)883-889
Number of pages7
JournalLaryngoscope
Volume133
Issue number4
DOIs
StatePublished - Apr 2023

Keywords

  • DISCO protocol
  • cough
  • posterior glottic stenosis

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