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The Liverpool Experience: The Role of Immunosuppression in treating Vasculitic Subglottic Stenosis
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  • Matthew Zammit,
  • Vedika Dhunnoo,
  • Andrew Kinshuck,
  • Sarah Hardy,
  • Janice Harper,
  • Alessandroo Panarese,
  • Christopher Webb
Matthew Zammit
Liverpool University Hospitals NHS Foundation Trust

Corresponding Author:matthewzammit17@gmail.com

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Vedika Dhunnoo
Liverpool University Hospitals NHS Foundation Trust
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Andrew Kinshuck
Liverpool University Hospitals NHS Foundation Trust
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Sarah Hardy
Liverpool University Hospitals NHS Foundation Trust
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Janice Harper
Liverpool University Hospitals NHS Foundation Trust
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Alessandroo Panarese
Liverpool University Hospitals NHS Foundation Trust
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Christopher Webb
Liverpool University Hospitals NHS Foundation Trust
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Abstract

Five Key Points • Subglottic stenosis (SGS) is the commonest tracheobronchial manifestation of granulomatosis with polyangiitis (GPA), with early recognition and treatment key to preventing its vasculitic progression and fibrosis. • Previous studies have shown SGS to be the first feature of GPA in 4% of cases. It is not uncommon to see negative biochemical (10% ANCA negative) and negative histological biopsies (77% of head and neck specimens are negative). • Our management strategy emphasized rapid SGS-GPA treatment with limited surgical manipulation of the airway and systemic immunosuppression (IS) to prevent evolution of SGS & concurrent systemic vasculitic relapse. • In our study early multi-disciplinary team involvement to deliver induction IS in the presence of active SGS-GPA led to a procedure free interval (PFI) of 31.3 months. This is a significant increase compared to other published studies. • Nineteen percent (4/21) of the cohort did not require any surgical input following induction IS.
06 Aug 2021Submitted to Clinical Otolaryngology
11 Aug 2021Submission Checks Completed
11 Aug 2021Assigned to Editor
16 Aug 2021Reviewer(s) Assigned
27 Sep 2021Review(s) Completed, Editorial Evaluation Pending
10 Oct 2021Editorial Decision: Revise Major
28 Oct 20211st Revision Received
30 Oct 2021Submission Checks Completed
30 Oct 2021Assigned to Editor
30 Oct 2021Reviewer(s) Assigned
16 Nov 2021Review(s) Completed, Editorial Evaluation Pending
21 Nov 2021Editorial Decision: Accept
Mar 2022Published in Clinical Otolaryngology volume 47 issue 2 on pages 351-356. 10.1111/coa.13900