Delayed Diagnosis of Idiopathic Subglottic Stenosis.

Abstract

OBJECTIVE\nIdiopathic subglottic stenosis (iSGS) is a rare disease, causing life-threatening dyspnea secondary to scarring. Perhaps because it is rarely encountered, there is often a delay in diagnosing iSGS. The objective of this study is to characterize diagnostic delay of iSGS, factors that prolong delay, and its impact on iSGS patients.\n\n\nSTUDY DESIGN\nRetrospective chart review.\n\n\nMETHODS\nA retrospective chart review of 124 iSGS patients was performed. Times of symptom onset, presentation to otolaryngologist, diagnosis, imaging, pulmonary function testing (PFTs), surgeries, emergency department (ED) visits, and hospitalizations were recorded and univariate analyses were used to identify risk factors for delay.\n\n\nRESULTS\nThe median total time to diagnosis from symptom onset was 24.5\u2009months, with time to first presentation of 6.3\u2009months and healthcare delay of 17.8\u2009months. 54.8% of patients were diagnosed with asthma. Earlier presentation to otolaryngologist was associated with shorter healthcare delay and total time to diagnosis (rho\xa0=\xa00.75, rho\xa0=\xa00.99, P\u2009<\u2009.0001). Earlier CT imaging was correlated to shorter healthcare delay (rho\xa0=\xa00.84, P\u2009<\u2009.0001) and total time to diagnosis (rho\xa0=\xa00.74, P\u2009<\u2009.001), while earlier PFTs were correlated to shorter total time to diagnosis alone (rho\xa0=\xa00.71, P\xa0=\xa0.01). During evaluation, 10.5% (n\xa0=\xa017/124) of patients had ED visits and 13.7% (n\xa0=\xa013/124) patients were hospitalized. Before diagnosis, 7% (9/124) of patients underwent surgeries (including 3% (n\xa0=\xa04) undergoing tracheostomy) and 8% (n\xa0=\xa010) of patients required unplanned urgent endoscopic surgery that may have been avoided with earlier diagnosis.\n\n\nCONCLUSION\niSGS diagnosis is frequently delayed, resulting in additional surgeries (including tracheostomy), ED visits, and hospitalizations. Further, patients symptoms are commonly attributed to asthma. Earlier otolaryngologist evaluation, PFTs, and CT imaging may expedite iSGS diagnosis.\n\n\nLEVEL OF EVIDENCE\n4 Laryngoscope, 2021.