Long-Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis

Objectives/Hypothesis: Cricotracheal resection (CTR) is an effective treatment for refractory idiopathic subglottic stenosis (iSGS) but is associated with persistent dysphonia. Outcomes were measured longitudinally to characterize how patients' voices and self-perceived voice handicaps changed after CTR. Study Design: Retrospective case-series. Methods: We conducted a retrospective cohort study of patients with refractory iSGS treated by CTR from 2006 to 2017. Voice Handicap Index (VHI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and acoustic analysis were prospectively collected preoperatively and postoperatively at 1, 3, 6, 12, and 24-month intervals. A linear mixed model was used to evaluate temporal change. Results: Thirty-three patients (97% female) were included. VHI scores increased significantly from baseline preoperative score (27.2 +/- 22.7) to a mean value of 44.3 +/- 25.6 (P < .001) 1-month postoperatively but decreased below preoperative scores after 2 years (18.8 +/- 11.9, P = .795). Mean fundamental frequency (FO) values in speech decreased significantly from 192.0 +/- 24.9 Hz preoperatively to 167.1 +/- 19.8 Hz at a 2-year follow-up (P = .002), with a nadir value at 1-month postoperatively (148.4 +/- 20.5, P < .001). CAPE-V scores increased significantly from preoperative to 1-month postoperative (3.0 +/- 2.3 vs. 21.9 +/- 17.3, P < .001) but returned toward baseline values at 24 months after CTR (6.9 +/- 4.8, P = .027). CAPE-V measurements postoperatively were correlated with VHI and FO (Pearson coefficient = 0.54 (VHI), -0.46 (FO), P < .001). Conclusions: Following CTR, mean FO values were significantly and consistently lower but did increase over time, correlating with patients' improving VHI and CAPE-V scores. VHI values indicate that patient's perception of their voice is not significantly impacted in long term. These results provide a framework to counsel patients about long term voice expectations.

Automated summary

Cricotracheal resection (CTR) is effective for refractory idiopathic subglottic stenosis (iSGS) but leads to persistent dysphonia. Voice Handicap Index (VHI) scores increased at 1 month postoperatively but decreased after 2 years, while fundamental frequency (FO) values decreased initially and then increased over time. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores increased at 1 month postoperatively and returned towards baseline at 24 months after CTR.