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.