What are the voice and swallowing concerns and outcomes of adults with laryngotracheal stenosis who undergo reconstructive surgery?

Abstract

Acquired laryngotracheal stenosis (LTS) is a rare condition causing narrowing of the upper airway leading to a range of laryngological symptoms. This thesis seeks to identify and evaluate the existing evidence base for the voice and swallowing difficulties of adult patients with LTS who undergo airway reconstruction; and identify voice and swallowing concerns and outcomes. Four studies were included: 1) a systematic review of the voice and swallowing outcomes in adults with LTS following reconstructive surgery, 2) a qualitative study focusing on voice and swallowing concerns, 3) a survey study exploring the impact of mucus and cough, 4) an observational study exploring voice and swallowing outcomes before and after airway reconstruction. The systematic review identifed no consistent reporting of outcomes and provided minimal information to guide clinical practice. The qualitative study indentified voice and swallowing concerns that were grouped into three themes; The Medical Journey which included information provision and staff expertise versus complacency; the Physical Journey which considered symptoms and treatment; the Emotional Journey encompassing identity, support networks and living with a chronic condition. Mucus and cough were raised in the qualitative research leading to a survey to investigate the issue further. They were noted to impact all aspects of health and were related to voice and swallowing issues. There was no consistent treatment advice or management, supporting the need for clearer guidance. The observational study highlighted the heterogeneity of voice and swallowing outcomes which could indicate a need for personalised assessment and management. In conclusion, adults with LTS present with a range of voice and swallowing concerns and outcomes. Clinical care should be personalised according to individuals, including pre-treatment information provision, and support beyond airway reconstruction. There is a need to develop a core outcome set for the assessment of voice and swallowing in adults with LTS.