{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:08:36Z","timestamp":1792789716290,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,11,4]],"date-time":"2015-11-04T00:00:00Z","timestamp":1446595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>Idiopathic subglottic stenosis (iSGS) is a rare and potentially life\u2010threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Medical record abstraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Utilizing an international, multi\u2010institutional collaborative, we collected retrospective data on patient characteristics, treatment, and clinical outcomes. We investigated variation between and within open and endoscopic treatment approaches and assessed therapeutic outcomes; specifically, disease recurrence and need for tracheostomy at last follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Strikingly, 479 iSGS patients across 10 participating centers were nearly exclusively female (98%, 95% confidence interval [CI], 96.1\u201399.6), Caucasian (95%, 95% CI, 92.2\u201398.8), and otherwise healthy (mean age\u2010adjusted Charlson Comorbidity Index 1.5; 95% CI, 1.44\u20131.69). The patients presented at a mean age of 50 years (95% CI, 48.8\u201351.1). A total of 80.2% were managed endoscopically, whereas 19.8% underwent open reconstruction. Endoscopic surgery had a significantly higher rate of disease recurrence than the open approach (chi\n                      <jats:sup>2<\/jats:sup>\n                      = 4.09,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.043). Tracheostomy was avoided in 97% of patients irrespective of surgical approach (95% CI, 94.5\u201399.8). Interestingly, there were outliers in rates of disease recurrence between centers using similar treatment approaches.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Idiopathic subglottic stenosis patients are surprisingly homogeneous. The heterogeneity of treatment approaches and the observed outliers in disease recurrence rates between centers raises the potential for improved clinical outcomes through a detailed understanding of the processes of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      4.\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 126:1390\u20131396, 2016\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.25708","type":"journal-article","created":{"date-parts":[[2015,11,4]],"date-time":"2015-11-04T10:17:13Z","timestamp":1446632233000},"page":"1390-1396","source":"Crossref","is-referenced-by-count":156,"title":["Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0078-1305","authenticated-orcid":false,"given":"Alexander","family":"Gelbard","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald T.","family":"Donovan","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Dept. of Otolaryngology Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julina","family":"Ongkasuwan","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Dept. of Otolaryngology Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.A.R.","family":"Nouraei","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Dept. of Otolaryngology London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guri","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Dept. of Otolaryngology London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Benninger","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Dept. of Otolaryngology Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Bryson","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Dept. of Otolaryngology Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert R.","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Dept. of Otolaryngology Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William S.","family":"Tierney","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Dept. of Otolaryngology Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Hillel","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Dept. of Otolaryngology Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekhar K.","family":"Gadkaree","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Dept. of Otolaryngology Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Lott","sequence":"additional","affiliation":[{"name":"Mayo Clinic Dept. of Otolaryngology and Pulmonology Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Edell","sequence":"additional","affiliation":[{"name":"Mayo Clinic Dept. of Otolaryngology and Pulmonology Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale C.","family":"Ekbom","sequence":"additional","affiliation":[{"name":"Mayo Clinic Dept. of Otolaryngology and Pulmonology Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan L.","family":"Kasperbauer","sequence":"additional","affiliation":[{"name":"Mayo Clinic Dept. of Otolaryngology and Pulmonology Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabien","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Mayo Clinic Dept. of Otolaryngology and Pulmonology Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua S.","family":"Schindler","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University Dept. of Otolaryngology Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall E.","family":"Smith","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine Dept. of Otolaryngology Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Daniero","sequence":"additional","affiliation":[{"name":"University of Virginia Health System Dept. of Otolaryngology Charlottesville Virginia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Gaelyn","family":"Garrett","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Netterville","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otis B.","family":"Rickman","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Sinard","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher T.","family":"Wootten","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Francis","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24287"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24956"},{"key":"e_1_2_6_4_1","volume-title":"Institute of Medicine. 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