Laryngeal keratosis occurs with an estimated annual incidence in the United States of 10.2 lesions per 100 000 males and 2.1 lesions per 100 000 females, respectively.¹ In a single-institution review of laryngeal leukoplakia and a subsequent comprehensive literature review, Isenberg and colleagues² found that more than half of these hyperkeratotic vocal fold lesions might not contain dysplasia; however, even lesions that did not contain dysplasia on initial biopsy had a risk of progression to malignant disease. Overall estimates of progression of laryngeal dysplasia to invasive laryngeal cancer vary widely, with estimates as low as 1.7% and as high as 46.3%; a meta-analysis³ of 940 cases of laryngeal dysplasia revealed a pooled malignant transformation rate of 13.6%, with severe dysplasia and carcinoma in situ having a higher rate of malignant transformation than mild or moderate dysplasia. Genomic analysis on an individual dysplastic lesion might someday allow better prognosis of which particular patients are most at risk of progression to invasive malignant disease,⁴ but to date there is no compelling evidence for use of this technology in routine clinical practice.⁵

Objective: To assess the impact of suspension microlaryngoscopy with balloon dilation on voice-related quality of life (V-RQOL) in laryngotracheal stenosis (LTS). Methods: Retrospective chart review of LTS patients dilated at a tertiary-care academic hospital from 2010 to 2013. Data were obtained and then analyzed. LTS was stratified by (1) subglottic or tracheal stenosis and (2) multilevel stenosis (MLS; glottic and subglottic/tracheal). Pre- and postoperative V-RQOL and grade, roughness, breathiness, asthenia, strain (GRBAS) scores were compared. The number and frequency of balloon dilation procedures over the lifetime were secondary outcome variables. Results: Thirty-eight patients were identified: 26 subglottic/tracheal and 12 multilevel. Of these, 71.4% required multiple dilations, with greatest dilations/patient for multilevel stenosis (4.8). V-RQOL improved in the 27 patients with completed pre- and postoperative scores from a mean of 70.4 to 80 ( P = .025). Pre/postoperative V-RQOLs for tracheal/subglottic (mean, 82.8/93.8) were significantly higher ( P = .0001/.0001) than multilevel stenosis (48/55.3). Voice quality-of-life improvement was significant for the subglottic/tracheal cohort ( P = .036) but not for the MLS group. GRBAS was performed pre- and postoperatively in 10 patients with improvement in all domains except breathiness. Conclusion: Laryngotracheal stenosis is associated with dysphonia. Patients with glottic involvement have significantly worse voice quality of life than those with tracheal/subglottic stenosis. Endoscopic balloon dilation improves V-RQOL in patients with subglottic/tracheal stenosis.