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A Promoter of Granulation Tissue Formation Following Laryngotracheal Reconstruction

S. A. Reza Nouraei, MBBChir; Michael A. Petrou, MD; Prem S. Randhawa, MRCS; Arvind Singh, MRCS; David J. Howard, FRCS; Guri S. Sandhu, FRCS

Arch Otolaryngol Head Neck Surg. 2006;132:1086-1090.

Objective  To investigate whether airway granulation, a common occurrence during laryngotracheal reconstructive surgery and a common cause of delays in definitive treatment and treatment failure, is associated with a microbial etiology.

Design  Prospective case-control study.

Setting  Tertiary referral airway reconstruction unit.

Patients  Patients who had an airway stent as part of their treatment for laryngotracheal stenosis.

Interventions  All airway stents were sent for microbiological analysis. Information about patient demographics, lesion characteristics, and presence of airway granulation tissue at different times during treatment were obtained and correlated against the microbiological findings from airway stents.

Main Outcome Measures  A ² test was used to correlate airway colonization with specific pathogens and occurrence of airway granulation. Logistic regression analysis was used to identify independent microbiological predictors of airway granulation.

Results  Thirty-one airway stents were removed from 26 patients. The mean (SD) age at presentation was 42 (18) years, and postintubation tracheal stenosis was the most common etiology. There were highly significant associations between stent colonization with Staphylococcus aureus and Pseudomonas aeruginosa and the occurrence of airway granulation (P<.02), and these microorganisms were independently associated with the risk of developing airway granulation. Furthermore, S aureus was associated with persistence of airway granulation on average 4 months following removal of the stent.

Conclusions  Airway granulation seems to be associated not with polymicrobial airway colonization but with infection with specific pathogenic microorganisms. All patients undergoing laryngotracheoplasty should receive antibiotic prophylaxis to cover these microorganisms, and the development and use of antibiotic-impregnated airway stents should be explored.

Author Affiliations: Department of Otolaryngology, Charing Cross Hospital (Drs Nouraei, Randhawa, Singh, and Sandhu); Department of Microbiology, Hammersmith Hospital (Dr Petrou); and Royal National Throat, Nose, and Ear Hospital (Drs Nouraei, Howard, and Sandhu); London, England.

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