Upper airway virus - driver or passenger on the journey to chronic infection?

Background

Subglottic stenosis (SGS) is a narrowing below the vocal cords of unknown cause. Including all subgroups, 4.9/1000,000/year are affected compared to recurrent respiratory papillomas (RRP), 2/100,000/year with a major impact on quality of life, voice and breathing. The annual cost of SGS is comparable to chronic obstructive pulmonary disease (COPD) and diabetes. The cost of care for RRP was estimated at $120 million in 2000. There is a recurring need for palliative surgical treatment under specific conditions. There is no curative treatment, occasional cases of spontaneous resolution for both SGS and RRP.

Goal

We are driven by a desire to have impact on patient quality of life and socio-economics associated to SGS through mapping possible causative agents and thus offer therapeutical options in a nearby future. The patient benefit consists of an expected additional treatment with reduced morbidity,  increased understanding of the disease. If less individuals will be affected by SGS, by a milder variant the healthcare costs will reduce

Feasibility

Our group has reported data on viruses in the respiratory tract since 2011 and presented 3 theses since 2016. New project running since 2021

Material and method

To understand how SGS affects life functionality, we use robust forms; SF-36 and dyspnea index. We compare the forms before and after surgery to measure effectiveness of surgeries even if they need to be repeated. We want to map the non-human genome in samples from SGS to understand what drives the scarring under the vocal cords 

Clinical relevans

If the inflammation that suffocates the SGS patient is driven by infectious agents, we may use already available vaccines and antiiotics. As a result, fewer people/year will be affected and the disease will have a milder course. In practice this means fewer and shorter caretimes, lower healthcare cost and a higher quality of life status for the patient. We know that RRP is driven by HPV 6 and 11 when vaccination, the incidens and prevalence of  RRP fell dramatically in Australia adopting gender neutral vaccination between 2012 and 2016. We expect the same reduction in HPV positive base of tongue cancer and tonsil cancer that debuts later in life, the future may confirm our hypothesis. We also exepct increased therapeutical options and a higher quality of life in SGS patients