Resident Update: Researching Airway Stenosis Treatment During Pregnancy

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

We're continuing our quarterly series with our Otolaryngology-Head and Neck Surgery residents today with Dr. Katherine Miller, a PGY3 in our program. Dr. Miller, welcome to Head and Neck Innovations.

Katherine Miller: Thank you so much for having me. I'm excited to be here.

Paul Bryson: Well, it's great to have you. Let's start by having you share some background on yourself for our listeners, where you're from, where you went to med school, what sort of cultivated your interest in otolaryngology and your desire to match at Cleveland Clinic.

Katherine Miller: Of course. So I'm originally from Colorado, a town called Broomfield. It's between Denver and Boulder. I did my undergraduate at a small Jesuit college called Rockhurst in Kansas City. And then from there I did medical school out in St. Louis for the four years, and then now I'm in Cleveland. So I always joke that I'm just making my way east as I keep going. For me otolaryngology called just because of what it gives back to patients. It's the sense of smell, how they're interacting with the world around them, the smiles that they share, the voice that they give to others, how they're hearing people and being able to restore that or play a role in that really, I think impacted where I fell into medicine itself.

Paul Bryson: That's a really beautiful description and I think it does sort of capture, it really captures the passion and a lot of the interactions in clinic when we're able to do things like that. People obviously enjoy the surgical elements of all of that, but it's that human interaction that you so elegantly describe. So thank you.

One of the fun things, aside from watching you grow as a surgeon, is we also get to do some research together. And so I wanted to take some time to highlight and have you describe a recent project that we were able to do together. And so just for some background, so subglottic stenosis - specifically idiopathic subglottic stenosis - is a rare but life-threatening condition that's particularly dangerous for pregnant patients. And perhaps for those that have listened to the podcast before that you may recall that idiopathic subglottic stenosis disproportionately affects women of childbearing age. And so for a patient who is struggling with this to breathe during labor or just over the course of a pregnancy, the increased fatigue can make people feel weak and potentially cause trouble during delivery. And so Dr. Miller, I was hoping, could you share just a little bit about what you looked at in this research project that you published on treating this condition during pregnancy?

Katherine Miller: Yeah, so this project really came about after a discussion that we had after a journal club where you had just brought up, I think you had just come back from COSM and you had said, we don't really know much about how this disease affects people who are pregnant. And that night I did a quick literature review just to be like, what's out there? What have people done? And I was shocked that really nothing has been done. The only thing that's out there is case studies and small case series, and I think that just highlights in this era where we're really thinking about women's health and moving forward and safe, natural pregnancies. What does this look like for the women of childbearing age? Just like you said, especially because we have so many with idiopathic of course, but I'm sure you're starting to see some with iatrogenic complications of COVID, or vaping use, or traumatic injuries.

There's a lot of women out there who will want to have children and who may feel limited because of their airway. So that's really where we started. We said of what's out there, what's been done, what have they been doing? And we went all the way back, I believe until the forties, like the 1940s, and then all the way forward until 2023, we looked specifically for case studies that described what they had done for a woman. So they had to describe the exact procedure. They couldn't just say we opened the airway and then we wanted to know when during pregnancy it was done. When during pregnancy did they deliver? Was the baby healthy during delivery? Did the mom have any complications during delivery so that we really got a better understanding about what was just being done in the community? I think of this, we found about 14 different papers that were able to tell us those specific factors. And really what we found was that the women were able to, in their second and third trimester, go through various procedures, whether that was balloon dilation, cold steel, sometimes some had tracheostomies of the different techniques that we use to open airways. They were able to do it safely. And I think the most interesting portion of it for me was that about 50-50 were able to have cesarean section versus a natural vaginal delivery. And that's huge in the childbearing world.

Paul Bryson: Yeah, it's a really nice contribution. As you said, there was definitely room for it in the literature, and I'm confident it's going to be something that people refer to. So what are the next steps? I know the project goes on, as you said, it was a lot of historical series and looking at our own stuff, but what happens next? I know one of my colleagues and you and others are interested in what this research might look like going forward. Can you give any previews?

Katherine Miller: Yeah. The big challenge of looking at a case review, looking at all these small case studies, is that people really only publish the good. They don't necessarily publish the bad and the ugly. So really a randomized controlled trial would be the greatest thing that we could get. But right now, I think our next step is going to be a retrospective chart review. Looking at the women that we have done at the Cleveland Clinic and looking at those same things, who's had it done, what trimester, what was done? How was the baby, how was mom? How did it turn out for everyone and publishing? What were the complications that we saw? Were there any complications? Is what they're reporting in the literature where we're looking at this saying, this is probably a safe thing to do. Is that really true? So working with Dr. William Tierney here at the Cleveland Clinic and a couple other colleagues just to figure out what have we done that's been successful? And then based on that, possibly even expanding it to do a real randomized controlled trial once we know that it's going to be safe for both mom and baby to pursue those options.

Paul Bryson: Thanks for that and congrats on the project.

And so I'll pivot back to the residency program a bit too. And one of the great aspects about our Otolaryngology-Head and Neck Surgery Residency Program is the opportunity to collaborate with staff on projects like this. And as you've been now in the program for several years, can you share some other highlights of the program why med students who are interested in otolaryngology should consider our program?

Katherine Miller: I think I've been overly impressed ever since I came here. For me, Cleveland Clinic was definitely a “stretch school.” It didn't seem possible to come from a smaller university out in St. Louis to be at one of the biggest institutions in the world. I think Cleveland Clinic definitely sets itself apart just simply by the case volume. The number of cases that we see, the repetition that we get touches on the ball, I think really makes a big difference in surgery. But also the number of procedures that we do, the number of in-office things that we do. When we were just at Academy, I know you led a really brilliant lecture on how to do in-office injections for tons of patients, and there were community members that had never even heard that it had been being done or had maybe heard of it, but never had the hands-on skills.

So to be able to learn that in residency and know that I'm going to be able to go anywhere in the community and really take that skill and provide a benefit, that same, those human interactions back to someone who maybe it wouldn't have been possible for them, the drive would've been too long, those kinds of things. So I think that's definitely a huge benefit of being at our program. I think the collaboration with staff is huge. It's not the attendings and the residents. It's very much a strong collaboration where we talk regularly with our attendings. They know our intimate life activities that are going on. They check in on us, they work with us. They know where we're struggling, they know where we want to be, and they want to help us get to those goals at all times.

Paul Bryson: Oh, thanks for that. We do have fun. I think as a group, we do like to work together. It's fun to see you grow over the five years. It's a big time. Well, what do you like best about living in Cleveland?

Katherine Miller: The summers? Summers, I think they're just beautiful. It's usually 70 or 80 degrees the whole summer long. You can get outside, you can get on the lake and do a little bit of boating activities. There's a lot of bicycling activities around, being able to walk around downtown and feel very safe. And I think it's just been very surprising to us what Cleveland has to offer in the summertimes. Winters are a little gray.

Paul Bryson: Yeah. That's fair. That's fair. Well, Dr. Miller, we really appreciate your time today. I just wanted to summarize a little bit this important work on patients that are pregnant who have a subglottic stenosis. It is safe to get care in the second and third trimesters, and we have several minimally invasive techniques to get them safely through the procedures so that they can move forward with their pregnancy.

Yeah, we really just appreciate your time. It's hard to believe that it's PGY three year and that you're kind of over the hump, if you will, and heading towards senior residency. So thanks again for joining the podcast.

Katherine Miller: Of course. Thank you so much for having me.

Paul Bryson: For more information on laryngology services at Cleveland Clinic, please visit clevelandclinic.org/laryngology. That's clevelandclinic.org/laryngology. And to connect directly with a specialist or to submit a referral, call 216.444.8500. That's 216.444.8500.

And if you're interested in learning more about our Otolaryngology-Head and Neck Surgery Residency Program, visit ClevelandClinic.org/HeadAndNeckResidency. That's ClevelandClinic.org/HeadAndNeckResidency. You can also follow our residency program on Instagram CCF OHNS Residents. That's CCF OHNS Residents. Finally, don't forget to check out our previous residency program update episodes from 2023 to hear more from our great group of residents.

Thanks again, Dr. Miller for joining the podcast.

Katherine Miller: Thank you.

Paul Bryson: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website clevelandclinic.org/podcasts. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you listen to podcasts. Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.