# Flexible Nasendoscopy in Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Ten-Year Otolaryngology Experience

## TL;DR

This study examines laryngeal involvement in Stevens–Johnson syndrome/toxic epidermal necrolysis and finds it does not significantly affect short-term outcomes like ICU stay or intubation.

## Contribution

The study presents the largest cohort of SJS/TEN patients assessed for upper aerodigestive involvement and evaluates clinical predictors of laryngeal complications.

## Key findings

- Laryngeal involvement was found in 31.5% of patients with SJS/TEN.
- Laryngeal involvement was not significantly linked to intubation, ICU stay, or mortality.
- Aerodigestive symptoms or oral cavity involvement were highly sensitive indicators of laryngeal involvement.

## Abstract

Background and Objectives: The primary objective of this study was to identify factors predictive of laryngeal involvement in patients with Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). The secondary objective was to observe the effect of laryngeal involvement upon short-term patient prognosis, including intensive care unit (ICU) stay and intubation rates. We present the largest cohort of patients examined for upper aerodigestive manifestations of SJS/TEN. Materials and Methods: We performed a retrospective observational analytic study of patients at a state-wide Australian Burns referral center between January 2013 to December 2022. Inclusion criteria were adult patients who underwent flexible nasendoscopy (FNE) with biopsy-proven SJS/TEN. Data collected from medical records included patient factors, aerodigestive symptoms, bedside examination, FNE findings, TEN-specific severity-of-illness score (SCORTEN) on admission, and patient outcomes such as intubation and ICU admission. Results: Fifty-four patients with biopsy-proven SJS/TEN underwent FNE, with 17 (31.5%) identified to have laryngeal involvement. Laryngeal involvement was not significantly associated with intubation, ICU stay, or mortality (p > 0.05). The presence of either aerodigestive symptoms or oral cavity involvement was highly sensitive (94.1%, 95% CI 73.0–99.7%) for laryngeal involvement. Conclusions: We did not find laryngeal involvement in SJS/TEN to significantly impact short-term outcomes, including intubation or mortality. FNE is the gold standard of upper aerodigestive assessment. Simple clinical evaluation of the oral cavity and a history of aerodigestive symptoms also provided a sensitive predictor of the laryngeal complications of SJS/TEN.