Background

Subglottic stenosis (SGS) of uncertain aetiology including idiopathic SGS (iSGS) and vasculitis-associated SGS (vSGS, classically granulomatosis with polyangiitis)—remains a therapeutic challenge. Restenosis commonly follows office based interventions, operating room (OR) procedures, and open neck surgery, yet definitive treatment guidelines are still lacking.

Objective

Compare long-term outcomes of office based, OR treatment and open neck procedures in uncertain-etiology SGS and use those data to craft a pragmatic flow chart that standardises work-up, treatment decision making.

Description

A retrospective institutional cohort of patients with idiopathic or vasculitic subglottic stenosis (SGS) will be analysed. Outcomes will include decannulation rate, number of operative and office-based interventions, complication rate and management.

Outcomes

Among 200 patients undergoing CTR, 15 had idiopathic SGS (all female) and 5 vasculitis SGS with a 100% decannulation rate. Postoperative issues included granulomas (n=6) managed with oral corticosteroids in 3 cases, and additional interventions—radial incision with intralesional corticosteroids, SILSI in others), and 1 case of restenosis managed with radial incision and keel placement. In the endoscopic group (N=24), 19 had iSGS (18 female, 1 male) and 2 vSGS (all female) undergoing a total of 33 OR procedures (including radial incisions, balloon dilatation, steroid injection, and synechia lysis. Three patients received T-tube placement and one required keel) and 5 office-based steroid injections (SILSI). Based on these findings, we will propose a structured, evidence-informed flow chart to guide clinical decision-making in the management of SGS.