Subglottic stenosis is caused by the fibrosis of the subglottis, which may be idiopathic or iatrogenic, often requiring multiple procedural interventions to prevent life-threatening narrowing of the upper trachea. The authors of this systematic review and meta-analysis looked at 55 studies (32 in the meta-analysis of 3091 patients) to evaluate the evidence base for its endoscopic management, including balloon dilatation, rigid dilatation, CO2/YAG laser and cold knife. Aetiology was idiopathic in 18 studies, acquired in 15 and mixed in 18. The authors report a 72.9% pooled success rate (375/509), a 60.5% recurrence rate (219/355) and a reassuringly low 5% complication rate (21/353). They also found successful intervention was higher in acquired disease (91.4%) than idiopathic (64.5%) with lower rates of recurrence (51.6% vs. 70% respectively). The subgroup breakdown of each intervention type shows YAG laser (93.8% success) and rigid dilatation (98.6%) have higher success than balloon dilatation (66.8%) but subgroup sizes are notably small. This paper concerns solely endoscopic intervention and does not consider the literature on cricotracheal resection and laryngeotracheoplasty, which often reports higher success rates and lower rates of re-intervention. Exclusion of this data creates possible selection bias towards less severe disease as more complex cases are disproportionately managed with open surgery in more specialist units. They also found success and recurrence were defined inconsistently across studies, which likely contributed to the high heterogeneity (I² frequently >90%). In addition, most included studies were single-arm observational cohorts, though quality was often shown to be decent using the Newcastle-Ottawa assessment (35 good, 17 moderate, and 1 poor). The most interesting takeaway from this study is the evidence gap for available adjunct treatments. The authors discuss the possible utility of mitomycin C, inhaled corticosteroids and reflux management for the maintenance of disease remission. They offer no data or conclusions, but this would make for interesting future research.
Treating subglottic stenosis means treating it again
Top Of Page
Accreditations
Pinpoint Scotland Ltd (Registered in Scotland No. SC068684) | © 2026 - Website by Gecko Agency