Management of Recurrent Subglottic Stenosis

Patient Assessment and Indication

The patient has documented idiopathic tracheal stenosis with recurrent subglottic stenosis, which is a recognized condition requiring intervention to maintain airway patency 1, 2
Current symptoms include increased restriction during exercise and nasal "congestion," indicating progression of stenosis since her last intervention 13 months ago 2
Physical examination confirms the presence of a "fairly tight" subglottic stenosis with crusting 2
CT imaging shows a 9mm diameter subglottic airway, confirming anatomical narrowing 2

Idiopathic subglottic stenosis is an uncommon disorder characterized by progressive stenosis at the level of the cricoid and upper trachea, occurring almost exclusively in women in their third to fifth decades 1
Common symptoms include dyspnea on exertion and restriction during physical activity, which align with this patient's presentation 1
The American College of Chest Physicians clinical practice guideline (2025) recommends airway dilation for patients with nonmalignant central airway obstruction with stenosis, either alone or in combination with other therapeutic modalities 2
For subglottic stenosis, a multimodality approach utilizing dilation, ablative resection, and medical treatment is more likely to achieve optimal outcomes 2

Tracheostomy should be considered only when other means of correcting the obstruction have failed 3
The American College of Chest Physicians recommends airway dilation for patients with nonmalignant central airway obstruction with stenosis, either alone or in combination with other therapeutic modalities, as part of the treatment approach for subglottic stenosis 2