In-office serial intralesional steroid injection for subglottic stenosis: Case series of 14 patients with multiple...

Subglottic stenosis (SGS) is commonly treated with endoscopic dilations or tracheal resection. Since office-based serial intralesional steroid injections (SILSI) were first reported in 2017, they have been established as an effective, less invasive treatment alternative or adjunct. The aim of this study is to add to the literature investigating the efficacy of office-based SILSIs for idiopathic and post-intubation SGS patients, specifically studying surgery-free intervals (SFIs) and discussing our experience with SILSI treatment order and stenosis grade.

This study is a retrospective case series of 14 patients with subglottic stenosis treated with in-office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.

Of seven patients with calculable SFI, a mean SFI increase of 481.28 days was observed following SILSI treatment (p = 0.042). Ten patients in our cohort presented with idiopathic or post-intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI. Two patients with post-intubation grade 1 SGS were managed successfully with SILSI as their primary treatment. Two patients with post-intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.

We have found that SFI significantly increased following SILSI initiation. Although statistical power was limited given the small sample size, our findings suggest that SILSI may be an effective primary treatment in low-grade stenosis. SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate-grade stenosis. SILSI may not be effective in high-grade stenosis patients who failed prior endoscopic treatment.