Subcordal Stenosis: A Glucocorticoid-Responsive Subtype of Autoimmune Laryngeal Stenosis

As our understanding of autoimmune laryngeal stenosis evolves, distinguishing patients who may benefit from systemic immunosuppression versus those needing only local treatment is increasingly important. In this study, we identify a distinct subset of autoimmune laryngeal stenosis characterized by edema of the inferior true vocal folds that extends to the superior aspect of the cricoid cartilage, termed "subcordal stenosis." The objective of this study is to characterize the clinical presentation and treatment outcomes of subcordal stenosis and compare it to typical autoimmune-related subglottic stenosis (AI-SGS).

We conducted a retrospective review of patients with laryngeal stenosis evaluated by both rheumatology and otolaryngology at our institution to identify two groups: patients with subcordal stenosis and those with typical AI-SGS. Data on immunosuppressive treatments and airway dilation procedures were collected. Time to first dilation was compared between groups.

Among 49 patients with laryngeal stenosis, 11 had subcordal involvement. Five of these also had subglottic disease, while six had isolated subcordal stenosis. Kaplan-Meier analysis showed significantly longer time to first dilation in patients with subcordal involvement (median 792 vs. 44 days; p = 0.048). They also underwent fewer dilations within two years (median 0 vs. 1; p = 0.05).

Among laryngeal stenosis patients referred to rheumatology, those with subcordal involvement experienced fewer dilations and longer intervals before first dilation compared to those with typical AI-SGS. These findings suggest that subcordal stenosis may represent a distinct, glucocorticoid-responsive phenotype within autoimmune laryngeal stenosis, with implications for treatment selection and multidisciplinary care.