Cryotherapy for Subglottic and Tracheal Stenosis in Patients Without Tracheostomies

Cryotherapy is used in the endoscopic treatment of subglottic and tracheal stenosis (SGTS), though comparative data remain limited.

A retrospective chart review identified 49 patients with benign SGTS treated with standard endoscopic management or cryotherapy between 2017 and 2025. Outcomes included annualized intervention rate, time to tracheal resection, change in Cotton-Myer grade, airway-related emergency department visits, and complications.

Forty-nine patients met inclusion criteria (27 cryotherapy-treated, 22 standard endoscopic management). In paired analysis, annualized intervention rate did not significantly change after cryotherapy initiation (6.25 vs. 5.49 procedures/year, p = 0.978). However, both pre- and post-cryotherapy rates remained higher than standard management (6.25 and 5.49 vs. 0.98 procedures/year; p = 0.008 and p = 0.006, respectively), consistent with greater baseline procedural burden in patients receiving cryotherapy. Tracheal resection occurred in 11 patients (22.4%), with no difference in resection-free survival (p = 0.937). Cryotherapy treatment was not independently associated with greater change in stenosis severity on multivariable analysis (p = 0.214). In subgroup analysis, cryotherapy without thermal intervention demonstrated a trend toward lower annualized intervention rates (3.68 vs. 6.59 procedures/year, p = 0.098) and significantly greater CM grade improvement compared with standard management (p = 0.022) and adjunctive cryotherapy (p = 0.049).

Both groups demonstrated improved airway stenosis, but cryotherapy was not independently associated with reduced intervention rates, resection-free survival, or superior stenosis improvement. Cryotherapy without thermal intervention showed greater improvement in CM grade on subgroup analysis. Prospective studies are needed to further define its role.