Global Multidisciplinary Variation in Idiopathic Subglottic Stenosis Surgical Management

Idiopathic subglottic stenosis (iSGS) is a rare, fibroinflammatory airway disorder with non-standardized management. This study aimed to quantify the global clinical variation in surgical strategies for iSGS and identify barriers and facilitators to the adoption of both established and novel techniques.

An international cross-sectional online survey was responded to by 193 clinicians (otolaryngologists, thoracic surgeons, and interventional pulmonologists) across 42 countries. Data on demographics, technique execution, treatment algorithms, clinician satisfaction (7-point Likert scale), and adoption barriers were collected. Both statistical analysis and thematic analysis were performed.

Otolaryngologists constituted the majority of respondents (84%), predominantly from Europe (52%) and North America (28%). Endoscopic dilation was nearly universal (95%), but execution was heterogeneous (85% used occlusive balloons, 56% used CO₂ laser). Newer techniques showed varied adoption: In-office serial intralesional steroid injections were used by 57% of clinicians and the Maddern procedure by 17%. Overall satisfaction with current treatment strategies was moderate (mean Likert score: 5.07; SD = 1.15). Significant variation was found in the definition of treatment failure. Fellowship-trained surgeons managed higher case volumes and were more likely to perform complex open surgery (p = 0.019). Key barriers to adoption included lack of experience and insufficient supporting evidence.

Significant global clinical variation exists in the management of iSGS, affecting surgical technique, adjuvant therapy, and the definition of treatment failure. Standardization of clinical outcomes, continued large-scale comparative effectiveness trials, and newer efforts aimed at implementing emerging evidence are needed to reduce variability, establish evidence-based guidelines, and improve global patient care for this complex disease.