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. 2025 Sep;135(9):3265-3272.
doi: 10.1002/lary.32179. Epub 2025 Apr 16.

Effect of Serial Intralesional Steroid Injections on Risk of Recurrence in Idiopathic Subglottic Stenosis

Shengjie Ying  1   2 , Peter Y F Zeng  1   2 , Kevin Fung  1 , Halema Khan  1 , Matthew J Cecchini  2 , Patrick MacInnis  3 , Jennifer Anderson  3 , Amir H Karimi  1   2 , MohdWessam Al Jawhri  1   2 , Harrison Pan  1   2 , Nhi Le  1   2 , Krista Joris  1 , Joe S Mymryk  1   4   5 , Vanessa Dumeaux  4   6 , John W Barrett  1 , Anthony C Nichols  1   2   4 , R Jun Lin  3 ; Canadian Airways Research Group of the Canadian Society of Otolaryngology Collaborative Research Initiative
Affiliations

Effect of Serial Intralesional Steroid Injections on Risk of Recurrence in Idiopathic Subglottic Stenosis

Shengjie Ying et al. Laryngoscope. 2025 Sep.

Abstract

Background: Serial intralesional steroid injections (ILSIs) have been suggested to be an effective adjunct treatment for idiopathic subglottic stenosis (iSGS) by maintaining airway patency and extending inter-surgical intervals. However, evidence for the effectiveness of serial ILSIs remains inconclusive. The current study aimed to assess whether ILSIs reduce the risk of subsequent surgical dilation (i.e., recurrence) in a cohort of patients with iSGS.

Methods: Prospectively collected clinical data for 75 female iSGS patients with 1-4 years of follow-up were analyzed. To assess the effect of ILSI use on the risk of recurrence, we assessed both the time-to-first recurrence using a standard Cox proportional hazards model and all recurrences per patient using a recurrent-events model. Overall, there were 36 patients who had received ILSIs at any point in the follow-up period and 39 patients who had not.

Results: ILSI use was associated with a significantly reduced risk of recurrence in both time-to-first event (hazard ratio (HR) = 0.20, 95% confidence interval (CI) 0.08-0.49) and recurrent events (HR = 0.44, 95% CI 0.26-0.75) multivariate Cox proportional hazard models, along with older age at diagnosis and longer time since diagnosis (all p < 0.05). In the time-to-first event analysis, the median time to recurrence among those who had received ILSIs was 2.5 years compared to 1.4 years among those who had not. The number needed to treat with ILSIs to avoid one recurrence by 2 years follow-up was two.

Conclusion: Serial ILSIs were associated with reduced risk of recurrence, along with older age at diagnosis and longer time since diagnosis.

Level of evidence: 3 (non-randomized controlled cohort/follow-up study).

Keywords: cox regression; endoscopic surgical dilation; idiopathic subglottic stenosis (iSGS); recurrence; serial intralesional steroid injections.

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Conflict of interest statement

A.C.N. has research funding from Novartis Canada, Merck Canada, LabCorp, and Droplet Biosciences for studies that are unrelated to the submitted work. He has equity from and is a consultant for NEED Inc. M.J.C. has research funding from Astra Zeneca, Merck and Pfizer. He has received payment for speaker honorarium and/or served on advisory boards for Eli Lilly Merck, Astra Zeneca, and Amgen. M.J.C. has equity from and is a consultant for NEED Inc. A.H.K. has consulted for Merck Inc. and serves on the advisory board for Pentax Inc., both unrelated to the current study. P.Y.F.Z., J.W.B., J.S.M., and A.C.N. hold patents for transcriptional biomarkers in head and neck cancer, unrelated to this work. R.J.L., K.F., H.K., J.A., P.M., A.H.K., S.Y., M.A.J., H.P., V.D. have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Follow‐up trajectory of 75 patients with idiopathic subglottic stenosis, where each horizontal line represents one patient, in descending order of follow‐up time. Shapes along the line indicate the type of medical visit. ISLI, intralesional steroid injection.
FIGURE 2
FIGURE 2
Time‐to‐first recurrence analysis in 75 female patients with idiopathic subglottic stenosis (iSGS). (A) Follow‐up trajectory where each horizontal line represents one patient, in descending order of the time‐to‐first recurrence or date of censoring. The line color indicates if one or more intralesional steroid injections (ILSI) was received (yes; blue) or not (no; red), and shapes along the line indicate the time point and type of each medical visit. Recurrence was defined as the first subsequent surgical dilation following the index dilation (time zero). A patient was censored if the last documented date was a clinic appointment or ILSI. (B) Kaplan–Meier curve comparing the time‐to‐first recurrence between those who received (yes; blue) versus those who did not receive (no; red) one or more ILSIs, prior to the first recurrence or date of censoring. An “Event” in the risk table was defined as a recurrence. Vertical ticks on the curves represent censored time points. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
FIGURE 3
FIGURE 3
Frequency of intralesional steroid injections (ILSIs). (A) Number of ILSIs received by a patient (range 1–8) between consecutive surgical dilations or from a surgical dilation to the censored time point, among surgery‐free intervals where one or more ILSI(s) were administered. (B) Number of days between consecutive ILSIs or from a surgical dilation to an ILSI.
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