Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis

Andrew Jay Bowen, Katherine Z. Xie, Thomas J. O’Byrne, Semirra L. Bayan, Eric S. Edell, Robert Vassallo, Dale C. Ekbom, Jan L. Kasperbauer

Research output: Contribution to journalArticlepeer-review


Objective: We present the outcomes for patients with idiopathic subglottic stenosis (iSGS) following their first carbon dioxide laser wedge excision (LWE) procedure, additionally examining the effect of compliance with adjuvant medical therapy (triple therapy) after the operation. Study Design: Retrospective chart review. Setting: Tertiary center. Methods: A retrospective review was performed on 183 patients with iSGS following their first LWE and their compliance to adjuvant medical therapy (inhaled corticosteroid, proton pump inhibitor, trimethoprim-sulfamethoxazole) following the operation, with all reviewed to December 31, 2020. The primary outcome variable was median time to recurrence (MTR). Patients were stratified by whether the LWE was their first operation (LWE primary or secondary), by compliance to triple therapy, and by compliance with trimethoprim-sulfamethoxazole. Kaplan-Meier analysis and Cox proportional hazards were used to evaluate the MTR across the stratifications. Results: An overall 113 patients underwent their first LWE, while 70 received the procedure after having undergone 1 to 13 procedures. The MTR between LWE primary and secondary was 4.6 and 2.9 years, respectively. Adjusted Cox proportional hazards comparing these 2 groups revealed the number of prior operations to be a confounding variable. A statistically increased MTR was demonstrated with greater degrees of medical compliance. Conclusion: LWE conferred an MTR of 4.1 years in the iSGS cohort. The number of prior procedures preceding LWE behaved as a confounding variable. Patients who were completely or partially compliant to triple therapy appear to demonstrate increased intervals prior to recurrence.

Original languageEnglish (US)
Pages (from-to)524-530
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number3
StatePublished - Sep 2022


  • CO laser
  • endoscopic dilation
  • endoscopic wedge resection
  • idiopathic subglottic stenosis
  • inhaled corticosteroids
  • proton pump inhibitor
  • trimethoprim-sulfamethoxazole
  • triple therapy

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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