There are several treatment options for (idiopathic) subglottic stenosis (ISGS). Once you receive the diagnosis, your doctor will usually schedule a dilation. This is the most common treatment, but other options exist as well. Read more about the different treatments below.
There are four types of tracheal stenosis. Read more about Subglottic Stenosis on this page.
A dilation is a procedure in which the narrowing in the windpipe is stretched open.
This is done by pushing the scar tissue aside. The procedure is always performed endoscopically (through a tube inserted via the mouth).
There are different ways to perform a dilation. The most common are:
Balloon dilation:
A balloon is placed inside the narrowed area and then inflated. Small tears appear in the scar tissue, making the airway wider.
The disadvantage is that it is difficult to control exactly where the small tears occur.
Cutting first, then stretching:
To have more control, the scar tissue is cut first. This can be done with a small blade or with a laser. After that, the airway is further stretched with a balloon.
The procedure takes about half an hour and is done under general anaesthesia. Most patients can go home the same day, although some hospitals may keep you overnight. After the procedure, you may have a sore throat, a bruised feeling in your mouth or tongue, drowsiness from the anaesthesia, or stiffness in the neck or upper back. These symptoms usually last a few days.
Most patients notice a clear improvement in their breathing quite quickly. Many describe this as a real “relief”.
Listen to your body and take time to recover before resuming your daily activities.
Tracheal Resection
A tracheal (or cricotracheal) resection is a major surgery in which the narrowed part of the windpipe, including scar tissue, is removed. The healthy ends of the trachea are then reconnected. This is a type of open surgery, performed through an incision in the neck.
After the surgery, most patients stay in the hospital for several days. Some may receive tube feeding for a short period. The scar left behind is typically a few centimeters long and is located at the lower part of the neck.
Laryngotracheal Reconstruction (LTR)
In some cases, a resection may not be the best option. This can happen when the narrowing is very close to the vocal cords or when the narrowed segment is too long to safely remove the narrowing in one piece. In these situations, the surgeon may choose to perform a laryngotracheal reconstruction (LTR).
During an LTR, the airway is widened using a small piece of rib cartilage. This increases the space in the trachea. A temporary stent may be placed to support the airway while it heals. Like the resection, this procedure is performed through an incision in the neck, and a hospital stay is required.
The Maddern procedure is an endoscopic treatment performed through the mouth, where only the scar tissue in the windpipe is removed. The cartilage rings remain intact. After the scar tissue is removed, the inside of the trachea is lined with a thin piece of skin (a skin graft), usually taken from the thigh, creating a smooth surface.
To help the skin graft attach properly, a temporary stent is placed in the trachea. This stent holds the graft in place during healing and is usually removed after about two weeks.
The Maddern procedure differs from a traditional resection in several important ways:
No open surgery: The procedure is done completely through the mouth, without an incision in the neck.
Cartilage rings stay intact: Only scar tissue is removed. In a resection, a full section of the airway, including the cartilage rings, is taken out.
Faster recovery: Because the structure of the airway remains intact, the healing period is often shorter.
Lower risk of complications: The risk of injury to the vocal cords or nerves is low, because no external neck surgery is needed.
Risks remain: As with any procedure, there is still a chance of infection or that the skin graft does not heal as expected.
The Maddern procedure is mainly used for patients with persistent or repeatedly returning airway narrowing. The Maddern procedure was first performed in the Netherlands in October 2025. International research indicates that this treatment is particularly promising for patients with idiopathic SGS.
In idiopathic subglottic stenosis (ISGS), inflammation often plays an important role. This inflammation can cause breathing problems even when there is little scar tissue. In such situations, steroids can help reduce swelling and inflammation. Steroids can be given through injections, tablets or inhalation.
Steroid injections
One treatment option is injecting steroids directly into the scar tissue. This is called SILSI (Serial In-Office Intralesional Steroid Injections). The medication is injected precisely into the affected area of the windpipe. As a result, larger procedures such as dilation or resection can sometimes be postponed or even avoided.
The preparation, numbing and injection together take about fifteen minutes. Most treatments consist of a series of four to six injections, with about four to six weeks between appointments. The treatment is generally well tolerated and can significantly reduce symptoms for a longer period.
When steroids are inhaled, the medicine is delivered directly into the airways.This helps reduce swelling and inflammation at the site of the stenosis.
There are two ways to inhale steroids:
with a nebuliser
Both methods can help reduce inflammation and improve breathing.
Side effects are usually limited to the mouth and throat. Hoarseness or a fungal infection in the mouth can occur. Rinsing your mouth after inhalation helps prevent this.
Steroid tablets can be effective in cases of significant inflammation or when fast relief is needed. Because the medication spreads through the bloodstream, the effect is broader, but so is the chance of side effects. Doctors therefore prescribe tablets mainly for severe inflammation or for short treatment periods.
Short courses can cause temporary side effects in some people, such as:
Some people are more sensitive to steroid tablets than others.
If you want to learn more about ISGS and the different treatment options, you can consult the Rough Guide for Beginners. This guide was written by ISGS patient Catherine Anderson. She is not a doctor, but shares her knowledge and personal experiences in a clear and accessible way.
You can also find information and peer support in Catherine’s Facebookgroup:
‘Living with idiopathic subglottic stenosis’.
This international group was created in 2009 by Catherine Anderson. The group has grown enormously and now has more than 9,500 members from all over the world. It is a place to share tips, experiences and support, and also serves as a helpful archive where you can search for topics or questions.
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