Interventions and Outcomes in Glottic Versus Multi‐level Airway Stenosis: A Multi‐institutional Review

Objective Airway stenosis—particularly multi‐level—presents complex management challenges. This study assessed rates of tracheostomy, decannulation, and the number of surgeries required in patients with posterior glottic stenosis (PGS), multi‐level airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP). Methods Airway stenosis patients treated between 2016 and 2021 at three tertiary medical centers were identified. Demographics, etiology of stenosis, medical comorbidities, and patient‐reported outcome measures (PROMs) were collected. Results 158 patients (84 women, mean age 56.98 ± 15.5 years) were identified (54 PGS, 38 MLAS, and 66 BVFP). 72.3% required tracheostomy, including 72.2%, 86.8%, and 63.6% in these groups, respectively. Decannulation rates were 43.6%, 21.2%, and 32.5% in these groups, respectively. Patients with MLAS had higher rates of tracheostomy than BVFP (p 0.05). MLAS required more surgeries (mean 4.0 ± 3.9) than PGS (2.4 ± 2.2, p = 0.02) or BVFP (1.0 ± 1.8, p 30 (41.4%), diabetes (31.8%), pulmonary disease (50.7%), gastroesophageal reflux disease (39.4%), autoimmune disease (22.9%), and tobacco use history (55.2%). Conclusions Airway stenosis is a challenging clinical problem that negatively impacts patients' quality of life and often requires numerous surgeries. PGS more frequently requires tracheostomy compared to BVFP, but patients can often decannulate successfully. Patients with multi‐level stenosis have lower decannulation rates and require more surgeries than glottic stenosis alone; these patients may benefit from earlier and/or more aggressive intervention. Level of Evidence 4 Laryngoscope, 133:528–534, 2023 This study evaluated surgical interventions and tracheostomy outcomes in patients with posterior glottis stenosis (PGS), multi‐level airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP) in a multi‐institutional setting. A wide variety of surgical interventions were utilized to address airway stenosis. There are statistically significant differences in the number of surgical interventions between these cohorts as well as higher decannulation rates among patients with unilevel versus multi‐level stenos