(726) Serial Intralesional Steroid Injections for Adult Subglottic Stenosis: A Systematic Review and Meta-Analysis

Introduction: Office-based serial intralesional steroid injections (SILSI) have been increasingly considered as a promising alternative or adjunct to traditional approaches in the management of adult subglottic stenosis (SGS). This study aims to summarise and synthesise evidence on the efficacy and safety of SILSI in treating SGS in adults.

Methods: PubMed, Embase and Cochrane Library databases were systematically searched from inception to 5 October 2025 for observational studies evaluating the use of SILSI, either as a primary or adjunctive treatment, in SGS adult patients. The primary outcome of interest was the change in surgery free interval (SFI) after starting SILSI, while secondary outcomes of interest included disease recurrence, degree of stenosis, spirometry outcomes, incidence of adverse events, and functional outcomes such as voice quality. All paediatric articles were excluded from this study. Two independent reviewers performed study selection, data extraction and risk of bias assessment. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results: This systematic review and meta-analysis included 15 studies comprising 897 patients. The risk of bias of included studies was low-moderate, and overall quality of evidence was moderate. Following the use of SILSI, SFI improved significantly compared to pre-treatment values (SMD: -1.06, 95%CI -1.39 to -0.73, I2=36.4%). Included studies reported low recurrence, improved peak expiratory flow, reduced stenosis, patient-reported improvements in voice quality and minimal side effects.

Conclusions: SILSI may be an effective and safe option for adult patients with SGS, offering advantage of avoiding the risks associated with anaesthesia and surgical intervention inherent to conventional approaches. Future prospective studies and randomised trials may offer greater insights on the efficacy and safety of SILSI in treating SGS in adults.