Centre: Guy's and St Thomas' Hospital, London

Principal surgeon: Mr Yakubu Karagama, Consultant Laryngologist and ENT Surgeon

Assistants: Miss Shiying Hey, Senior Laryngology Fellow, Dr Carlo Robotti, Senior Laryngology Fellow

Microlaryngoscopy + CO2 laser division of recurrent subglottic stenosis + steroid injection + balloon dilatation (Twinstream ® ventilation)

Patient: 26F. (Ms I)

Background: 4 years history of difficulty breathing treated with asthma but no improvement. Diagnosed with idiopathic subglottic stenosis (>50%) following a CT neck scan and in-office transnasal laryngoscopy and tracheoscopy in July 2022. Underwent CO2 laser division of subglotticstenosis, balloon dilatation and steroid injection in July 2022. Regular clinic surveillance with stable airway. In October 2023, patient reported increasingly breathless with noisy breathing.

PROM: VHI-10 2, RSI 26, EAT-10 2, GRBAS 00000, AVS scale 321.

Assessment: On videostrobolaryngoscopy, recurrent SGS confirmed at multiple levels with a spiral appearance

Outcome: As breathing is increasingly affecting quality of life and exercise tolerance, patient would like to undergo repeat surgery to improve subglottic airway.