Exploring pathogenetic mechanisms in subglottic stenosis: A narrative review toward an integrated molecular classification.

Subglottic stenosis (SGS) is a chronic fibroinflammatory condition that causes pathological narrowing of the airway between the vocal cords and the trachea, with symptoms ranging from dyspnea to stridor and respiratory failure. The causes are heterogeneous: traumatic iatrogenic forms (such as prolonged intubation), autoimmune (e.g., granulomatosis with polyangiitis), post-viral (including COATS related to COVID-19), and idiopathic (iSGS), the latter affecting primarily adult Caucasian women with no obvious predisposing factors. All forms share a common pathogenetic core: epithelial damage, immune activation, chronic inflammation, and progressive fibrosis. Recent molecular studies, however, reveal that different variants of SGS exhibit distinct biological signatures, suggesting the existence of molecular subtypes with differentiated clinical courses. The emerging approach therefore aims for a biomarker-based classification for precision medicine. Future treatments may include targeted immunotherapies (e.g., IL-17A/IL-23 inhibitors), anti-fibrotic drugs, and epithelial regeneration strategies, alongside current surgical techniques to improve long-term prognosis.