Hormone Replacement Therapy and Recurrence Risk in Postmenopausal Idiopathic Subglottic Stenosis

OBJECTIVE: To evaluate whether systemic hormone replacement therapy (HRT) influences recurrence outcomes in postmenopausal patients with idiopathic subglottic stenosis (iSGS). STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic medical center. METHODS: Postmenopausal women (≥50 years) with iSGS who underwent laser-wedge excision between 2002 and 2024 were included. Patients were categorized by systemic HRT exposure (oral estrogen, progesterone, combined estrogen-progesterone, or transdermal estrogen) at or before their first surgery. Overdispersion was assessed for all Poisson models; given significant overdispersion, negative binomial regression with a log-offset for follow-up time was used as the primary model. Surgery-free intervals were analyzed using linear mixed models, and time to first recurrence using Cox regression. Models were adjusted for age, body mass index (BMI), parity, oophorectomy, follow-up length, surgery type, and serial intralesional steroid injections (SILSI) use. RESULTS: Among 125 patients, 96 had never used HRT (Never HRT) and 29 used HRT, including 19 actively using HRT at presentation (Current HRT), 5 past users, and 5 subsequent users. The HRT versus Never-HRT recurrence rate comparison was not significant (adjusted incidence rate ratio [IRR] = 0.81, 95% CI: 0.48-1.37, P = .422). However, Current HRT use was associated with a 53% lower adjusted recurrence rate versus Never-HRT use (adjusted IRR = 0.47, 95% CI: 0.25, 0.89, P = .0203). Surgery-free intervals and time to first recurrence trended longer in Current HRT users but were not statistically significant. CONCLUSION: Current HRT use at presentation was associated with significantly fewer recurrences in postmenopausal iSGS patients. These findings may inform individualized, shared decision-making regarding HRT use in this population.