The impact of healthcare settings on diagnostic outcomes for adolescent and adult laryngotracheal stenosis: a narrative review

Diagnostic pathways for adolescent and adult laryngotracheal stenosis (AALTS) are critically shaped by the healthcare setting, reflecting profound global health inequities. This review synthesizes evidence on how resource availability, infrastructure, and workforce expertise influence diagnostic timeliness and accuracy, with a specific focus on disparities between high-income (HICs) and low- and middle-income countries (LMICs). We conducted a narrative review, searching PubMed, Scopus, Web of Science, and the Cochrane Library for literature on AALTS diagnosis, diagnostic delay, and healthcare access. Studies of acquired AALTS in patients aged ≥ 12 were included. Marked disparities in AALTS aetiology and diagnostic capacity were identified. LMICs contend with a predominance of trauma-related stenosis, critical shortages of specialist workforce (e.g., ≤ 1 ENT surgeon per 1.2 million people), and limited access to advanced imaging. Consequently, diagnostic delays exceed 24 months in some settings, with misdiagnosis rates as high as 54.8%. These systemic failures contribute to elevated rates of tracheostomy dependence and preventable mortality. In contrast, HICs report more non-traumatic aetiologies and superior, though variable, access to definitive diagnostic modalities like computed tomography and endoscopy. The analysis, framed by health equity principles, demonstrates that outcomes are mediated by structural determinants, including geography and socioeconomic status. The diagnostic paradigm for AALTS is inextricably linked to the healthcare setting. Mitigating inequitable outcomes requires a fundamental shift towards resource-stratified, evidence-based diagnostic algorithms. Future efforts must prioritize the validation of context-appropriate tools, the implementation of streamlined referral pathways, and policy reforms that strengthen health systems to ensure equitable diagnosis for all AALTS patients.