Subglottic stenosis is being recognized with increasing frequency in adults, and may be the most frequent indication for airway intervention in this patient population. A variety of factors may lead to subglottic narrowing but in many individuals, usually women, no antecedent cause is identified. Once the diagnosis is recognized, initial management with endoscopic therapy is indicated to provide symptom relief and to gain information about the suitability of open surgical intervention. In most cases, surgical resection and reconstruction will provide the best long term outcome.