A 63-year-old man presented with dyspnea and stridor on effort that gradually progressed over 6 months. The patient had a drug history of anti-tuberculosis medication, including isoniazid, rifampicin, and ethambutol for pulmonary tuberculosis that he developed 32 years ago. However, he never felt restricted in his everyday life, until he recently became aware of stridor during deep breathing. Subsequently, he developed stridor at rest and severe dyspnea on effort. Thus, he visited a local hospital. Although bronchoscopy revealed tracheal scar stenosis, the sputum smear for acid-fast bacilli was negative. He was admitted to our hospital for further treatment. On admission, physical examination revealed a pulse rate of 113 beats/min, blood pressure of 132/74 mm Hg, and oxygen saturation of 97% on room air. The flow-volume curve was consistent with fixed airway obstruction with a functional vital capacity (FVC) of 2.77 L and 1-second forced expiratory volume (FEV1) of 1.18 L (FEV1/FVC: 42.7%). Chest computed tomography (CT) examination including three-dimensional reconstructions revealed thickening of the tracheal lumen and deformation of the tracheal cartilage from the annular cartilage to the middle trachea (length, 52 mm; luminal diameter, 4 mm) and severe stenosis in the orifice of the left main bronchus (Fig. 1a-d). Thus, we diagnosed him with airway stenosis probably resulting from EBTB, based on the case history and imaging findings. We believe that the latent symptoms associated with airway stenosis became apparent owing to a decrease in pulmonary function with age. Since reconstruction of the airway was considered difficult due to the site of the operation and range of the defect, we decided to perform balloon dilatation combined with laser cauterization under bronchoscopy. Moreover, the patient did not wish to undergo invasive procedures. We intended to place a stent under a rigid endoscope, if expansion was obtained. Under general anesthesia, bronchoscopy using a laryngeal mask revealed severe subglottic scar stenosis (Fig. 2) through which the bronchoscope (BF type-260, Olympus Corporation, Tokyo, Japan) with an external diameter of 4.9 mm could not pass. The stenosis was Grade III according to the Myers-Cotton subglottic stenosis grading scale. Under X-ray fluoroscopic imaging, a guide wire was placed transbronchoscopically through the stenotic portion. Subsequently, the bronchoscope was withdrawn leaving behind the guide wire. CRE  Pulmonary Balloon Dilatation Catheter (Boston Scientific Corporation, Marlborough, MA, USA; Fig. 3a and b) was introduced over the wire and placed in the tracheal stenosis area. The balloon was inflated with a diluted contrast solution for 10 seconds repeatedly, gradually increasing the expansion pressures. Based on CT findings, the balloon diameter that did not exceed the airway diameter at maximum expansion was selected. After the first expansion at a pressure of 3 atm, which was performed thrice (balloon diameter: 12 mm), the bronchoscope could pass through the stenosis. After maximum cauterization of the scar site with the laser (Fig. 3c and d), balloon dilatation was performed at an expansion pressure of 4.5 atm (balloon diameter: 13.5 mm) followed by 8 atm (balloon diameter: 15 mm) thrice each, with simultaneous observation of the lumen with the bronchoscope (Fig. 2). Although the degree of tracheal stenosis improved to Grade II after balloon dilatation, placement of the Dumon stent under a rigid endoscope was impossible due to residual stenosis that did not allow sufficient expansion of the silicon stent. In this course of treatment, only the balloon dilatation was performed in the left main bronchus at an expansion pressure of 3 atm (balloon diameter: 12 mm); however, notable improvement was not observed as the stenosis grading scale remained unchanged. Subsequently, intubation with a 7-mm tracheal tube, management with a mechanical ventilator overnight, and extubation the next day were performed. He was discharged because his symptoms were alleviated; however, the stridor and dyspnea on effort gradually worsened during the follow-up period. A chest CT scan showed restenosis of the trachea (Fig. 4a and b). Consequently, we decided to perform balloon dilatation with laser cauterization after 3 months of the initial treatment. The CRE  Pulmonary Balloon Dilatation Catheter (Boston Scientific Corporation, Marlborough, MA, USA) with a maximal expanded diameter of 18 mm at an expansion pressure of 7 atm was selected for this round of treatment. The balloon dilatation was performed with excision and incision of the fibrocicatrization by laser cauterization in a more aggressive manner than that during the initial treatment. Tracheal stenosis improved from Grade III to I. We also performed balloon dilatation with laser cauterization for the left main bronchus during this round of treatment; however, approximately 70% of the stenosis remained. The perioperative management after the treatment was performed in the same way as that in the initial treatment. His symptoms disappeared quickly and he was discharged from our hospital. Even after 22 months of the treatment, he was free from symptoms and good patency of the trachea was maintained, as revealed by the chest CT examination (Fig. 4c).