Background <p>Laryngotracheal stenosis (LTS) is a life-threatening condition whose diagnosis relies on invasive endoscopy or high-cost computed tomography, creating critical barriers to care in resource-limited settings. Neck X-rays offer a potentially accessible alternative, but their diagnostic features for LTS, particularly within the unique epidemiological context of South Africa, remain poorly characterized and standardized.</p> Objective <p>To characterize the radiographic findings of LTS on anteroposterior and lateral neck X-rays in a South African tertiary hospital cohort, and to integrate an equity analysis by examining variations across demographic groups defined by PROGRESS-Plus factors.</p> Methods <p>This retrospective cohort study will include all patients with endoscopically confirmed LTS at a South African tertiary hospital (2005–2024). Two blinded otorhinolaryngologists will assess predefined quantitative (minimal diameter, stenosis length, cross sectional area) and qualitative radiographic signs on neck X-rays using a standardized protocol. Inter-rater reliability will be quantified using Intraclass Correlation Coefficients and Cohen’s Kappa. Correlation with endoscopic severity grades (Cotton–Myer, McCaffrey, Lano–Netterville) will be analyzed using Spearman’s correlation. Equity analysis will investigate disparities in disease severity and radiographic feature prevalence across place of residence, gender, and socioeconomic status.</p> Conclusion <p>This study will provide the first comprehensive, equity-focused characterization of LTS on neck X-rays within a South African cohort. The results will yield novel data on the prevalence and reliability of key radiographic signs, their correlation with endoscopic severity, and will explicitly test for diagnostic disparities across equity strata. The findings are expected to validate a pragmatic, accessible diagnostic pathway to reduce delays and improve outcomes for this vulnerable population.</p>