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Gaylord JN, Schaaf S, Frederick E. Exercise-Induced Dyspnea in Collegiate Athletes: Are We Missing the Diagnosis? J Voice 2023; 37:722-728. [PMID: 34162495 DOI: 10.1016/j.jvoice.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Exercise-induced dyspnea (EID) can disrupt an athlete's participation and performance in their given sport. Differential diagnosis of EID is often completed using subjective report and may be inaccurate, therefore increasing the frustration and stress of the athlete. This nonexperimental research study was used to determine prevalence of EID and related respiratory symptoms in athletes at a small, Division I university. METHODS An anonymous survey was provided to athletes at Murray State University as they registered for participation in sports for the 2020-2021 school year. Data from this survey was analyzed as to reported physician-given diagnosis of a respiratory disorder as well as reported symptoms of EID. RESULTS Results showed that athletes with a physician-given diagnosis often did not report symptoms or responses to medications that support that diagnosis. Additionally, athletes frequently reported symptoms of EID without a formal diagnosis of a respiratory disorder. CONCLUSIONS These findings provide preliminary insight and pilot data that may be used to understand the prevalence of EID in collegiate athletes and the need for improved methods of diagnosis for etiologies of EID.
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Affiliation(s)
- J Nikki Gaylord
- Murray State University, Center for Communication Disorders, Murray, KY.
| | - Stephanie Schaaf
- Murray State University, Center for Communication Disorders, Murray, KY
| | - Eric Frederick
- Murray State University, Athletics Department, Murray, KY
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2
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Brekka AK, Vollsæter M, Ntoumenopoulos G, Clemm HH, Halvorsen T, Røksund OD, Andersen TM. Adjustments of non-invasive ventilation and mechanically assisted cough by combining ultrasound imaging of the larynx with transnasal fibre-optic laryngoscopy: a protocol for an experimental study. BMJ Open 2022; 12:e059234. [PMID: 35613803 PMCID: PMC9134209 DOI: 10.1136/bmjopen-2021-059234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Application of non-invasive positive airway pressure may provoke laryngeal responses that obstruct the airways, especially in patients with disturbed laryngeal control. To control and adjust for this, transnasal fibre-optic laryngoscopy (TFL) is used to visualise laryngeal movements during therapeutic interventions. Being an invasive procedure, this may be unpleasant for patients. The aim of this study is to evaluate if ultrasound (US) imaging of the larynx may be used as an alternative less invasive diagnostic tool for evaluating the upper airway responses to non-invasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). METHODS AND ANALYSIS This protocol presents an experimental cross-sectional study of a novel method to study laryngeal responses in adult healthy volunteers (n=30). The participants will be assessed with simultaneous TFL and laryngeal US imaging (anterior and lateral approaches) during NIV and MI-E therapy. Additionally, airflow and pressure signals will be registered during the procedures. The primary outcome is whether laryngeal US is a feasible method to study laryngeal responses and, if so, to compare the laryngeal responses visualised with TFL and US. The participants' perception of the examinations will be recorded. Secondary outcomes include airflow curve shapes and calculated ventilation volumes during the interventions. ETHICS AND DISSEMINATION The study has been approved by The Regional Committee for Medical Research Ethics in Norway, and registered in ClinicalTrials.gov. Results will be disseminated through peer-reviewed journals, presentation of scientific abstracts at international medical conventions and oral presentations in relevant medical conventions. TRIAL REGISTRATION NUMBER NCT04586855.
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Affiliation(s)
| | - Maria Vollsæter
- Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - George Ntoumenopoulos
- Department of Physiotherapy, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Hege Havstad Clemm
- Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tiina Maarit Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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3
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Exercise-induced laryngeal obstruction: From clinical examination to continuous laryngoscopy during exercise. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:479-482. [PMID: 33622626 DOI: 10.1016/j.anorl.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The diagnosis of exercise-induced laryngeal obstruction (EILO) should be suspected when exercise triggers inspiratory stridor. EILO is common in adolescent populations and has a significant impact on sports. Identification of laryngeal obstruction during continuous laryngoscopy during exercise (CLE) is the gold standard diagnostic tool for this disorder, which is not widely known in France. The challenge faced by otolaryngologists is to identify, among patients referred by pulmonologists or sports physicians, those with exercise-induced inspiratory symptoms or poorly controlled exercise-induced asthma, in whom a diagnosis of EILO is strongly suspected. Laryngoscopy at rest may reveal a laryngeal, glottic or supraglottic abnormality predictive of obstruction at increased inspiratory airflow. When pulmonary function tests are normal or in the case of failure of treatment of exercise-induced asthma, the otolaryngologist must complete the examination by a CLE test to confirm the diagnosis of EILO and identify the site of obstruction. This examination is well tolerated, minimally invasive and allows identification of the site of airflow obstruction, allowing specific conservative or surgical treatment. This technical note describes in detail clinical examination and CLE testing in patients with suspected EILO.
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4
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Sails J, Hull JH, Allen H, Darville L, Walsted ES, Price OJ. High prevalence of exercise-induced stridor during Parkrun: a cross-sectional field-based evaluation. BMJ Open Respir Res 2020; 7:7/1/e000618. [PMID: 32998911 PMCID: PMC7528425 DOI: 10.1136/bmjresp-2020-000618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/31/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The differential diagnosis for exercise-associated breathlessness is broad, however, when a young athletic individual presents with respiratory symptoms, they are most often prescribed inhaler therapy for presumed exercise-induced asthma (EIA). The purpose of this study was therefore to use a novel sound-based approach to assessment to evaluate the prevalence of exertional respiratory symptoms and characterise abnormal breathing sounds in a large cohort of recreationally active individuals. METHODS Cross-sectional field-based evaluation of individuals completing Parkrun. PHASE 1: Prerace, clinical assessment and baseline spirometry were conducted. At peak exercise and immediately postrace, breathing was monitored continuously using a smartphone. Recordings were analysed retrospectively and coded for signs of the predominant respiratory noise. PHASE 2: A subpopulation that reported symptoms with at least one audible sign of respiratory dysfunction was randomly selected and invited to attend the laboratory on a separate occasion to undergo objective clinical workup to confirm or refute EIA. RESULTS Forty-eight participants (22.6%) had at least one audible sign of respiratory dysfunction; inspiratory stridor (9.9%), expiratory wheeze (3.3%), combined stridor+wheeze (3.3%), cough (6.1%). Over one-third of the cohort (38.2%) were classified as symptomatic. Ten individuals attended a follow-up appointment, however, only one had objective evidence of EIA. CONCLUSIONS The most common audible sign, detected in approximately 1 in 10 individuals, was inspiratory stridor, a characteristic feature of upper airway closure occurring during exercise. Further work is now required to further validate the precision and feasibility of this diagnostic approach in cohorts reporting exertional breathing difficulty.
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Affiliation(s)
- Joe Sails
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Hayden Allen
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Liam Darville
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Emil S Walsted
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Oliver J Price
- Clinical Exercise and Respiratory Physiology Research Group, Carnegie School of Sport, Leeds Beckett University, Leeds, UK .,Leeds Institute of Medical Research at St. James', University of Leeds, Leeds, UK
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5
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Hull JH, Godbout K, Boulet LP. Exercise-Associated Dyspnea and Stridor: Thinking Beyond Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2202-2208. [PMID: 32061900 DOI: 10.1016/j.jaip.2020.01.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/26/2022]
Abstract
Breathlessness during sport can be caused by various cardiorespiratory conditions, but when associated with stridor, usually arises from an upper airway etiology. The term exercise-induced laryngeal obstruction (EILO) is now used to describe the phenomenon of transient glottic closure occurring in association with physical activity. Exercise-related laryngeal closure is most commonly encountered in athletic individuals and likely affects between 5% and 7% of all young adults and adolescents. The diagnosis of EILO is not always straightforward because features can overlap with exercise-induced asthma/exercise-induced bronchoconstriction. EILO can therefore remain misdiagnosed for years, and most patients receive inappropriate asthma therapy. In contrast with asthma, EILO symptoms are usually most prominent at maximal exercise intensity and resolve quickly on exercise cessation. It is important to recognize that EILO and asthma can coexist in a proportion of athletes. The criterion standard test for diagnosing EILO is continuous laryngoscopy during exercise testing, although eucapnic voluntary hyperpnea testing has also been used. Various surgical or pharmacological interventions can be used to treat EILO, but first-line treatment is breathing technique work. Further research is needed to establish the optimal treatment algorithm, and more work is needed to increase awareness of this important clinical entity.
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Affiliation(s)
- James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Krystelle Godbout
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, Québec, Canada
| | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, Québec, Canada.
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Norlander K, Johansson H, Emtner M, Janson C, Nordvall L, Nordang L. Differences in laryngeal movements during exercise in healthy and dyspnoeic adolescents. Int J Pediatr Otorhinolaryngol 2020; 129:109765. [PMID: 31706111 DOI: 10.1016/j.ijporl.2019.109765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To compare glottic and supraglottic movements in healthy adolescents and adolescents experiencing dyspnoea during strenuous exercise. METHODS Using the continuous laryngoscopy exercise (CLE)-test laryngeal movements during exercise were analysed in healthy controls (n = 28) and compared to subjects with exercise induced bronchoconstriction (EIB) (n = 10), exercise induced laryngeal obstruction (EILO) (n = 10) and subjects experiencing exercise-induced dyspnoea without having any of these diagnoses (n = 31). Images from the video recordings were assessed regarding glottic angle, glottic area and supraglottic area using the software measuring tool EILOMEA. RESULTS No significant differences were detected between controls, the dyspnoea group without a diagnosis of EIB or EILO and the EIB group regarding glottis angle, glottis area or supraglottic area at maximum effort. All three parameters differed significantly in the EILO group compared to the other groups (p=<0.001). In the group with EILO all but one had supraglottic obstruction (corresponding to a CLE-test score ≥2). Movement of the laryngeal structures, corresponding to a CLE-test score of 1, at glottic and/or supraglottic level was seen in 26 of 35 (74%) of controls, 34 out of 41 (83%) of patients in the dyspnoea group, and in 25 of 38 (66%) of EIB-subjects. CONCLUSION Minor movements at both glottic and supraglottic level are equally common in healthy controls as among adolescents with exercise induced dyspnoea without EIB or EILO and adolescents with EIB. Adolescents with EILO had a statistically significant more pronounced supraglottic obstruction than the other groups.
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Affiliation(s)
- Katarina Norlander
- Department of Surgical Sciences, Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Henrik Johansson
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden.
| | - Margareta Emtner
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Lennart Nordvall
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Leif Nordang
- Department of Surgical Sciences, Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
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7
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Understanding the total airway response to exercise: current perspectives and future challenges. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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8
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Sandnes A, Hilland M, Vollsæter M, Andersen T, Engesæter IØ, Sandvik L, Heimdal JH, Halvorsen T, Eide GE, Røksund OD, Clemm HH. Severe Exercise-Induced Laryngeal Obstruction Treated With Supraglottoplasty. Front Surg 2019; 6:44. [PMID: 31417908 PMCID: PMC6684966 DOI: 10.3389/fsurg.2019.00044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/16/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction: Exercise induced laryngeal obstruction (EILO) is relatively common in adolescents, with symptoms often confused with exercise induced asthma. EILO often starts with medial or inward rotation of supraglottic structures of the larynx, whereas glottic adduction appears as a secondary phenomenon in a majority. Therefore, surgical treatment (supraglottoplasty) is used in thoroughly selected and highly motivated patients with pronounced symptoms and severe supraglottic collapse. Aim: To investigate efficacy and safety of laser supraglottoplasty as treatment for severe supraglottic EILO by retrospective chart reviews. Methods: The EILO register at Haukeland University Hospital, Bergen, Norway was used to identify patients who had undergone laser supraglottoplasty for severe supraglottic EILO, verified by continuous laryngoscopy exercise (CLE) test, during 2013–2015. Laser incision in both aryepiglottic folds anterior to the cuneiform tubercles and removal of the mucosa around the top was performed in general anesthesia. Outcomes were questionnaire based self-reported symptoms, and laryngeal obstruction scored according to a defined scheme during a CLE-test performed before and after surgery. Results: Forty-five of 65 eligible patients, mean age 15.9 years, were included. Post-operatively, 38/45 (84%) patients reported less symptoms, whereas CLE-test scores had improved in all, of whom 16/45 (36%) had no signs of obstruction. Most improvements were at the supraglottic level, but 21/45 (47%) also improved at the glottic level. Two of 65 patients had complications; self-limiting vocal fold paresis and scarring/shortening of plica ary-epiglottica. Conclusion: Supraglottoplasty improves symptoms and decreases laryngeal obstruction in patients with severe supraglottic EILO, and appears safe in highly selected cases.
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Affiliation(s)
- Astrid Sandnes
- Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Magnus Hilland
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - Tiina Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | | | - Lorentz Sandvik
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ola Drange Røksund
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hege H Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
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Siewers K, Backer V, Walsted ES. A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction. Laryngoscope Investig Otolaryngol 2019; 4:227-233. [PMID: 31024992 PMCID: PMC6476268 DOI: 10.1002/lio2.257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/05/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives Exercise‐induced laryngeal obstruction (EILO) is a condition causing breathing difficulties and stridor during exercise. The condition has in severe cases been treated surgically with supraglottoplasty. The purpose of this systematic review is to assess the evidence and recommendations for surgical intervention in treating patients with EILO. Methods A systematic search was performed in PubMed and Embase to identify relevant studies describing surgical treatment of patients diagnosed with severe EILO. According to eligibility criteria, data were independently extracted by two reviewers. To assess the risk of bias of each included study, the Newcastle‐Ottawa scale (NOS) was used. Results The screening process identified 11 observational studies with a total of 75 patients. Findings indicated that many beneficial outcomes are to be found in surgical treatment for EILO. These indications were found both on visual verification of improvement of the laryngeal obstruction during exercise and patient self‐reported symptom severity. The average NOS score (4.3) indicated low level of evidence in the included studies. Conclusion Studies reporting effects of surgical treatment of EILO have shown promising results in patients with laryngeal obstruction. However, the heterogeneity of study methodologies and the level of evidence precludes definitive recommendations for or against supraglottoplasty at this time; prospective and methodologically robust studies are now needed. Level of Evidence 4
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Affiliation(s)
- Karina Siewers
- Respiratory Research Unit Bispebjerg University Hospital Copenhagen Denmark
| | - Vibeke Backer
- Respiratory Research Unit Bispebjerg University Hospital Copenhagen Denmark
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10
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Røksund OD, Olin JT, Halvorsen T. Working Towards a Common Transatlantic Approach for Evaluation of Exercise-Induced Laryngeal Obstruction. Immunol Allergy Clin North Am 2018; 38:281-292. [PMID: 29631736 DOI: 10.1016/j.iac.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Exertional dyspnea can be a manifestation of dysfunction in a variety of organ systems. Exercise-induced laryngeal obstruction (EILO), a condition previously known as vocal cord dysfunction and paradoxic vocal fold motion, is defined as inappropriate, reversible narrowing of the larynx during vigorous exercise. EILO is usually characterized by typical symptoms, which nevertheless frequently are confused with those of other conditions, including asthma. Laryngoscopy performed as symptoms evolve from rest to peak exercise is pivotal in patient work-up. Moving forward, laryngoscopy findings that definitively characterize EILO need to be defined as do objective measures that can quantitate absolute laryngeal measurements during exercise.
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Affiliation(s)
- Ola Drange Røksund
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
| | - J Tod Olin
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Thomas Halvorsen
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Section for Paediatrics, University of Bergen, Bergen, Norway
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11
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Abstract
Exertional dyspnea is common in health and disease. Despite having known for centuries that breathlessness can arise from the larynx, exercise-induced laryngeal obstruction is a more prevalent condition than previously assumed. This article provides a brief overview of the history, epidemiology, and pathophysiology of exercise-induced laryngeal obstruction.
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12
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Exercise inducible laryngeal obstruction: diagnostics and management. Paediatr Respir Rev 2017; 21:86-94. [PMID: 27492717 DOI: 10.1016/j.prrv.2016.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022]
Abstract
Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.
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13
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Shembel A, Kolouri S, Xu H, Verdolini Abbott K. Quantification of Respiratory Laryngeal Morphometry: Comparison of Laryngeal Lumen Angle Estimate Methods. J Voice 2016; 30:764.e23-764.e37. [DOI: 10.1016/j.jvoice.2015.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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14
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Hilland M, Røksund OD, Sandvik L, Haaland Ø, Aarstad HJ, Halvorsen T, Heimdal JH. Congenital laryngomalacia is related to exercise-induced laryngeal obstruction in adolescence. Arch Dis Child 2016; 101:443-8. [PMID: 26906070 PMCID: PMC4853585 DOI: 10.1136/archdischild-2015-308450] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 01/15/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Congenital laryngomalacia (CLM) is the major cause of stridor in infants. Most cases are expected to resolve before 2 years of age, but long-term respiratory prospects are poorly described. We aimed to investigate if CLM was associated with altered laryngeal structure or function in later life. METHODS Twenty of 23 (87%) infants hospitalised at Haukeland University Hospital during 1990-2000 for CLM without comorbidities and matched controls were assessed at mean age 13 years. Past and current respiratory morbidity was recorded in a questionnaire, and spirometry performed according to standard quality criteria. Laryngoscopy was performed at rest and continuously throughout a maximal treadmill exercise test (continuous laryngoscopy exercise test (CLE-test)), and scored and classified in a blinded fashion according to preset criteria. RESULTS In the CLM group, laryngeal anatomy supporting CLM in infancy was described at rest in nine (45%) adolescents. Eleven (55%) reported breathing difficulties in relation to exercise, of whom 7 had similarities to CLM at rest and 10 had supraglottic obstruction during CLE-test. Overall, 6/20 had symptoms during exercise and similarities to CLM at rest and obstruction during CLE-test. In the control group, one adolescent reported breathing difficulty during exercise and two had laryngeal obstruction during CLE-test. The two groups differed significantly from each other regarding laryngoscopy scores, obtained at rest and during exercise (p=0.001 or less). CONCLUSIONS CLM had left footprints that increased the risk of later exercise-induced symptoms and laryngeal obstruction. The findings underline the heterogeneity of childhood respiratory disease and the importance of considering early life factors.
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Affiliation(s)
- Magnus Hilland
- Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Lorentz Sandvik
- Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Øystein Haaland
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hans Jørgen Aarstad
- Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, Section for Pediatrics, University Bergen, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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15
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Mehlum CS, Walsted ES, Godballe C, Backer V. Supraglottoplasty as treatment of exercise induced laryngeal obstruction (EILO). Eur Arch Otorhinolaryngol 2015; 273:945-51. [DOI: 10.1007/s00405-015-3823-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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16
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Røksund OD, Heimdal JH, Olofsson J, Maat RC, Halvorsen T. Larynx during exercise: the unexplored bottleneck of the airways. Eur Arch Otorhinolaryngol 2015; 272:2101-9. [PMID: 25033930 PMCID: PMC4526593 DOI: 10.1007/s00405-014-3159-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022]
Abstract
Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.
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Affiliation(s)
- Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway,
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Gallena SJK, Solomon NP, Johnson AT, Vossoughi J, Tian W. The Effect of Exercise on Respiratory Resistance in Athletes With and Without Paradoxical Vocal Fold Motion Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:470-479. [PMID: 26001627 PMCID: PMC4657526 DOI: 10.1044/2015_ajslp-14-0110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/28/2014] [Accepted: 05/12/2015] [Indexed: 05/30/2023]
Abstract
PURPOSE An investigational, portable instrument was used to assess inspiratory (R(i)) and expiratory (R(e)) resistances during resting tidal breathing (RTB), postexercise breathing (PEB), and recovery breathing (RB) in athletes with and without paradoxical vocal fold motion disorder (PVFMD). METHOD Prospective, controlled, repeated measures within-subject and between-groups design. Twenty-four teenage female athletes, 12 with and 12 without PVFMD, breathed into the Airflow Perturbation Device for baseline measures of respiratory resistance and for two successive 1-min trials after treadmill running for up to 12 min. Exercise duration and dyspnea ratings were collected and compared across groups. RESULTS Athletes with PVFMD had lower than control R(i) and R(e) values during RTB that significantly increased at PEB and decreased during RB. Control athletes' R(e) decreased significantly from RTB to PEB but not from PEB to RB, whereas R(i) did not change from RTB to PEB but decreased from PEB to RB. Athletes without PVFMD ran longer, providing lower dyspnea ratings. CONCLUSION Immediately following exercise, athletes with PVFMD experienced increased respiratory resistance that affected their exercise performance. The difference in resting respiratory resistances between groups is intriguing and could point to anatomical differences or neural adaptation in teenagers with PVFMD. The Airflow Perturbation Device appears to be a clinically feasible tool that can provide insight into PVFMD and objective data for tracking treatment progress.
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Affiliation(s)
| | - Nancy Pearl Solomon
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
| | | | - Jafar Vossoughi
- University of Maryland, College Park
- Engineering and Scientific Research Associates, Olney, MD
| | - Wei Tian
- University of Maryland, College Park
- Private practice, Bellevue, TX
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18
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Scheinherr A, Bailly L, Boiron O, Lagier A, Legou T, Pichelin M, Caillibotte G, Giovanni A. Realistic glottal motion and airflow rate during human breathing. Med Eng Phys 2015; 37:829-39. [PMID: 26159687 DOI: 10.1016/j.medengphy.2015.05.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/20/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
The glottal geometry is a key factor in the aerosol delivery efficiency for treatment of lung diseases. However, while glottal vibrations were extensively studied during human phonation, the realistic glottal motion during breathing is poorly understood. Therefore, most current studies assume an idealized steady glottis in the context of respiratory dynamics, and thus neglect the flow unsteadiness related to this motion. This is particularly important to assess the aerosol transport mechanisms in upper airways. This article presents a clinical study conducted on 20 volunteers, to examine the realistic glottal motion during several breathing tasks. Nasofibroscopy was used to investigate the glottal geometrical variations simultaneously with accurate airflow rate measurements. In total, 144 breathing sequences of 30s were recorded. Regarding the whole database, two cases of glottal time-variations were found: "static" or "dynamic" ones. Typically, the peak value of glottal area during slow breathing narrowed from 217 ± 54 mm(2) (mean ± STD) during inspiration, to 178 ± 35 mm(2) during expiration. Considering flow unsteadiness, it is shown that the harmonic approximation of the airflow rate underevaluates the inertial effects as compared to realistic patterns, especially at the onset of the breathing cycle. These measurements provide input data to conduct realistic numerical simulations of laryngeal airflow and particle deposition.
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Affiliation(s)
- Adam Scheinherr
- CNRS, Aix Marseille Université, Centrale Marseille, IRPHE UMR 7342, 13384, Marseille, France.
| | - Lucie Bailly
- CNRS, Aix Marseille Université, Centrale Marseille, IRPHE UMR 7342, 13384, Marseille, France; CNRS, 3SR, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR, F-38000, Grenoble, France
| | - Olivier Boiron
- CNRS, Aix Marseille Université, Centrale Marseille, IRPHE UMR 7342, 13384, Marseille, France
| | - Aude Lagier
- CNRS, Aix Marseille Université, LPL UMR 7309, 13100, Aix-en-Provence, France; APHM, ENT Department, La Timone Hospital, 13385, Marseille, France
| | - Thierry Legou
- CNRS, Aix Marseille Université, LPL UMR 7309, 13100, Aix-en-Provence, France
| | | | | | - Antoine Giovanni
- CNRS, Aix Marseille Université, LPL UMR 7309, 13100, Aix-en-Provence, France; APHM, ENT Department, La Timone Hospital, 13385, Marseille, France
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Gallena SK, Solomon NP, Johnson AT, Vossoughi J, Tian W. Test-retest reliability of respiratory resistance measured with the airflow perturbation device. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:1323-1329. [PMID: 24686535 DOI: 10.1044/2014_jslhr-s-13-0246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE In this study, the authors aimed to determine reliability of the airflow perturbation device (APD) to measure respiratory resistance within and across sessions during resting tidal (RTB) and postexercise breathing in healthy athletes, and during RTB across trials within a session in athletes with paradoxical vocal fold motion (PVFM) disorder. METHOD Prospective, repeated-measures design. The APD measured respiratory resistance during 3 baseline assessments in 24 teenage female athletes, 12 with and 12 without PVFM. Control athletes provided data at rest and following a customized exercise challenge during each of 3 sessions. Intraclass correlation coefficient (ICC) analysis assessed strength of relationships, and repeated-measures analysis of variance assessed differences across trials and sessions. RESULTS ICC analyses confirmed strong correlations across RTB trials for inspiratory, expiratory, and mean respiratory resistance in both groups. Inspiratory resistance decreased ~5% between sessions for control participants; expiratory and mean respiratory resistances were stable. Data from control athletes across sessions and following rigorous exercise were strongly correlated when taken at comparable intervals. CONCLUSIONS APD-measured respiratory resistance, including separate assessments for the inspiratory and expiratory phases, has strong test-retest reliability during RTB and after exercising. This suggests that the APD is a useful measurement tool for the assessment of airway function in patients suspected of having PVFM.
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20
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Gallena SJK, Tian W, Johnson AT, Vossoughi J, Sarles SA, Solomon NP. Validity of a new respiratory resistance measurement device to detect glottal area change. J Voice 2013; 27:299-304. [PMID: 23497798 DOI: 10.1016/j.jvoice.2013.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the correlation between respiratory resistance (Rr) values measured with the Airflow Perturbation Device (APD) to laryngoscopic images of glottal area (GA) in feigned paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction. HYPOTHESIS There is a strong inverse relationship between Rr and GA such that laryngeal constriction can be detected and quantified by APD-measured Rr. STUDY DESIGN Prospective, single subject study. METHODS A healthy adult feigned breathing that was characteristic of PVFM. Rr and GA were simultaneously recorded, synchronized, and analyzed for three complete breathing cycles with significant glottal constriction occurring during inspiration. RESULTS Cross-correlation analysis revealed a strong negative correlation (-0.824) between GA and Rr during feigned PVFM breathing such that Rr increased when GA decreased. CONCLUSION APD-measured Rr appears to be a viable noninvasive method for diagnostic screening and monitoring of treatment outcomes for individuals presenting with dyspnea related to PVFM.
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Affiliation(s)
- Sally J K Gallena
- Department of Speech-Language Pathology, Loyola University Maryland, Baltimore, Maryland, USA.
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21
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Dion GR, Eller RL, Thomas RF. Diagnosing Aerodynamic Supraglottic Collapse With Rest and Exercise Flexible Laryngoscopy. J Voice 2012; 26:779-84. [DOI: 10.1016/j.jvoice.2012.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 01/23/2012] [Indexed: 11/26/2022]
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Røksund OD, Maat RC, Heimdal JH, Olofsson J, Skadberg BT, Halvorsen T. Exercise induced dyspnea in the young. Larynx as the bottleneck of the airways. Respir Med 2009; 103:1911-8. [PMID: 19782550 DOI: 10.1016/j.rmed.2009.05.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 05/22/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exercise induced asthma may symptomatically be difficult to differentiate from exercise related obstruction in the upper airways, sometimes leading to diagnostic confusion and inappropriate treatment. Larynx accounts for a significant fraction of total airway resistance, but its role as a limiting factor for airflow during exercise has been hampered by lack of diagnostic tools. We aimed to study laryngeal function in exercising humans by transnasal laryngoscopy. METHODS Continuous video recording of the larynx was performed in parallel with continuous film recording of the upper part of the body and recording of breath sounds in subjects running to respiratory distress or exhaustion on a treadmill. RESULTS A successful examination was obtained in 20 asymptomatic volunteers and 151 (91%) of 166 young patients with a history of inspiratory distress or stridor during exercise. At rest, six patients had abnormal laryngeal findings. During exercise, a moderate or severe adduction of laryngeal structures was observed in parallel with increasing inspiratory distress in 113 (75%) patients. In 109 of these, adduction started within supraglottic structures, followed by adduction of the vocal cords in 88. In four patients, laryngeal adduction started in the vocal cords, involving supraglottic structures secondarily in three. CONCLUSION Larynx can safely be studied throughout a maximum intensity exercise treadmill test. A characteristic laryngeal response pattern to exercise was visualised in a large proportion of patients with suspected upper airway obstruction. Laryngoscopy during ongoing symptoms is recommended for proper assessment of these patients.
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Affiliation(s)
- Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, N-5021 Bergen, Norway.
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23
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Orlikoff RF. Voice Production during a Weightlifting and Support Task. Folia Phoniatr Logop 2008; 60:188-94. [DOI: 10.1159/000128277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Maat RC, Roksund OD, Olofsson J, Halvorsen T, Skadberg BT, Heimdal JH. Surgical treatment of exercise-induced laryngeal dysfunction. Eur Arch Otorhinolaryngol 2007; 264:401-7. [PMID: 17203312 DOI: 10.1007/s00405-006-0216-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 12/06/2006] [Indexed: 11/29/2022]
Abstract
A method for combined ergo-spirometry and continuous laryngeal inspection during exercise, entitled continuous laryngoscopy exercise test (CLE-test) has been developed in order to study airway obstruction at the laryngeal level during exercise. The aim of the study was to apply the CLE-test on patients experiencing respiratory distress during exercise in order to reveal the usefulness of the CLE-test both as a diagnostic tool in the selection of patients for surgery and in evaluation of treatment effects postoperatively. Until now, 81 patients with a history of exercise-induced stridor have undergone the CLE-test. Ten of these patients were selected for surgical treatment based on the severity of symptoms and their motivation for treatment. All ten patients underwent endoscopic supraglottoplasty (ES), with laser incision in both aryepiglottic folds anterior to the cuneiform cartilages and removal of the mucosa around the top of the tubercles. Each patient was examined by the CLE-test before and 3 months after surgery. Eight patients felt subjectively that their breathing capacity during exercise was improved. When pre- and postoperative ergo-spirometry evaluations were compared, increased peak oxygen consumption was observed in four out of ten patients and better maximal minute ventilation in seven out of ten. Postoperative evaluation of the laryngeal images showed less prominent aryepiglottic folds. The typical adduction of the supraglottic structures concomitant with inspiratory stridor found preoperatively was not present in any of the patients during exercise postoperatively. The ES procedure is an efficient surgical treatment for exercise-induced laryngeal supraglottic obstruction and the CLE-test eases the selection of patients for surgery and facilitates the evaluation of treatment effects.
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Affiliation(s)
- Robert C Maat
- Department of Otolaryngology, Haukeland University Hospital, Bergen, Norway
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25
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Heimdal JH, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J. Continuous laryngoscopy exercise test: a method for visualizing laryngeal dysfunction during exercise. Laryngoscope 2006; 116:52-7. [PMID: 16481809 DOI: 10.1097/01.mlg.0000184528.16229.ba] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the diagnostic feasibility and patient acceptance of a new developed diagnostic test for exercise induced upper airway flow limitation. STUDY DESIGN Clinical case control study including evaluation of contemporary ergo-spirometry and laryngoscopy continuously performed during exercise. METHODS Twelve nonsymptomatic controls and four young females with documented dyspnea and noisy breathing during exercise were studied. All subjects exercised to exhaustion on a treadmill while attached to a fully equipped ergo-spirometry unit and a fiberoptic laryngoscope linked to a video camera and a sound recorder. RESULTS The test situation was well tolerated. Two control subjects had a minor inspiratory synchronous medial motion of the aryepiglottic folds without limitation of laryngeal airflow. In the four symptomatic subjects, exercise induced inspiratory synchronous medial motion of the dorsal part of the aryepiglottic folds as well as vocal cord adduction and inspiratory stridor was demonstrated. CONCLUSION The continuous laryngoscopy exercise test was easy to perform, well tolerated, and can be implemented in future diagnostic work-up programs of laryngeal dysfunction.
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Affiliation(s)
- John-Helge Heimdal
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
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Heinle R, Linton A, Chidekel AS. Exercise-induced Vocal Cord Dysfunction Presenting as Asthma in Pediatric Patients: Toxicity of Inappropriate Inhaled Corticosteroids and the Role of Exercise Laryngoscopy. ACTA ACUST UNITED AC 2003. [DOI: 10.1089/088318703322751273] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Björnsdóttir US, Gudmundsson K, Hjartarson H, Bröndbo K, Magnússon B, Juliusson S. Exercise-induced laryngochalasia: an imitator of exercise-induced bronchospasm. Ann Allergy Asthma Immunol 2000; 85:387-91. [PMID: 11101182 DOI: 10.1016/s1081-1206(10)62552-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with exercise-induced laryngochalasia present with dyspnea and stridor during exercise. Symptoms are due to a subtotal occlusion of the larynx resulting from mucosal edema from the aryepiglottic folds being drawn into the endolarynx. METHODS We report on three patients with exercise-induced bronchospasm, refractory to standard therapy. RESULTS Spirometry with flow-volume loops revealed truncation of the inspiratory limb. Abnormal movement of the arytenoid region was visualized on laryngoscopy. A diagnosis of exercise-induced laryngochalasia was made. CONCLUSIONS Evaluation of laryngeal motion in patients with refractory exercise-induced bronchospasm is important. Surgical correction with laser laryngoplasty is effective in carefully selected cases.
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