Exercise-induced laryngeal obstruction: natural history and effect of surgical treatment

Robert Christiaan Maat, Magnus Hilland, Ola Drange Røksund, Thomas Halvorsen, Jan Olofsson, Hans Jørgen Aarstad, John-Helge Heimdal, Robert Christiaan Maat, Magnus Hilland, Ola Drange Røksund, Thomas Halvorsen, Jan Olofsson, Hans Jørgen Aarstad, John-Helge Heimdal

Abstract

The current follow-up study concerning the supraglottic type of exercise-induced laryngeal obstruction (EILO) was performed to reveal the natural history of supraglottic EILO and compare the symptoms, as well as the laryngeal function in conservatively versus surgically treated patients. A questionnaire-based survey was conducted 2-5 years after EILO was diagnosed by a continuous laryngoscopy exercise (CLE) test in 94 patients with a predominantly supraglottic obstruction. Seventy-one patients had been treated conservatively and 23 with laser supraglottoplasty. The questionnaire response rate was 70 and 100% in conservatively treated (CT) and surgically treated (ST) patients, respectively. A second CLE test was performed in 14 CT and 19 ST patients. A visual analogue scale on symptom severity indicated improvements in both the groups, i.e. mean values (± standard deviations) declined from 73 (20) to 53 (26) (P < 0.001) in the CT group and from 87 (26) to 25 (27) (P < 0.001) in the ST group. At follow-up, ST patients reported lower scores regarding current level of complaints, and higher ability to perform exercise, as well as to push themselves physically, all compared to CT patients (P < 0.001). CLE scores were normalized in 3 of 14 (21%) CT and 16 of 19 (84%) ST patients (Z = -3.6; P < 0.001). In conclusion, symptoms of EILO diagnosed in adolescents generally decreased during 2-5 years follow-up period but even more after the surgical treatment. Patients with supraglottic EILO may benefit from supraglottoplasty both as to laryngeal function and symptom relief.

Figures

Fig. 1
Fig. 1
Schematic overview chart concerning inclusion of patients and questionnaire response
Fig. 2
Fig. 2
a Change in severity of exercise-induced laryngeal obstruction symptoms, as given by visual analogue scores between- and within the treated and untreated group (VAS at diagnosis by memory). b Athletic activity level obtained at diagnosis compared to the follow-up
Fig. 3
Fig. 3
Change in continuous laryngoscopy exercise sub-scores for patients without treatment and surgically treated patients where the CLE score from the second CLE test is subtracted from the first CLE test (the vocal folds showed normal abduction at moderate effort in all the cases, therefore, this is not shown)
Fig. 4
Fig. 4
Proposed flow chart for treatment of EILO, based on clinical experience until now. Prospective studies are required to establish evidence-based treatment algorithms for patients with EILO

References

    1. Roksund 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;103:1911–1918. doi: 10.1016/j.rmed.2009.05.024.
    1. Christopher KL, Morris MJ. Vocal cord dysfunction, paradoxic vocal fold motion, or laryngomalacia? our understanding requires an interdisciplinary approach. Otolaryngol Clin North Am. 2010;43:43–66. doi: 10.1016/j.otc.2009.12.002.
    1. Bjornsdottir US, Gudmundsson K, Hjartarson H, Brondbo K, Magnusson B, Juliusson S. Exercise-induced laryngochalasia: an imitator of exercise-induced bronchospasm. Ann Allergy Asthma Immunol. 2000;85:387–391. doi: 10.1016/S1081-1206(10)62552-5.
    1. Smith RJ, Bauman NM, Bent JP, Kramer M, Smits WL, Ahrens RC. Exercise-induced laryngomalacia. Ann Otol Rhinol Laryngol. 1995;104:537–541.
    1. Hicks M, Brugman SM, Katial R. Vocal cord dysfunction/paradoxical vocal fold motion. Prim Care. 2008;35:81–103.
    1. Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest. 2010;138:1213–1223. doi: 10.1378/chest.09-2944.
    1. Maat RC, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J, Ellingsen TA, Aarstad HJ, Heimdal JH. Audiovisual assessment of exercise-induced laryngeal obstruction: reliability and validity of observations. Eur Arch Otorhinolaryngol. 2009;266:1929–1936. doi: 10.1007/s00405-009-1030-8.
    1. Sullivan MD, Heywood BM, Beukelman DR. A treatment for vocal cord dysfunction in female athletes: an outcome study. Laryngoscope. 2001;111:1751–1755. doi: 10.1097/00005537-200110000-00016.
    1. Murry T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope. 2004;114:1341–1345. doi: 10.1097/00005537-200408000-00005.
    1. Mandell DL, Arjmand EM. Laryngomalacia induced by exercise in a pediatric patient. Int J Pediatr Otorhinolaryngol. 2003;67:999–1003. doi: 10.1016/S0165-5876(03)00178-2.
    1. Bent JP, 3rd, Miller DA, Kim JW, Bauman NM, Wilson JS, Smith RJ. Pediatric exercise-induced laryngomalacia. Ann Otol Rhinol Laryngol. 1996;105:169–175.
    1. Heimdal JH, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J. Continuous laryngoscopy exercise test: a method for visualizing laryngeal dysfunction during exercise. Laryngoscope. 2006;116:52–57. doi: 10.1097/.
    1. Maat RC, Roksund OD, Olofsson J, Halvorsen T, Skadberg BT, Heimdal JH. Surgical treatment of exercise-induced laryngeal dysfunction. Eur Arch Otorhinolaryngol. 2007;264:401–407. doi: 10.1007/s00405-006-0216-6.
    1. Carlsen KH, Carlsen KC. Exercise-induced asthma. Paediatr Respir Rev. 2002;3:154–160. doi: 10.1016/S1526-0550(02)00009-4.
    1. Shiba K, Isono S, Nakazawa K. Paradoxical vocal cord motion: a review focused on multiple system atrophy. Auris Nasus Larynx. 2007;34:443–452. doi: 10.1016/j.anl.2007.03.006.
    1. Kahane JC. A morphological study of the human prepubertal and pubertal larynx. Am J Anat. 1978;151:11–19. doi: 10.1002/aja.1001510103.
    1. Bittleman DB, Smith RJ, Weiler JM. Abnormal movement of the arytenoid region during exercise presenting as exercise-induced asthma in an adolescent athlete. Chest. 1994;106:615–616. doi: 10.1378/chest.106.2.615.
    1. Abu-Hasan M, Tannous B, Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what? Ann Allergy Asthma Immunol. 2005;94:366–371. doi: 10.1016/S1081-1206(10)60989-1.
    1. Castelli WA, Ramirez PC, Nasjleti CE. Linear growth study of the pharyngeal cavity. J Dent Res. 1973;52:1245–1248. doi: 10.1177/00220345730520061401.
    1. Kahane JC. Growth of the human prepubertal and pubertal larynx. J Speech Hear Res. 1982;25:446–455.
    1. Pearson N, Atkin AJ, Biddle SJ, Gorely T, Edwardson C. Patterns of adolescent physical activity and dietary behaviours. Int J Behav Nutr Phys Act. 2009;6:45. doi: 10.1186/1479-5868-6-45.
    1. Kimm SY, Glynn NW, Kriska AM, Fitzgerald SL, Aaron DJ, Similo SL, McMahon RP, Barton BA. Longitudinal changes in physical activity in a biracial cohort during adolescence. Med Sci Sports Exerc. 2000;32:1445–1454. doi: 10.1097/00005768-200008000-00013.
    1. Wengreen HJ, Moncur C. Change in diet, physical activity, and body weight among young-adults during the transition from high school to college. Nutr J. 2009;8:32. doi: 10.1186/1475-2891-8-32.
    1. Ruddy BH, Davenport P, Baylor J, Lehman J, Baker S, Sapienza C. Inspiratory muscle strength training with behavioral therapy in a case of a rower with presumed exercise-induced paradoxical vocal-fold dysfunction. Int J Pediatr Otorhinolaryngol. 2004;68:1327–1332. doi: 10.1016/j.ijporl.2004.04.002.
    1. Christopher KL, Wood RP, 2nd, Eckert RC, Blager FB, Raney RA, Souhrada JF. Vocal-cord dysfunction presenting as asthma. N Engl J Med. 1983;308:1566–1570. doi: 10.1056/NEJM198306303082605.
    1. Murry T, Tabaee A, Owczarzak V, Aviv JE. Respiratory retraining therapy and management of laryngopharyngeal reflux in the treatment of patients with cough and paradoxical vocal fold movement disorder. Ann Otol Rhinol Laryngol. 2006;115:754–758.

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