Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery

Abstract

Exercise-induced laryngeal obstruction (E-ILO) causes exertional dyspnoea. There is no standardised methodology which characterises laryngeal obstruction in relation to exercise or links laryngeal obstruction and dyspnoea severity. Continuous laryngoscopy during exercise (CLE) may improve diagnostic sensitivity by enabling laryngeal visualisation at peak work capacity in patients with rapidly resolving obstruction. The time course of laryngeal obstruction across exercise and recovery has not been quantitated until this report.Adolescents and young adults referred for CLE were laryngoscopically monitored across rest, maximal cycle ergometry exercise, and recovery. Three reviewers, blinded to time sequencing, rated inspiratory glottic and supraglottic obstruction during 10 windows of 15-s corresponding to rest, 25%, 50%, 75%, 90% and 100% of individual symptom-limited peak work capacity (expressed in Watts), and four consecutive recovery windows.85 patients were screened and 71 included. Over 96% of time windows were interpretable. Laryngeal obstruction severity reached observed maximal levels at peak work capacity, and rapidly resolved. A spectrum of observed maximal obstruction was measured.CLE provides interpretable data demonstrating laryngeal obstruction in patients with suspected E-ILO that is more severe at peak work capacity than during rest, submaximal exercise, or recovery. Observed maximal obstruction was infrequently severe and rapidly resolved.

Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement

“…Specifically, the change in laryngeal features from baseline to the point of maximal obstruction should be described. Furthermore, whether the obstruction to airflow is at a glottic or supraglottic level should be detailed [3,6,[11][12][13]. In cases of combined supraglottic and glottic involvement, the two levels of obstruction may not be co-temporal throughout the attack.…”

Exercise‐induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis

“…We did not utilize a technique that allows for continuous visualization of the larynx throughout exercise. 8,10 It is possible that continuous visualization of the larynx would reveal additional findings.…”

“…Continuous laryngoscopy during exercise (CLE) has been reported as an alternate test for detecting ILO and can be adapted to replicate the scenario under which patients experience symptoms. [8][9][10] The test requires a specific setup that may be unavailable to all but the most specialized clinicians.…”

Therapeutic laryngoscopy during exercise: A novel non‐surgical therapy for refractory EILO

“…Treadmill sessions for selected runners are performed in some cases. High work rates are necessary to trigger EILO repeatedly, thus allowing several independent opportunities to work on prevention, minimization, and resolution of symptoms. This is a challenging exercise stimulus, but high‐intensity interval training is familiar to most competitive athletes.…”