Exercise-Induced Laryngeal Obstruction (EILO) in Athletes

Hamdan, Abdul‐Latif; Sataloff, Robert T.; Hawkshaw, Mary J.

doi:10.1007/978-3-030-69831-7_8

Cited by 3 publications

(5 citation statements)

References 98 publications

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“…Symptom triggers vary and include irritants, environmental factors, and physical exertion . When symptoms are induced by physical exertion, proper nomenclature is exercise-induced laryngeal obstruction (EILO) . Symptoms include inhalation/exhalation difficulty, chest/throat tightness, dizziness, and lightheadedness .…”

Section: Introductionmentioning

confidence: 99%

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Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Fujiki,

Thibeault

2024

JAMA Otolaryngol Head Neck Surg

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ImportancePatients with induced laryngeal obstruction (ILO) present with a variety of behavioral health profiles. Identifying these profiles is crucial in that behavioral health conditions may affect treatment duration and outcomes.ObjectiveTo characterize the prevalence of anxiety, depression, posttraumatic stress disorder (PTSD), and physical somatic symptoms in adult and pediatric patients with ILO and determine the factors associated with anxiety, depression, PTSD, and physical somatic symptoms in patients with ILO?Design, Setting, and ParticipantsThis cross-sectional study included a nonprobability sample of 83 adult and 81 pediatric patients diagnosed with ILO at outpatient adult and pediatric otolaryngology clinics between 2021 and 2023. Exclusion criteria included a comorbid respiratory diagnosis other than asthma, head or neck cancer, or neurological impairments. Recruitment took place between September 2021 and March 2023. The analyses were run in January 2024.Main Outcome MeasuresPatients were prospectively screened for anxiety, depression, PTSD, and somatic physical symptoms. In addition, any past behavioral health diagnoses were extracted from the medical record. Comorbidities, ILO symptoms triggers, and onset details were gathered from ILO evaluations. Adult patients completed the Screen for Adult Anxiety Related Disorders (SCAARED), depression (Patient Health Questionnaire [PHQ]-9), and somatic physical symptoms portions of the Patient Health Questionnaires (PHQ-15), and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5). Pediatric patients completed the Screen for Child Anxiety Related Disorders (SCARED), depression (PHQ-9A) and somatic physical symptoms portions of the Patient Health Questionnaires for Adolescents (PHQ-15A), and the UCLA PTSD Reaction Index brief screeners.ResultsEighty-three adult patients participated in this study (mean [SD] age, 45.8 [14.3] years; 64 female, 19 male). Eighty-one pediatric patients participated (mean [SD] age, 13.83 [2.55] years; 67 female, 14 male). Adult and pediatric patients with ILO screened positive for elevated rates of anxiety (53 adults [63%]; 49 children [60%]), depression (27 adults [32%]; 25 children [30%]), and PTSD (29 adults [34%]; 13 children [16%]). Most of the patients with anxiety and depression symptoms were formally diagnosed prior to ILO evaluation, with rates of previously diagnosed anxiety, depression, and PTSD also above published norms. Adults were twice as likely as children to present with PTSD (odds ratio, 2.1; 95% CI, 0.05-4.48). Elevated rates of physical somatic symptoms were also evident, with 38 adults (45%) and 32 children (39%) scoring in the moderate to severe range.Conclusions and RelevanceThis study found high rates of adult and pediatric patients with ILO screened positive for anxiety, depression, and PTSD symptoms. Future work should investigate how behavioral health and ILO treatments can best be coordinated to maximize treatment outcomes.

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Section: Introductionmentioning

confidence: 99%

“…1,6 When symptoms are induced by physical exertion, proper nomenclature is exercise-induced laryngeal obstruction (EILO). 7,8 Symptoms include inhalation/exhalation difficulty, chest/throat tightness, dizziness, and lightheadedness. 9 Numerous terms have been used to describe ILO, including paradoxical vocal fold motion and vocal cord dysfunction.…”

mentioning

confidence: 99%

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Fujiki,

Thibeault

2024

JAMA Otolaryngol Head Neck Surg

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“…12,[17][18][19] When symptoms are induced by physical exertion, the term Exercise Induced Laryngeal Obstruction (EILO) is used. 20,21 Cases triggered by stress or environmental factors (such as exposure to strong smells or irritants including smoke, gasoline, or perfumes) are labeled as ILO. [22][23][24] It is also common for patients with EILO to experience secondary emotional or environmental triggers.…”

Section: Introductionmentioning

confidence: 99%

“…EILO and ILO have only recently been assigned distinct labels, previously having been referred to as vocal cord dysfunction (VCD), paradoxical vocal fold motion (PVFM), fictitious asthma, or laryngeal dysfunction. 20,21,[26][27][28] When left untreated, EILO/ILO symptoms may lead to recurrent hospitalizations, emergency department visits, inability to participate in athletics, inappropriate medication, or even intubation. 7,8,11,29 Although the prevalence of EILO/ILO remains unknown, emerging evidence suggests the condition is relatively common-occurring in as many as 2% to 22% of dyspnea patients.…”

Section: Introductionmentioning

confidence: 99%

“…7,8,11,29 Although the prevalence of EILO/ILO remains unknown, emerging evidence suggests the condition is relatively common-occurring in as many as 2% to 22% of dyspnea patients. [30][31][32][33] Athletes may be particularly susceptible 21,[34][35][36] as EILO has been documented in 5% of elite adult athletes. 37 EILO/ILO is fairly common in the pediatric population as well, with as many as 30% of cases occurring in children.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Profiles of Children and Adolescents With Induced Laryngeal Obstruction (ILO) and Exercise Induced Laryngeal Obstruction (EILO)

Fujiki,

Olson-Greb,

Thibeault

2023

Ann Otol Rhinol Laryngol

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Purpose: To compare clinical profiles of pediatric patients with Induced Laryngeal Obstruction (ILO), Exercise Induced Laryngeal Obstruction (EILO), and EILO with non-exertion related secondary triggers (EILO+). Methods: A retrospective observational cohort design was employed. Four-hundred and twenty-three patients <18 years of age were identified from the electronic medical record of a large children’s hospital. All patients underwent evaluations with a laryngologist and speech-language pathologist and were diagnosed with EILO/ILO. Patients were divided into 3 groups based on dyspnea triggers reported in initial evaluations. Groups consisted of patients with EILO (N = 281), ILO (N = 30), and EILO+ (N = 112). Patient demographics, EILO/ILO symptoms, endoscopy findings, medical comorbidities, medical history, and EILO/ILO treatment information were extracted and compared across EILO/ILO subtypes. Results: Patients with EILO experienced higher rates of hyperventilation ( P < .001), sore throat ( P = .023), and chest pain ( P = .003). Patients with ILO were significantly younger in age ( P = .017) and presented with increased rates of nighttime symptoms ( P < .001), globus sensation ( P = .008), self-reported reflux symptoms ( P = .023), and history of gastrointestinal conditions ( P = .034). Patients with EILO+ were more likely to be female ( P = .037) and presented with higher prevalence of anxiety ( P = .003), ADHD ( P = .004), chest tightness ( P = .030), and cough ( P < .001). Conclusions: Patients with EILO, ILO, and EILO+ present with overlapping but unique clinical profiles. A prospective study is warranted to determine the etiology of these differences and clarify how the efficacy of EILO, ILO, and EILO+ treatment can be maximized. Level of Evidence: 4

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Effects of Exercise-Induced Laryngeal Obstruction in Adolescents: A Qualitative Study

Fujiki,

Johnson,

Fujiki

et al. 2024

Am J Speech Lang Pathol

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Purpose: The purpose of this study was to examine the influence of exercise-induced laryngeal obstruction (EILO) on adolescents. Method: Twenty patients (< 17 years) diagnosed with EILO participated in this study. Patients completed semistructured interviews examining their experience with the health care system, treatment, and the effects of EILO symptoms on quality of life. Interviews were analyzed using a combination of directed and conventional content analyses. Researchers identified seven overarching themes either prior to or during analysis, and 24 subthemes were inductively identified from patient interviews using open, axial, and selective coding. Results: On average, patients went 1.9 years between symptom onset and EILO diagnosis. Patients described symptom onset as frightening and confusing. Even after initially reporting symptoms to a medical provider, patients went an average of 10.5 months before diagnosis. Patients perceived that delays in diagnosis prevented efficient management and allowed symptoms to escalate. Patients reported that EILO detrimentally influenced athletic performance, forcing them to pace themselves or cease participation altogether. Social and academic effects of EILO included missed classes, difficulty in physical education courses, and resentment from teammates if athletic performance declined. Both athletes and nonathletes indicated that EILO elicited feelings of fear, frustration, dread, guilt, and embarrassment. Patients reported that therapy with a speech-language pathologist (SLP) effectively addressed symptoms; however, employing rescue breathing techniques was often more difficult than anticipated. Conclusions: Physical and emotional sequelae associated with EILO may have widespread influence on patient quality of life. Therapy with an SLP reportedly ameliorated EILO symptoms; however, patients indicated that delayed diagnosis allowed negative effects to intensify prior to treatment.

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Exercise-Induced Laryngeal Obstruction (EILO) in Athletes

Cited by 3 publications

References 98 publications

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Clinical Profiles of Children and Adolescents With Induced Laryngeal Obstruction (ILO) and Exercise Induced Laryngeal Obstruction (EILO)

Effects of Exercise-Induced Laryngeal Obstruction in Adolescents: A Qualitative Study

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