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

Abstract

Objective: To identify different presentations, referral patterns, comorbidities, and laryngoscopy findings in children and young adults with exercise-induced laryngeal obstruction (EILO).Methods: We performed a retrospective chart review of 112 patients, age <26 years, with EILO between 2013 and 2016. Results: Of the 112 patients who met criteria, 91 were female and 21 were male. Patients were most frequently referred by pulmonologists (60.7%). The majority of patients (93%) participated in organized sports, most of them at a competitive level. The mean age at symptom onset was 13.8 AE 3.3 years, and the mean age of diagnosis was 15.4 AE 3.0 years. Sixty-seven (59.8%) patients presented with a prior diagnosis of asthma, the majority of whom had failed asthma treatment. The most common symptoms reported were dyspnea (93.8%), wheezing/stridor (78.6%), and throat tightness (48.2%). Ninety-one (81.3%) patients had spirometry performed, with 46 (51.1%) showing inspiratory loop flattening. On flexible laryngoscopy, 87 (78.4%) of 111 patients had paradoxical vocal fold motion. Supraglottic involvement was observed to obstruct the airway in 26 (23.9%) patients, with patterns of obstruction similar to those observed in children with laryngomalacia.Conclusion: Most patients participated in competitive sports, were female, and presented with exertional dyspnea. Most patients were diagnosed with exercise-induced asthma but treated unsuccessfully. Almost one-quarter of our patients showed supraglottic collapse obstructing the airway. Exercise-induced laryngeal obstruction is a more descriptive term than paradoxical vocal fold motion or vocal cord dysfunction, which only describe vocal fold involvement. The time to diagnosis of EILO was shorter than previously reported, suggesting that awareness of this condition is increasing.

Respiratory Laryngeal Dystonia: Characterization and Diagnosis of a Rare Neurogenic Disorder

“…6 Interarytenoid injection and ventricular fold injections have been reported to improve function in some patients. 4,6,7 Using botulinum toxin injection to treat RLD was first described by Grillone et al, Blitzer and Brin, and Brin et al 8,13,14 It has been shown to reduce the quantity and quality of spasms and therefore produce noticeable improvement in breathing. 1 Botulinum toxin takes effect after an average of 43.2 hours, with maximal effect after 2 weeks.…”

“…To date, the most effective treatment of RLD has been botulinum toxin injections into the adductor compartment to affect the lateral cricothyroid muscles and thyroarytenoid muscles 6 . Interarytenoid injection and ventricular fold injections have been reported to improve function in some patients 4,6–7 . Using botulinum toxin injection to treat RLD was first described by Grillone et al, Blitzer and Brin, and Brin et al 8,13–14 It has been shown to reduce the quantity and quality of spasms and therefore produce noticeable improvement in breathing 1 .…”

“…Patients with RLD typically present with dyspnea, desynchronized breathing, inspiratory stridor, dysphonia, and paradoxical vocal fold motion (PVFM) or inducible laryngeal obstruction (ILO). 3,4 This is a condition where supraglottic structures and not the vocal folds obstruct the airway. Symptoms occur continuously while the patient is awake and typically not observed during sleep.…”

Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management

“…Dysfunctional breathing is a term describing changes in breathing pattern that result most commonly in dyspnoea (4). Dysfunctional breathing can be viewed in two component parts; a breathing pattern component and an upper airway component.…”

“…Shortness of breath is the most common presenting complaint ( 4 ). It may be precipitated by exertion and is often worse with increasing intensity and duration of exercise, however it can occur at rest.…”