Feasibility of portable continuous laryngoscopy during exercise testing

Hull, James H.; Walsted, Emil Schwarz; Orton, Christopher M.; Williams, P. K.; Ward, Simon; Pavitt, Mathew J.

doi:10.1183/23120541.00219-2018

Cited by 15 publications

(14 citation statements)

References 14 publications

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“…Cross-country skiers are usually very familiar with treadmill tests, as they regularly perform submaximal and maximal tests running or skiing on a treadmill. In the future, we see no major obstacles to perform a CLE on a larger treadmill using roller skis, or perhaps on skis in an outdoor skiing setting, using portable CLE equipment, which has recently been shown to be feasible ( 42 ). Furthermore, investigators tend to underestimate glottic angle during CLE tests ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Exercise-induced Laryngeal Obstruction in a Cohort of Elite Cross-country Skiers

Irewall

Bäcklund

Nordang

et al. 2020

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction Exercise-induced laryngeal obstruction (EILO) is a differential diagnosis for asthma and prevalent in athletes referred for exercise-induced dyspnea. The aim of this study was to estimate the prevalence of EILO in elite cross-country skiers, known for a high prevalence of asthma. Method Elite cross-country skiers were invited for screening of EILO. Screening consisted of clinical assessment, questionnaires, skin prick test, spirometry, eucapnic voluntary hyperventilation test, and continuous laryngoscopy during exercise test. Current asthma was defined as physician-diagnosed asthma and use of asthma medication during the last 12 months. EILO was defined as ≥2 points at the supraglottic or glottic level during exercise at maximal effort, using a visual grade score system. Result A total of 89 (51% female) cross-country skiers completed the study. EILO was identified in 27% of the skiers, 83% of whom were female. All skiers with EILO had supraglottic EILO, and there was no glottic EILO. Current asthma was present in 34 (38%) of the skiers, 10 (29%) of whom had concomitant EILO. In the skiers with EILO, a higher proportion reported wheeze or shortness of breath after exercise, compared with skiers without EILO. In skiers with EILO and current asthma, compared with skiers with asthma only, a higher proportion reported wheeze or shortness of breath after exercise. Asthma medication usage did not differ between these groups. Conclusion EILO is common in elite cross-country skiers, especially females. Asthma and EILO may coexist, and the prevalence of respiratory symptoms is higher in skiers with both. Testing for EILO should be considered in cross-country skiers with respiratory symptoms.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Exercise-induced Laryngeal Obstruction in a Cohort of Elite Cross-country Skiers

Irewall

Bäcklund

Nordang

et al. 2020

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Specifically, the most commonly reported surgical procedure performed is a supraglottoplasty, a procedure most commonly and historically employed for childhood laryngomalacia. [6][7][8][9][10][11][12][13][14][15][16][17][18] Surgical intervention in this context most typically involves the use of either a carbon dioxide laser or cold steel microlaryngeal instruments to divide the aryepiglottic fold along the lateral edge of the epiglottis. [19][20][21] There are currently approximately 100 cases reported in the literature (Table I), [17][18][19][20][21][22][23][24][25][26][27][28][29][30] with a recent systematic review concluding that this intervention has promising results, although clearly, larger more robust studies, preferably performed in a randomized controlled format, are needed.…”

Section: Introductionmentioning

confidence: 99%

“…The latter permits direct visualization of the laryngeal inlet by placing and then securing a flexible laryngoscope in situ on specialist headgear, while the athlete then exercises to precipitate symptoms. The CLE test is most commonly performed in an exercise laboratory but can be adapted for sport‐specific use and has been utilized more recently in the ambulatory setting . The CLE test permits gradation of EILO severity based on degree and location of laryngeal closure, most commonly using a standardized 0 to 3 (0 = none, 1 = mild, 2 = moderate, 3 = severe) scale, with differentiation between glottic‐ and supraglottic‐level closure.…”

Section: Introductionmentioning

confidence: 99%

“…In such cases, surgical treatment has been described for the supraglottic form of EILO. Specifically, the most commonly reported surgical procedure performed is a supraglottoplasty, a procedure most commonly and historically employed for childhood laryngomalacia . Surgical intervention in this context most typically involves the use of either a carbon dioxide laser or cold steel microlaryngeal instruments to divide the aryepiglottic fold along the lateral edge of the epiglottis .…”

Section: Introductionmentioning

confidence: 99%

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Surgical intervention for exercise‐induced laryngeal obstruction: A UK perspective

2020

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Objectives: Exercise-induced laryngeal obstruction (EILO) is a prevalent cause of exertional breathlessness and wheeze in young individuals. Typically diagnosed using the continuous laryngoscopy during exercise (CLE) test, treatment is largely based on breathing retraining promoting improved laryngeal function. In some cases, these techniques fail to alleviate symptoms, and surgical intervention with supraglottoplasty can be valuable in the supraglottic form of EILO. Globally, there is currently limited experience utilizing a surgical approach to EILO, and data regarding the optimum surgical technique and published outcomes and complication rates are thus limited. Study Design: Retrospective observational case series. Methods: In this report, we describe our experience as the only UK center undertaking supraglottoplasty for EILO. We report the surgical outcome of 19 patients (n = 16 female), mean age, 29.6 AE 13.1 years, referred for surgery with moderate to severe supraglottic EILO. Follow-up clinic AE CLE was performed within 4 months (median = 6 weeks), and CLE scores were evaluated before and following surgery. Results: We found a beneficial effect of surgery on supraglottic CLE scores (median score reducing from 3/3 to 1/3 postoperatively [P < .05] overall) with 79% (n = 15) of patients reporting an improvement in their exercise capacity. One patient developed an apparent increased tendency for glottic-level EILO following surgery; however, no voice-or swallowing-related complications were encountered. Conclusions: This study is the first to report the UK experience, surgical technique, and outcome for EILO surgery. The findings indicate that EILO surgery appears to be a safe and effective option for individuals with moderate to severe supraglottic-type EILO who have failed initial conservative treatment.

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“…However, the result is limited by including only one participant; thus, future studies should aim to determine the validity and reliability of ambulant CLE testing to improve diagnostic opportunities. 13 …”

Section: Discussionmentioning

confidence: 99%

Changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running

Engan

Hammer

Stensrud

et al. 2020

BMJ Open Sport Exerc Med

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ObjectiveTo evaluate changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running.MethodsHealthy volunteers participated in an uphill race. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and 5 and 10 min after finishing the race. Capillary blood lactate concentration ([BLa-]) and Borg score for perceived exertion were registered immediately after the race. One participant wore a portable video-laryngoscope during the race, and the video was assessed for technical performance.ResultsTwenty adult subjects participated with a mean (SD) age of 40.2 (9.7) years. Mean (SD) race duration and post-exercise [BLa-] was 13.9 (2.3) min and 10.7 (2.1) mmol/L, respectively, and the median (range) Borg score for perceived exertion was 9 (5–10). Mean percentage change (95% CI) 5 and 10 min post-exercise in FEV1 were 6.9 (3.7 to 10.2) % and 5.9 (2.7 to 9.0) %, respectively, and in FVC 5.2 (2.3 to 8.1) % and 4.7 (1.6 to 7.9) %, respectively. The recorded video of the larynx was of good quality.ConclusionsMaximal aerobic field exercise induced bronchodilatation in the majority of the healthy non-asthmatic participants. It is feasible to perform continuous video-laryngoscopy during heavy uphill exercise.

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Feasibility of portable continuous laryngoscopy during exercise testing

Cited by 15 publications

References 14 publications

High Prevalence of Exercise-induced Laryngeal Obstruction in a Cohort of Elite Cross-country Skiers

High Prevalence of Exercise-induced Laryngeal Obstruction in a Cohort of Elite Cross-country Skiers

Surgical intervention for exercise‐induced laryngeal obstruction: A UK perspective

Changes in pulmonary function and feasibility of portable continuous laryngoscopy during maximal uphill running

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