Inducible Laryngeal Obstruction Differential Diagnosis in Adolescents and Adults: A Tutorial

Abstract

Inducible laryngeal obstruction (ILO), formerly referred to as paradoxical vocal fold motion and vocal cord dysfunction, is a complex disorder of the upper airway that requires skillful differential diagnosis. There are several medical conditions that may mimic ILO (or which ILO may mimic) that should be considered in the differential diagnosis before evidence-supported behavioral intervention is initiated to mitigate or eliminate this upper airway condition. A key in treatment planning is determination of an isolated presentation of ILO or ILO concurrent with other conditions that affect the upper airway. Accurate, timely differential diagnosis in the clinical assessment of this condition mitigates delay of targeted symptom relief and/or insufficient intervention. Accurate assessment and nuanced clinical counseling are necessary to untangle concurrent, competing conditions in a single patient. This tutorial describes the common and rare mimics that may be encountered by medical professionals who evaluate and treat ILO, with particular attention to the role of the speech-language pathologist. Speech-language pathologists receive referrals for ILO from several different medical specialists (allergy, pulmonology, and sports medicine), sometimes without a comprehensive team assessment. It is paramount that speech-language pathologists who assess and treat this disorder have a solid understanding of the conditions that may mimic ILO. Summary tables that delineate differential diagnosis considerations for airway noise, origin of noise, symptoms, triggers, role of the speech-language pathologist, and β-agonist response are included for clinician reference. A clinical checklist is also provided to aid clinicians in the critical assessment process.

Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children

“…[1][2][3] Common symptom triggers include exercise as well as environmental irritants and/or heightened emotional state. 4,5 When symptoms are induced by physical exertion, the term exerciseinduced laryngeal obstruction (EILO) is used. 6,7 ILO has also been referred to as paradoxical vocal fold motion or vocal cord dysfunction.…”

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

“…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. 25 Nomenclature for this EILO subtype has not been established, but will henceforth be referred to as EILO+ (EILO+ secondary triggers).…”

Prevalence and impact of exercise-induced laryngeal obstruction in asthma: a study protocol for a cross-sectional and longitudinal study

“…The evidence on how treatment of comorbid gastro-oesophageal reflux impacts asthma control is conflicting 50–52. Several other conditions might mimic EILO, such as laryngeal oedema, extra thoracic obstruction, dysfunctional breathing, laryngospasm, panic attacks, respiratory laryngeal dystonia, exertional dysautonomia, diaphragm flutter and respiratory dystonias 53. Such mimics will be examined and diagnosed to the extent possible given the tools available within the frames of this study (spirometry data, exercise data and findings/observations recorded during CLE tests).…”