Perceptual Clinical Features in Exercise-Induced Laryngeal Obstruction (EILO): Toward Improved Diagnostic Approaches

Shembel, Adrianna C.; Hartnick, Christopher J.; Bunting, Glenn; Ballif, Catherine; Shaiman, Susan; Guzman, Vanessa de; Abbott, Katherine Verdolini

doi:10.1016/j.jvoice.2018.05.006

Cited by 10 publications

(4 citation statements)

References 60 publications

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“…In a case series study of 12 adolescent athletes seen for suspected exercise-induced laryngeal obstruction (EILO) (15), dyspnoea during inspiration was reported by all (100%) and dyspnoea during expiration by 8 (67%), and throat tightness was reported more frequently (50%) than chest tightness (25%). A Danish study that compared 42 adolescents with EILO with 16 adolescents diagnosed with airway hyper-responsiveness (AHR) similarly found that all reported wheeze and stridor, but those with EILO mostly reported cough and throat tightness while those with AHR reported mostly dyspnoea (14).…”

Section: Discussionmentioning

confidence: 99%

Reported symptoms differentiate diagnoses in children with exercise-induced respiratory problems: findings from the Swiss Paediatric Airway Cohort (SPAC)

Pedersen

Jong

Ardura‐Garcia

et al. 2020

Preprint

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Background: Exercise-induced breathing problems with similar clinical presentations can have different aetiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult. Objective: We studied which parent-reported, exercise-induced symptoms (EIS) can help distinguish diagnoses of EIS in children seen in respiratory outpatient clinics. Methods: This study was nested in the Swiss Paediatric Airway Cohort (SPAC), an observational study of children aged 0-17 years referred to paediatric respiratory outpatient clinics in Switzerland. We studied children aged 6-17 years and compared information on EIS from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyse whether parent-reported symptoms differed between diagnoses (asthma as base). Results: Among 1109 children, EIS were reported for 732 (66%) (mean age 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnoea best distinguished thoracic DB (relative risk ratio [RRR] 5.4, 95%CI 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR 2.4, 95%CI 1.3-6.2) and asthma plus DB (RRR 1.8, 95%CI 0.9-3.4) from asthma only. Late onset of EIS was less common for extrathoracic DB (RRR 0.1, 95%CI 0.03-0.5) and thoracic DB (RRR 0.4, 95%CI 0.1-1.2) compared with asthma. Localisation of dyspnoea (throat vs. chest) differed between extrathoracic DB (RRR 2.3, 95%CI 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses. Conclusion: Parent-reported symptoms help distinguish different diagnoses in children with EIS. This highlights the importance of physicians obtaining detailed patient histories.

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Section: Discussionmentioning

confidence: 99%

Reported symptoms differentiate diagnoses in children with exercise-induced respiratory problems: findings from the Swiss Paediatric Airway Cohort (SPAC)

Pedersen

Jong

Ardura‐Garcia

et al. 2020

Preprint

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“…Theories put forward to explain EILO include psychological causes [9,10], laryngeal hypersensitivity [11,12], increased autonomic activity and exposure to high levels of stress [13][14][15][16]. Increased activation of intrinsic laryngeal muscles and the trapezius muscle following whole body autonomic nervous system (ANS) activation has been demonstrated in females indicating that laryngeal muscles, as well as other muscles involved in the respiration, react in response to ANS activation [17].…”

Section: Introductionmentioning

confidence: 99%

“…Increased activation of intrinsic laryngeal muscles and the trapezius muscle following whole body autonomic nervous system (ANS) activation has been demonstrated in females indicating that laryngeal muscles, as well as other muscles involved in the respiration, react in response to ANS activation [17]. Stress reactivity in individuals with EILO may also reflect dispositions to stress responses recognized in competitive young athletes in general [16]. More recently, a pattern of dysfunctional breathing has been suggested to be involved in EILO [1,15,18].…”

Section: Introductionmentioning

confidence: 99%

A multidimensional strategy to managing dysfunctional breathing and exercise-induced laryngeal obstruction in adolescent athletes

Kolnes,

Stensrud,

Andersen

2024

BMC Sports Sci Med Rehabil

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Background Exercise induced laryngeal obstruction (EILO) causes inspiratory distress in the upper airway in many adolescent athletes. The nature of EILO is not fully understood, and effective management strategies are lacking. This study aimed to assess the effectiveness of a multidimensional individually tailored intervention, including Norwegian Psychomotor Physiotherapy (NPMP), elements of cognitive behavioural therapy and a rehabilitation plan, in reducing inspiratory distress and dysfunctional breathing in adolescent athletes with EILO. Methods A mixed methods design, which combined qualitative and quantitative research, was used. Data, including subjective experiences of respiratory distress, findings from body examinations and objective measurements of lung function and aerobic capacity were gathered before and after a five month intervention involving 18 participants. Results Following the intervention, the participants showed a reduction in respiratory distress and anxiousness associated with their breathing difficulties. Furthermore, the participants reported to be more in control of their breathing. The body assessments revealed a more functional breathing motion and improved posture, which imply that the breathing was less thoracic and more diaphragmatic in rest and exercise in all participants after the intervention. Conclusions Our results suggest that a multidimensional individually tailored intervention, including NPMP based physiotherapy, cognitive behavioural therapy elements, and a rehabilitation plan may reduce inspiratory distress and dysfunctional breathing in athletes with EILO. Trial registration ClinicalTrials.gov Protocol Registration and Results system NCT06033755, date of registration: September12, 2023. Retrospectively registered.

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“…7-13 Symptom onset is often abrupt and activated by detectable triggers. 14-16 Common symptom triggers include physical exertion, physical irritants, and/or emotional stressors. 12,17-19 When symptoms are induced by physical exertion, the term Exercise Induced Laryngeal Obstruction (EILO) is used.…”

Section: Introductionmentioning

confidence: 99%

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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Perceptual Clinical Features in Exercise-Induced Laryngeal Obstruction (EILO): Toward Improved Diagnostic Approaches

Cited by 10 publications

References 60 publications

Reported symptoms differentiate diagnoses in children with exercise-induced respiratory problems: findings from the Swiss Paediatric Airway Cohort (SPAC)

Reported symptoms differentiate diagnoses in children with exercise-induced respiratory problems: findings from the Swiss Paediatric Airway Cohort (SPAC)

A multidimensional strategy to managing dysfunctional breathing and exercise-induced laryngeal obstruction in adolescent athletes

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

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