The Olin EILOBI Breathing Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise-Induced Laryngeal Obstruction

Johnston, Kristina L.; Bradford, H M D Edward; Hodges, Heather L.; Moore, Camille M.; Nauman, Emily; Olin, J. Tod

doi:10.1016/j.jvoice.2017.08.020

Cited by 45 publications

(31 citation statements)

References 32 publications

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“…Several authors have suggested that IBA facilitates control of EILO symptoms [7,19], and that IMT may have an added positive influence [27]. The present study might be used to support these views, as symptoms shortly after IBA + IMT had improved in a majority, and these improvements were associated with better CLE-scores.…”

Section: Information and Breathing Advice Versus Inspiratory Muscle Trainingsupporting

confidence: 65%

“…Treatment of EILO is largely based on empirical data [4,12]. Most conservative strategies focus on making patients properly aware of their breathing pattern, structured breathing advice, and various breathing practices [1,[17][18][19]. Tailoring treatment modalities based on EILO subgroups or CLE-scores is still based on weak evidence, except for severe supraglottic EILO where supraglottoplasty has been reported successful [20].…”

Section: Introductionmentioning

confidence: 99%

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Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Sandnes

Andersen

Clemm

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4–6 years later. Methods Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2–4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4–6 years, both groups were re-assessed with a questionnaire. Results We identified 116 eligible patients from the EILO-register. Response rates after 4–6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2–4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7–0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4–6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants. Conclusion Self-reported EILO symptoms had improved after 4–6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered.

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Section: Information and Breathing Advice Versus Inspiratory Muscle Trainingsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Sandnes

Andersen

Clemm

et al. 2021

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…The EILOBI breathing techniques feature a high resistance and low resistance phase of inspiration that can be performed rapidly. 15 The techniques were discovered fortuitously during the endoscopic evaluation of patients who had previously not responded to conventionally used breathing techniques. Many of the conventional respiratory retraining strategies focus on slow breathing in the use of the diaphragm-concepts not compatible with the high respiratory rates and engagement of abdominal muscles that accompany intense exercise with athletes.…”

Section: Discussionmentioning

confidence: 99%

“…Many of the conventional respiratory retraining strategies focus on slow breathing in the use of the diaphragm-concepts not compatible with the high respiratory rates and engagement of abdominal muscles that accompany intense exercise with athletes. 15 The techniques are challenging yet important to learn and require a thoughtful teaching strategy. Nonetheless, in appropriately selected patients, like ours, that demonstrated a high degree of motor coordination, the techniques can minimize or eliminate symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…They were developed through observations made during TLE and designed for use in highintensity exercise. 15 The EILOBI techniques help trigger laryngeal abduction which reduces the degree of upper respiratory obstruction in athletes with EILO. 16 The following case describes a patient who was unresponsive to many common treatments for EILO, including Botulinum toxin injections, and found the greatest symptom relief with the EILOBI technique This case is important because relief from traditional therapies may not yield the most relief and alternative methods provide better results.…”

Section: Introductionmentioning

confidence: 99%

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Exercise Induced Laryngeal Obstruction in a Collegiate Runner: A Case Report of a Novel Therapy

Inskeep¹,

Olin²,

Arthur

2019

Clin Prac Athl Train

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A 23-year-old male Division I distance runner presented with several years of exertional stridor (high-pitched inspiratory noise caused by airflow obstruction), previously diagnosed as exercised-induced laryngeal obstruction (EILO), a condition formerly known as vocal cord dysfunction and exercisedinduced paradoxical vocal fold motion. Over the course of roughly 3 years, the patient had previously failed conventional and invasive respiratory therapies for EILO including respiratory retraining, inspiratory muscle training, reflux suppression, allergy suppression, amitriptyline, performance psychology, and injection of botulinum toxin to the larynx. At a referral center that specializes in the treatment of EILO, the patient's diagnosis was confirmed through the use of a new procedure called continuous laryngoscopy during exercise. He underwent three sessions of therapeutic laryngoscopy during exercise (which relies on real-time laryngoscopy footage as biofeedback during exercise) and concurrently learned novel breathing techniques to address the problem. It is common to misdiagnose exercise induced respiratory problems based on patients-described symptoms alone. Athletic trainers should be able to recognize EILO cases and feel comfortable contacting and collaborating with expert providers on appropriate treatment. This case is also important in that it documents a treatment failure of laryngeal injection of botulinum toxin for EILO, something not previously reported in the literature.

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Multi‐Institutional Study of Patient‐Reported Outcomes of Paradoxical Vocal Fold Motion

et al. 2022

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Objective: To explore patient-reported outcome measures of pediatric paradoxical vocal fold motion through a multiinstitutional study of geographically diverse United States medical facilities to assess long-term management and outcomes.Methods: Eligible participants >8 years of age diagnosed with PVFM over a 10-year period from 7 tertiary pediatric hospitals were invited to complete a survey addressing study objectives.Results: 65 participants completed the survey, of whom 80% were female, 75% reported a 3.5 grade point average or better, and 75% identified as competitive athletes or extremely athletic individuals. Participants rated their perceived efficacy of 13 specific treatments. Only five treatments were considered effective by a majority of the participants who tried them. The treatments that participants tried most often were breathing exercises (89.2%), bronchodilator treatments (45%), and allergy medications (35.4%). 78.8% of participants reported receiving more than one treatment and 25% reported receiving a combination of bronchodilators, anticholinergics, and steroids. At the time of PVFM diagnosis, 38% of participants had no idea when their symptoms would completely resolve. 23.3% of participants did not experience symptom resolution until greater than 1 year after diagnosis.Conclusions: Traditional management tools such as breathing exercises and biofeedback treatments may not provide the long-term benefit that providers anticipate. In addition to these commonly used management strategies, highly efficacious techniques such as counseling and lifestyle management should be incorporated into the long-term management of patients whose symptoms are refractory to traditional care.

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The Olin EILOBI Breathing Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise-Induced Laryngeal Obstruction

Cited by 45 publications

References 32 publications

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Exercise Induced Laryngeal Obstruction in a Collegiate Runner: A Case Report of a Novel Therapy

Multi‐Institutional Study of Patient‐Reported Outcomes of Paradoxical Vocal Fold Motion

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