Therapeutic laryngoscopy during exercise: A novel non‐surgical therapy for refractory EILO

Abstract

Our data support further study of therapeutic laryngoscopy during exercise as a possible intervention for patients with refractory EILO. Pediatr Pulmonol. 2017;52:813-819. © 2016 Wiley Periodicals, Inc.

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

“…The most commonly employed front-line treatments for EILO are breathing techniques promoting improved airflow and laryngeal relaxation strategies, typically comprising speech and language therapy (SLT) or physiotherapy-based intervention to modulate inspiratory airflow 13 AE direct biofeedback. 14,15 Ultimately, however, in some cases, EILO symptoms can remain refractory to this conservative approach. 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. [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.…”

Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

“…The latter is performed by securing a flexible laryngoscope in the nasopharynx, thus allowing continuous visualization of laryngeal movement and only one passage of the endoscope. It also offers an opportunity for biofeedback, and the development of battery‐powered portable laryngoscope systems has now made it possible to deliver continuous laryngoscopy in challenging environments, for example, when swimming …”

“…9 The latter is performed by securing a flexible laryngoscope in the nasopharynx, thus allowing continuous visualization of laryngeal movement and only one passage of the endoscope. It also offers an opportunity for biofeedback, 10 and the development of battery-powered portable laryngoscope systems has now made it possible to deliver continuous laryngoscopy in challenging environments, for example, when swimming. 11 Despite these developments, very little information is published regarding the optimum methodology for the assessment of laryngeal movement during environmentaltype (i.e., nonexercise) provocation.…”

Bronchial or Laryngeal Obstruction Induced by Exercise?

“…The videolaryngoscopy is the gold standard for diagnosis as it visualizes the paradoxical motion of the larynx and identifies precisely the site of obstruction, i.e., supraglottic, glottic, or both as in this report where closure of the anterior two-thirds of the glottis was associated with a small posterior chink during inspiration. Continuous laryngoscopy throughout an exercise test (2, 13) has been described in centers where specialist resources are readily available but may be difficult to implement in more conventional pediatric lung function laboratories. The inspiratory spirometry has been reported as a potential tool to identify EILO with characteristic flattening of the inspiratory loop.…”