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Döllinger M, Jakubaß B, Cheng H, Carter SJ, Kniesburges S, Aidoo B, Lee CH, Milstein C, Patel RR. Computational fluid dynamics of upper airway aerodynamics for exercise-induced laryngeal obstruction: A feasibility study. Laryngoscope Investig Otolaryngol 2023; 8:1294-1303. [PMID: 37899858 PMCID: PMC10601582 DOI: 10.1002/lio2.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Use of computational fluid dynamic (CFD) simulations to measure the changes in upper airway geometry and aerodynamics during (a) an episode of Exercise-Induced Laryngeal Obstruction (EILO) and (b) speech therapy exercises commonly employed for patients with EILO. Methods Magnetic resonance imaging stills of the upper airway including the nasal and oral cavities from an adult female were used to re-construct three-dimensional geometries of the upper airway. The CFD simulations were used to compute the maximum volume flow rate (l/s), pressure (Pa), airflow velocity (m/s) and area of cross-section opening in eight planes along the vocal tract, separately for inhalation and exhalation. Results Numerical predictions from three-dimensional geometrical modeling of the upper airway suggest that the technique of nose breathing for inhalation and pursed lip breathing for exhalation show most promising pressure conditions and cross-sectional diameters for rescue breathing exercises. Also, if EILO is due to the constriction at the vocal fold level, then a quick sniff may also be a proper rescue inhalation exercise. EILO affects both the inspiratory and the expiratory phases of breathing. Conclusions A prior knowledge of the supraglottal aerodynamics and the corresponding upper airway geometry from CFD analysis has the potential to assist the clinician in choosing the most effective rescue breathing technique for optimal functional outcome of speech therapy intervention in patients with EILO and in understanding the pathophysiology of EILO on a case-by-case basis with future studies. Level of Evidence 4.
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Affiliation(s)
- Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck SurgeryUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck SurgeryUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Program of NeuroscienceIndiana UniversityBloomingtonIndianaUSA
| | - Stephen J. Carter
- Department of KinesiologySchool of Public Health, Indiana UniversityBloomingtonIndianaUSA
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck SurgeryUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Bea Aidoo
- Department of MedicineIndiana University School of MedicineBloomingtonIndianaUSA
| | - Chi Hwan Lee
- Department of Biomedical Engineering & Mechanical EngineeringPurdue UniversityWest LafayetteIndianaUSA
| | - Claudio Milstein
- Department of Otolaryngology‐Head & Neck Surgery, Cleveland Clinic Lerner and Case Western Reserve University Schools of MedicineHead and Neck Institute, Cleveland ClinicClevelandOhioUSA
| | - Rita R. Patel
- Department of Speech, Language, and Hearing Sciences and Department of Otolaryngology Head and Neck SurgeryIndiana UniversityBloomington/IndianapolisIndianaUSA
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Sandage MJ, Milstein CF, Nauman E. Inducible Laryngeal Obstruction Differential Diagnosis in Adolescents and Adults: A Tutorial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1-17. [PMID: 36383426 DOI: 10.1044/2022_ajslp-22-00187] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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.
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Affiliation(s)
- Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Koh J, Phyland D, Baxter M, Leong P, Bardin PG. Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics. Expert Rev Respir Med 2023; 17:429-445. [PMID: 37194252 DOI: 10.1080/17476348.2023.2215434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based. AREAS COVERED A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure. EXPERT OPINION Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.
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Affiliation(s)
- Joo Koh
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Debra Phyland
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Malcolm Baxter
- Monash Health Department of Otolaryngology, Head and Neck Surgery, Monash Hospital and University, Melbourne, Australia
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Hospital and University, Melbourne, Australia
- Hudson Institute, Monash Hospital and University, Melbourne, Australia
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Solomon NP, Pham A, Gallena S, Johnson AT, Vossoughi J, Faroqi-Shah Y. Resting Respiratory Resistance in Female Teenage Athletes With and Without Exercise-Induced Laryngeal Obstruction. J Voice 2022; 36:734.e1-734.e6. [PMID: 32988702 PMCID: PMC7990743 DOI: 10.1016/j.jvoice.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Exercise-induced laryngeal obstruction (EILO) occurs with paradoxical vocal fold motion or supraglottic collapse during moderate to vigorous exercise. Previously, Gallena et al (2015) reported lower-than-normal inspiratory (Ri) and expiratory (Re) resistances during resting tidal breathing (RTB) in female teenage athletes with EILO. This study aimed to replicate that unexpected result. METHOD The Airflow Perturbation Device measured Ri and Re during three 1-minute trials of RTB in 16 teenage female athletes with EILO and 16 sex-, age-, and height-matched controls. Multiple linear regression examined group, age, height, and weight as predictors of Ri and Re. RESULTS Ri and Re tended to be lower in the EILO group than the control group [Ri: F(1,30) = 3.58, P = 0.068, d = 0.686; Re: F(1,30) = 3.28, P = 0.080, d = 0.640], but there was no statistically significant difference in the overall effect [F(2,29) = 1.75, P = 0.192]. After one outlier for Re from the EILO group and her matched control were removed, the overall difference was statistically significant, F(2,27) = 3.38, P = 0.049, with Re primarily contributing to the difference [Ri: F(1,28) = 3.66, P = 0.066, d = 0.719; Re: F(1,28) = 5.69, P = 0.024, d = 0.899]. CONCLUSION These results did not replicate the robust differences found previously between Ri and Re during RTB in teenage girls with and without EILO, but the results trended in the same direction and met criterion for statistical significance once an outlier was removed from analysis. Overall, the observation that resting respiratory resistances were lower in most teenage girls with EILO suggests that reduced tone of the laryngeal and/or lower airways may predispose young athletes to EILO.
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Affiliation(s)
- Nancy Pearl Solomon
- Walter Reed National Military Medical Center, Bethesda, Maryland; University of Maryland, College Park, Maryland.
| | - Andrea Pham
- University of Maryland, College Park, Maryland; Montgomery County Public Schools, Rockville, Maryland
| | | | | | - Jafar Vossoughi
- Engineering & Scientific Research Associates, Brookeville, Maryland
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Abstract
Work-related rhinitis and laryngeal disorders are common and can significantly contribute to work absences and presenteeism. Each can cause respiratory symptoms that may be misdiagnosed as asthma symptoms, and each may occur as an isolated disorder or may also accompany asthma. Suspicion of these disorders and correct management require a careful medical and occupational history. Investigations for work-related rhinitis include examination of the nose, allergy skin tests, and in some cases, monitoring of peak inspiratory nasal flows at work and off work, or specific challenge tests. Work-related laryngeal disorders require assistance from an otolaryngologist and speech language pathologist.
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Affiliation(s)
- Ambrose Lau
- Department of Medicine, Toronto Western Hospital, St Michael's Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Susan M Tarlo
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto Western Hospital, St Michael's Hospital, EW7-449, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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Shembel AC, Hartnick CJ, Bunting G, Ballif C, Shaiman S, de Guzman V, Abbott KV. Perceptual Clinical Features in Exercise-Induced Laryngeal Obstruction (EILO): Toward Improved Diagnostic Approaches. J Voice 2019; 33:880-893. [DOI: 10.1016/j.jvoice.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
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Shay EO, Sayad E, Milstein CF. Exercise-induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis. Laryngoscope 2019; 130:E400-E406. [PMID: 31498449 DOI: 10.1002/lary.28276] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/02/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify different presentations, referral patterns, comorbidities, and laryngoscopy findings in children and young adults with exercise-induced laryngeal obstruction (EILO). METHODS We performed a retrospective chart review of 112 patients, age <26 years, with EILO between 2013 and 2016. RESULTS Of the 112 patients who met criteria, 91 were female and 21 were male. Patients were most frequently referred by pulmonologists (60.7%). The majority of patients (93%) participated in organized sports, most of them at a competitive level. The mean age at symptom onset was 13.8 ± 3.3 years, and the mean age of diagnosis was 15.4 ± 3.0 years. Sixty-seven (59.8%) patients presented with a prior diagnosis of asthma, the majority of whom had failed asthma treatment. The most common symptoms reported were dyspnea (93.8%), wheezing/stridor (78.6%), and throat tightness (48.2%). Ninety-one (81.3%) patients had spirometry performed, with 46 (51.1%) showing inspiratory loop flattening. On flexible laryngoscopy, 87 (78.4%) of 111 patients had paradoxical vocal fold motion. Supraglottic involvement was observed to obstruct the airway in 26 (23.9%) patients, with patterns of obstruction similar to those observed in children with laryngomalacia. CONCLUSION Most patients participated in competitive sports, were female, and presented with exertional dyspnea. Most patients were diagnosed with exercise-induced asthma but treated unsuccessfully. Almost one-quarter of our patients showed supraglottic collapse obstructing the airway. Exercise-induced laryngeal obstruction is a more descriptive term than paradoxical vocal fold motion or vocal cord dysfunction, which only describe vocal fold involvement. The time to diagnosis of EILO was shorter than previously reported, suggesting that awareness of this condition is increasing. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E400-E406, 2020.
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Affiliation(s)
- Elizabeth O Shay
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Edouard Sayad
- Texas Children's Hospital, Department of Pediatric Pulmonology, Houston, Texas, U.S.A
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8
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Rendo M, Sjulin TJ, Morris MJ, Burguete S. Upper airway wheezing: Inducible laryngeal obstruction vs. excessive dynamic airway collapse. Respir Med Case Rep 2019; 27:100827. [PMID: 30989047 PMCID: PMC6446124 DOI: 10.1016/j.rmcr.2019.100827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/02/2022] Open
Abstract
There are multiple causes of dyspnea upon exertion in young, healthy patients to primarily include asthma and exercise-induced bronchospasm. Excessive dynamic airway collapse (EDAC) describes focal collapse of the trachea or main bronchi with maintained structural integrity of the cartilaginous rings. It is commonly associated with pulmonary disorders like bronchiectasis, chronic obstructive pulmonary disease and asthma. It is believed to result secondary to airway obstruction in these conditions. While uncommon in young, healthy adults, it has recently been found as a cause of dyspnea in this population. Inducible laryngeal obstruction (ILO) is an umbrella term that describes an induced, intermittent upper airway impediment. While ILO is found in 10% of young patients with exertional dyspnea, it is primarily inspiratory in nature due to paradoxical closure of the glottis or supraglottis. This report highlights the presentation of a United States Army soldier who after a deployment was given a diagnosis of asthma, later found to have ILO and was subsequently diagnosed with concurrent EDAC. We follow up with a literature review and discussion of symptomatology, diagnosis, exercise bronchoscopy, and treatment modalities for both EDAC and ILO.
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Affiliation(s)
- Matthew Rendo
- San Antonio Military Medical Center, Internal Medicine, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6160, USA
| | - Tyson J Sjulin
- San Antonio Military Medical Center, Pulmonary/Critical Care, USA
| | - Michael J Morris
- San Antonio Military Medical Center, Pulmonary/Critical Care, USA
| | - Sergio Burguete
- University of Texas Health Science Center at San Antonio, Pulmonary/Critical Care, USA
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9
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Kolnes LJ, Vollsæter M, Røksund OD, Stensrud T. Physiotherapy improves symptoms of exercise-induced laryngeal obstruction in young elite athletes: a case series. BMJ Open Sport Exerc Med 2019; 5:e000487. [PMID: 30740235 PMCID: PMC6347884 DOI: 10.1136/bmjsem-2018-000487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE A constricted, upper chest breathing pattern and postural dealignments habitually accompany exercise-induced laryngeal obstruction (EILO), but there are few effective treatments for athletes presenting with EILO. This case series was conducted to examine whether physiotherapy based on principles from the Norwegian psychomotor physiotherapy (NPMP) combined with elements of cognitive behavioural therapy can reduce laryngeal distress in athletes with EILO. METHODS Respiratory distress in four subjects was examined by interview prior to a physiotherapeutic body examination. Inappropriate laryngeal movements during exercise were measured by the continuous laryngoscopy exercise test, lung function was measured by flow-volume curves, and non-specific bronchial hyper-responsiveness was measured by a methacholine provocation test. History of asthma, allergy and respiratory symptoms was recorded in a modified AQUA2008 questionnaire. Parasympathetic activity was assessed by pupillometry. All data were gathered before and after 5 months of intervention. RESULTS Physiotherapy based on the principles from NPMP improved breathing problems in athletes with EILO. All athletes had less respiratory distress, improved lung function at rest and reduced inappropriate laryngeal movements during maximal exercise. CONCLUSION A diaphragmatic breathing pattern, a more balanced tension in respiratory muscles, and sound cervical alignment and stability may help to reduce adverse stress on the respiratory system and optimise the function of the larynx during high-intensity exercise. Our results suggest that understanding and management of EILO need to extend beyond structures located in the anterior neck and include factors influencing the whole respiratory system.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Department of Health and Care Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Kolnes LJ, Stensrud T. Exercise-induced laryngeal obstruction in athletes: Contributory factors and treatment implications. Physiother Theory Pract 2018; 35:1170-1181. [PMID: 29757061 DOI: 10.1080/09593985.2018.1474306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Otherwise healthy adolescent athletes presenting with respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO) are frequently encountered in clinical practice. The symptoms are often incorrectly considered to result from exercise-induced asthma, and may be wrongly treated as such. Given the potential implications for health and performance if EILO is left untreated, a more comprehensive understanding of contributory mechanisms is essential in order to create appropriate treatment procedures. Informed by knowledge from physical therapy, as well as the fields of voice rehabilitation and vocal pedagogy, this theoretical article presents a novel way of understanding and managing EILO by exploring bodily mechanisms and structures that may disturb laryngeal function during strenuous exercise. Firstly, the status quo of the EILO diagnosis, its aetiology and treatment options are reviewed. Secondly, considerations associated with laryngeal structures and mechanisms, and their potential influence on laryngeal movement and sensitivity are examined. Thirdly, the manner in which postural de-alignment and breathing pattern may interfere with laryngeal functioning will be discussed. Finally, interventions for voice disorders and singing and the relevance of these for EILO are evaluated. It is argued that clients with EILO should undergo a thorough physical examination to identify constrictions in the body as a whole - such as postural de-alignments and a dysfunctional breathing pattern - as these are hypothesized as playing a critical role in laryngeal tightness during exercise. Physical therapists possess particular skills and competence with regard to examining breathing patterns and postural de-alignments, and should be included in the treatment process of EILO.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of health, Norwegian Institute of Sports Medicine, Oslo, Norway
| | - Trine Stensrud
- Department of Sports medicine, The Norwegian School of Sport Sciences, Oslo, Norway
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11
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Exercise-Induced Laryngeal Obstruction and Performance Psychology. Immunol Allergy Clin North Am 2018; 38:303-315. [DOI: 10.1016/j.iac.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Pianosi PT, Orbelo DM, Cofer SA. Observational study of laryngoscopy plus flow-volume loops during exercise. Clin Case Rep 2018; 6:735-740. [PMID: 29636950 PMCID: PMC5889239 DOI: 10.1002/ccr3.1375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/10/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022] Open
Abstract
Laryngoscopy is the gold standard to diagnose exercise‐induced laryngeal obstruction, though inspiratory flow‐volume loop may provide a clue. We combined tidal flow‐volume loop analysis plus laryngoscopy during exercise and found that cigar‐shaped – not flattened – inspiratory loops are associated with obstruction. Pursed‐lip breathing slows inhalation thereby reducing vocal fold adduction.
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Affiliation(s)
- Paolo T Pianosi
- Department of Pediatric & Adolescent Medicine Mayo Clinic 200 First St. SW Rochester Minnesota 55905
| | - Diana M Orbelo
- Department of Otorhinolaryngology Mayo Clinic 200 First St. SW Rochester Minnesota 55905
| | - Shelagh A Cofer
- Department of Otorhinolaryngology Mayo Clinic 200 First St. SW Rochester Minnesota 55905
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Olin JT, Hull JH. Exercise and the Total Airway: A Call to Action. Immunol Allergy Clin North Am 2018; 38:xv-xix. [PMID: 29631744 DOI: 10.1016/j.iac.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Tod Olin
- Pediatric Exercise Tolerance Center, Department of Pediatrics, Division of Pediatric Pulmonology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - James H Hull
- Royal Brompton Hospital, Imperial College, Department of Respiratory Medicine, Royal Brompton Hospital, Fulham Road, London SW3 6HP, UK.
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Olin JT, Clary MS, Fan EM, Johnston KL, State CM, Strand M, Christopher KL. Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery. Eur Respir J 2016; 48:1192-1200. [DOI: 10.1183/13993003.00160-2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/01/2016] [Indexed: 11/05/2022]
Abstract
Exercise-induced laryngeal obstruction (E-ILO) causes exertional dyspnoea. There is no standardised methodology which characterises laryngeal obstruction in relation to exercise or links laryngeal obstruction and dyspnoea severity. Continuous laryngoscopy during exercise (CLE) may improve diagnostic sensitivity by enabling laryngeal visualisation at peak work capacity in patients with rapidly resolving obstruction. The time course of laryngeal obstruction across exercise and recovery has not been quantitated until this report.Adolescents and young adults referred for CLE were laryngoscopically monitored across rest, maximal cycle ergometry exercise, and recovery. Three reviewers, blinded to time sequencing, rated inspiratory glottic and supraglottic obstruction during 10 windows of 15-s corresponding to rest, 25%, 50%, 75%, 90% and 100% of individual symptom-limited peak work capacity (expressed in Watts), and four consecutive recovery windows.85 patients were screened and 71 included. Over 96% of time windows were interpretable. Laryngeal obstruction severity reached observed maximal levels at peak work capacity, and rapidly resolved. A spectrum of observed maximal obstruction was measured.CLE provides interpretable data demonstrating laryngeal obstruction in patients with suspected E-ILO that is more severe at peak work capacity than during rest, submaximal exercise, or recovery. Observed maximal obstruction was infrequently severe and rapidly resolved.
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Mehlum CS, Walsted ES, Godballe C, Backer V. Supraglottoplasty as treatment of exercise induced laryngeal obstruction (EILO). Eur Arch Otorhinolaryngol 2015; 273:945-51. [DOI: 10.1007/s00405-015-3823-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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