Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Exercise-induced laryngeal obstruction: Prevalence, laryngeal findings and evaluation of treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Exercise-induced laryngeal obstruction (EILO) is one of many different causes for adolescents to experience dyspnoea during exercise. Objective exercise-testing with continuous video laryngoscopy is crucial for a correct diagnosis since it is difficult to differentiate EILO from other exercise related conditions in the airways only on the symptomatology. The main symptom in EILO is inspiratory stridor arising from an obstruction at the laryngeal level during ongoing exercise which quickly resolves after the exercise has stopped. EILO is often misdiagnosed as exercise-induced bronchoconstriction (EIB), which is obstruction in the peripheral airways that typically arises after cessation of exercise.

From a previous survey investigating self-reported exercise-induced dyspnoea in all 12-13-year-old adolescents in Uppsala (n=3,838, response rate 60.2%) a subset of 150 randomly selected adolescents (103 with dyspnoea and 47 controls) performed standardized treadmill exercise-tests for EIB and EILO.

During the exercise-test for EIB the subjects breathed dry air according to the current recommended guidelines. EIB was defined as a decrease in FEV1 ≥10% from baseline. EILO was diagnosed during a continuous laryngoscopy exercise (CLE) test by use of the CLE-score method and was defined as an obstruction of grade 2 at either glottic or/and supraglottic laryngeal level. The estimated prevalence of EIB in the general population was 19.2% and the estimated prevalence of EILO was 5.7%. No gender differences were detected.

A diagnostic software program for EILO, EILOMEA, was compared with the CLE-score and the methods were found to be compatible. EILOMEA was used to map and compare laryngeal response patterns in adolescents with exercise-induced dyspnoea (EIB and/or EILO), in adolescents with dyspnoea but without a diagnosis of EIB or EILO, and in healthy controls, all of whom had performed the CLE-test. No differences were seen between the healthy controls and the adolescents with dyspnoea without a diagnosis. Only adolescents diagnosed with EILO showed a significant different laryngeal response pattern which strongly suggests that the diagnostic procedure is reliable.

In a follow-up study of patients referred for investigation of exercise-induced dyspnoea, we investigated the outcome of surgical vs. conservative treatment of EILO-positive subjects and subjects tested negative for the diagnosis, regarding the level of exercise-induced dyspnoea and physical activity. Surgically treated patients had less breathing problems and were more physically active than both conservatively treated patients and patients who were tested negative.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 61
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1300
Keywords [en]
Exercise, laryngeal obstruction, bronchoconstriction, CLE-score, EILOMEA
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:uu:diva-315123ISBN: 978-91-554-9819-1 (print)OAI: oai:DiVA.org:uu-315123DiVA, id: diva2:1072874
Public defence
2017-03-31, Skoogsalen, Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-03-08 Created: 2017-02-09 Last updated: 2017-03-13
List of papers
1. Comparison between two assessment methods for exercise-induced laryngeal obstructions
Open this publication in new window or tab >>Comparison between two assessment methods for exercise-induced laryngeal obstructions
Show others...
2016 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, no 2, p. 425-430Article in journal (Refereed) Published
Abstract [en]

Exercise-induced laryngeal obstructions (E-ILOs) are important differential diagnoses to exercise-induced asthma and are diagnosed by the continuous laryngoscopy exercise (CLE) test. There are two different methods for evaluating the severity of E-ILOs using recordings from the CLE test; the CLE score and EILOMEA. The aim of this study was to investigate the consistency between these methods. Using their respective method, the developers of each method evaluated 60 laryngoscopic recordings from patients with different subtypes and various levels of severity of E-ILOs. The CLE score evaluates glottic and supraglottic obstructions on a 4-grade scale. EILOMEA uses software to calculate the obstruction severity on continuous scales from a still frame of the larynx during maximal obstruction giving three parameters reflecting glottic and supraglottic obstruction. The means of the EILOMEA measures differed significantly for CLE score 1 vs. 2 and 2 vs. 3, but not for 0 vs. 1 for glottic as well as supraglottic obstructions. The EILOMEA method does not distinguish between CLE score 0 and 1, but otherwise the methods correlate. Since previous studies have suggested that only CLE scores of 2 and 3 reflect a severity of E-ILOs of clinical importance, this lack of the EILOMEA method is not crucial for a correct medical evaluation.

Keywords
E-ILO; Continuous laryngoscopy exercise test; CLE score; EILOMEA; Exercise-induced respiratory difficulties
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-266447 (URN)10.1007/s00405-015-3758-7 (DOI)000368990700022 ()26351037 (PubMedID)
External cooperation:
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
2. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
Open this publication in new window or tab >>Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
Show others...
2015 (English)In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 70, no 1, p. 57-63Article in journal (Refereed) Published
Abstract [en]

Background Exercise-induced respiratory symptoms are common among adolescents. Exercise is a known stimulus for transient narrowing of the airways, such as exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO). Our aim was to investigate the prevalence of EIB and EILO in a general population of adolescents. Methods In this cross-sectional study, a questionnaire on exercise-induced dyspnoea was sent to all adolescents born in 1997 and 1998 in Uppsala, Sweden (n=3838). A random subsample of 146 adolescents (99 with self-reported exercise-induced dyspnoea and 47 without this condition) underwent standardised treadmill exercise tests for EIB and EILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease of >= 10% in FEV1 from baseline. EILO was investigated using continuous laryngoscopy during exercise. Results The estimated prevalence of EIB and EILO in the total population was 19.2% and 5.7%, respectively. No gender differences were found. In adolescents with exercise-induced dyspnoea, 39.8% had EIB, 6% had EILO and 4.8% had both conditions. In this group, significantly more boys than girls had neither EIB nor EILO (64.7% vs 38.8%; p=0.026). There were no significant differences in body mass index, lung function, diagnosed asthma or medication between the participants with exercise-induced dyspnoea who had or did not have a positive EIB or EILO test result. Conclusions Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents. EILO is equally common among girls and boys and can coexist with EIB.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-241953 (URN)10.1136/thoraxjnl-2014-205738 (DOI)000346338300012 ()
Note

Henrik Johansson and Katarina Norlander have shared first authorship on this paper.

Available from: 2015-01-20 Created: 2015-01-19 Last updated: 2017-12-05Bibliographically approved
3. Laryngeal findings during exercise in healthy and dyspneic adolescents
Open this publication in new window or tab >>Laryngeal findings during exercise in healthy and dyspneic adolescents
(English)Manuscript (preprint) (Other academic)
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-315122 (URN)
Available from: 2017-02-09 Created: 2017-02-09 Last updated: 2017-02-09
4. Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction: A follow-up study
Open this publication in new window or tab >>Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction: A follow-up study
Show others...
2015 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 11, p. 1152-1159Article in journal (Refereed) Published
Abstract [en]

Conclusions: Surgery is an effective treatment in severe cases of supraglottic exercise-induced laryngeal obstruction (E-ILO). Conservatively treated subjects and subjects tested negative for E-ILO, who still experience breathing problems 1–3 years after diagnosis, tend to adjust their physical activity to a greater extent than surgically treated subjects. Objective: To investigate how symptoms and level of physical activity change over time in patients with E-ILO who have undergone surgery, patients with E-ILO treated conservatively and patients who tested negative for laryngeal obstruction at continuous laryngoscopy exercise-test (CLE-test). Methods: Patients referred for exercise-induced breathing difficulties answered questionnaires at diagnostic CLE-test and at follow-up. Questions regarded exercise-induced breathing problems, current physical activity level, and medical history of asthma and perennial allergy. Results: Out of 84 invited subjects, 59 (70%) answered both questionnaires. Surgically treated subjects had less breathing problems at follow-up compared with conservatively treated subjects and subjects who tested negative (p < 0.001). None of the surgically treated subjects were less physically active or had changed sport due to exercise-induced dyspnoea, whereas 41.7% of the conservatively treated subjects had made such adjustments (p < 0.001).

Keywords
Laryngoplasty; exercice-induced dyspnoea; vocal cord dysfunction; physical activity; E-ILO
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-264379 (URN)10.3109/00016489.2015.1062548 (DOI)000369936800010 ()26200564 (PubMedID)
Available from: 2015-10-10 Created: 2015-10-10 Last updated: 2017-12-01Bibliographically approved

Open Access in DiVA

fulltext(1264 kB)303 downloads
File information
File name FULLTEXT01.pdfFile size 1264 kBChecksum SHA-512
fa048853dd0501da1a3e66a62c3e6421aa11efda998346d0f6592adefc7b953b4e09d7d7c0dbc6f5ab6a7f9bb5898defb46a3470ecb5da9b120331aeef07e8ce
Type fulltextMimetype application/pdf
Buy this publication >>

Search in DiVA

By author/editor
Norlander, Katarina
By organisation
Otolaryngology and Head and Neck Surgery
Otorhinolaryngology

Search outside of DiVA

GoogleGoogle Scholar
Total: 303 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1111 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf