Abstract
Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature provides an overview of the current understanding of the definition, epidemiology, diagnosis and management of EILO. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines the Cochrane, Embase, Ovid MEDLINE and PubMed databases were searched. Four search domains “exercise”, “induced”, “laryngeal” and “obstruction” were used. Primary searching found 469 records, 308 were excluded following screening of titles and citation. 100 were duplicates, a further 47 studies were excluded after applying inclusion and exclusion criteria. Two studies were identified following cross-referencing. A total of 15 studies were included. The last search date was 6/06/15. Average prevalence in the general adolescent population and athletes was 7.1 and 35.2 %, respectively. Dyspnoea was reported in 96.5, 99 and 100 % of three EILO patient cohorts. Two studies (n = 107) reported continuous laryngoscopy during exercise (CLE) testing could differentiate between patients and controls. In two studies (n = 33) the visual analogue scale (VAS) showed a beneficial effect of endoscopic supraglottoplasty (ES). Thirty-eight out of 43 patients who received two or more laryngeal control therapy sessions (LCT) had improvement or resolution of EILO symptoms. Exercise induced dyspnoea is the most common EILO symptom. EILO has a high occurrence in adolescents and athletes. The CLE test is the current gold standard for EILO diagnostics. Management of EILO includes both surgical and non-surgical interventions.
Highlights
Laryngeal lumen size is dependent on its cartilaginous skeleton, neuromuscular control of the vocal cords and aryepiglottic folds [1]
Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise
The varied underlying causes has led to numerous terms, namely exercise induced vocal cord dysfunction (EI-VCD), exercise-induced laryngomalacia (EIL), exercise induced vocal cord dysfunction (EIVCD) and exercise induced paradoxical vocal fold motion (EIPVFM), being used to describe the condition [4,5,6]
Summary
Laryngeal lumen size is dependent on its cartilaginous skeleton, neuromuscular control of the vocal cords and aryepiglottic folds [1]. EILO exercise induced laryngeal obstruction, EIVCD exercise induced vocal cord dysfunction, EIPVFM exercise induced paradoxical vocal fold motion One of these studies identified a female/male odds ratio of 3.41 in EILO and this was in an older population (14–24) allowing most of the male subjects to have an adult size larynx (by the age of 16–17) [7]. Despite the literature suggesting the usefulness of CLE in diagnosing EILO, one should be aware that performance through the test, together with subjective perception of distress is likely to be affected by features such as skills, attitude, expectations, and personal goals Regarding this point, it has been observed that young athletes who continued running regardless of harsh symptoms of distress, whilst different subjects stopped sooner with comparatively minor symptoms [11]. More studies are needed to clarify complex interactions between somatic and psychological factors, physical capacity, and motivation and how they may influence the test score [11]
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