Postoperative Complications After Surgical Treatment For Exercised Induced Laryngeal Obstruction

Abstract

PURPOSE: Exercised induced laryngeal obstruction (EILO) is a situation in which an apparently normal larynx instead of opening fully during exercise adducts, and thus represents an obstruction to free airflow. In principle, EILO can be primarily glottic or supraglottic. Surgery has been suggested as treatment for highly motivated patients suffering from severe forms of the latter. We would like to report on complications after surgical treatment for supraglottic EILO. METHODS: During 2010-2015, 66 patients underwent laser supraglottoplasty due to a primary severe supraglottic EILO verified using continuous laryngoscopy during exercise. The surgical procedure was performed in general anaesthesia by one of three surgeons. Care was taken to avoid patients with glottic EILO or other upper airway malformations. RESULTS: Of 66 patients operated at mean age 15.8 (range 5-26) years, 43 (65%) were females, three (4.5 %) required two surgical procedures, and 63 (95 %) met for a postoperative follow-up exercise laryngoscopy (mean interval 5.8 months). Complications were reported for two patients: (A) Male, 15 years at surgery, diagnosed with postoperative left recurrent laryngeal nerve palsy. Injury caused by intubation or a direct complication from surgery were possible explanations. A mediastinal mass discovered on chest x-ray and a concomitant Epstein-Barr infection, prompted comprehensive work-up; however, with no conclusive findings. At a second follow-up 1.5 year later, the patient had nearly fully recovered and had no problems performing daily activities. (B) Male, 13 years at surgery, diagnosed with postoperative extensive scarring needing a re-operation. Fifteen months after the last surgery, he still had breathing problems during heavy exercise, but reported no problems performing daily activities. Exercise laryngoscopy performed at that time indicated better laryngeal opening when compared to the findings before the first surgery, despite the postoperative scarring. CONCLUSIONS: Complications were experienced by 2/66 (3%) highly motivated patients operated with supraglottoplasty for severe supraglottic EILO. At follow-up approximately 1.5 years after last surgery, none had symptoms influencing their daily activities.