Supraglottoplasty in patients with Exercise induced laryngeal obstruction (EILO)

Abstract

Introduction: Exercise Induced Inspiratory Symptoms (EIIS) are often confused with symptoms of exercise induced asthma. EIIS is related to laryngeal obstruction in most patients, and was previously attributed to inappropriate adduction of the vocal cords, hence the old label VCD. However, exercise induced laryngeal obstruction (EILO) primarily involves supraglottic structures in a majority of patients with EIIS. Therefore, surgical treatment (supraglottoplasty) has been performed in highly selected and motivated patients with pronounced symptoms and severe supraglottic collapse. Aim: To investigate efficiency and safety of laser supraglottoplasty as treatment for severe supraglottic EILO by retrospective chart reviews. Method: During 2010-2015, 43 patients mean age 16.9 (range 12-25) underwent laser supraglottoplasty due to a severe supraglottic EILO verified using continuous laryngoscopy during exercise (CLE-test). The surgical procedure was performed in general anaesthesia by one of three surgeons, and outcome was evaluated by questionnaire based self-reported symptoms and a CLE test performed before and after the operation. Preliminary Results: Postoperatively, 39/43 patients reported improvements of symptoms, 41/43 had a lower CLE-score, all but 3 had improvement at the supraglottic level, and 21/43 had normal laryngeal inlet at maximum exercise (i.e. a CLE-score of 0 or 1). Complications were experienced by 2/43. Conclusion: Supraglottoplasty improve symptoms in patients with supraglottic EILO, and appears as a safe and efficient treatment in highly selected severe cases.