Using Exercise Stress Laryngoscopy in the Pediatric Patient with Exercise Intolerance

Abstract

Objectives: Exercise induced airway obstruction in the pediatric patient is a unique phenomenon with multiple potential etiologies. Because patients are frequently asymptomatic at rest, establishing an accurate diagnosis can be challenging. Exercise Stress Laryngoscopy (ESL) presents a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms. The purpose of this study is to demonstrate the diagnostic utility of pediatric ESL and to guide the treatment of patients with exercise intolerance. Methods: All patients undergoing ESL for exercise intolerance and airway symptoms at a tertiary care children’s hospital were reviewed. Data extracted included patient demographics, exam indications, exam findings, and management recommendations. Results: A total of 37 patients, average age 11.8 years (range 5-19), were included. There were 14 male and 37 female patients. A specific airway abnormality became evident upon exertion in 56% of patients undergoing ESL. Of these, 24% had focal supraglottic collapse, 43% had paradoxical vocal fold motion, 24% had combined dysfunction, and 9% had distal airway abnormalities. A focal airway abnormality resulting in a change in management occurred in 71% of patients. 57% of patients in this review had a history of laryngotracheoplasty with equivocal findings on operative bronchoscopy. Of these patients, 83% received a focal diagnosis following ESL that resulted in treatment. Conclusions: Determining the etiology of exercise intolerance is often a challenge in the pediatric patient. ESL is a contemporary modality by which complex patients with undiagnosed airway symptoms can be effectively evaluated, frequently leading to effective treatment.