Nonsurgical Management Research Articles

Non-Surgical Endodontic Management of Large Periapical Lesions After Traumatic Dental Injuries.

Traumatic dental injuries of permanent teeth result in multiple immediate and long-term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three-dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non-surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation-free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non-surgical endodontic management of large periapical lesions secondary to traumatic dental injuries.

Controversies in the Management of Type II Odontoid Fractures.

The management of type II odontoid fractures in the elderly is controversial, as these patients often have numerous medical comorbidities that increase the risks of surgery, but they may also fail to achieve fracture healing with nonsurgical management. Recent changes in technology and surgeon attitudes may influence the preferred approach to both surgical and nonsurgical treatments for many clinicians. While bony fracture healing remains the goal of management, a stable fibrous union is increasingly considered a satisfactory outcome. The optimal surgical approach remains debated, with some authors raising concerns about the risk of swallowing dysfunction being particularly problematic with odontoid screw placement in the elderly. The use of BMP-2 applied either anteriorly into the fracture site or posteriorly in the interlaminar space and placement of temporary posterior fixation to be removed upon demonstration of anterior bony healing are novel surgical techniques that are presently the subject of investigation. A clearer understanding of the currently available treatment options and the associated controversies may improve clinician decision-making and potentially better patient outcomes in the management of type II odontoid fractures for the growing geriatric population.

Bacterial etiology, antibiotic susceptibility pattern, and treatment modality of surgical site infections among post-caesarean delivery women: A 2019 cross-sectional study conducted in Iringa, Tanzania

Background: Surgical site infection (SSI) is a common complication after cesarean section in Tanzania, with high rates of infection and multidrug-resistant isolates reported. Understanding bacterial etiology and antibiotic susceptibility patterns is crucial for effective treatment and prevention. Therefore, this study aimed to determine the bacterial etiology, antibiotic susceptibility patterns, and treatment modalities of SSI among post-cesarean delivery women in the Iringa region. Methods: A cross-sectional study involving 162 women with SSI was conducted across five hospitals in Iringa. Data on demographics were collected using a structured questionnaire, and wound discharge samples were taken for culture and sensitivity testing. Definitive treatment modalities were identified from patients’ files. Data analysis was performed using SPSS version 20, with chi-square tests used to identify associations, and a p-value < 0.05 considered significant. Results: Among 162 participants, 59.7% had superficial SSIs and 35.2% had deep SSIs. Culture positivity was 96.3%, with 53.2% being gram-positive and 37.2% gram-negative. Staphylococcus aureus was the most commonly isolated pathogen (40.1%), with 64.6% of cases being methicillin-resistant (MRSA). Resistance to vancomycin and chloramphenicol among gram-positive isolates was 3.1% and 13.8%, respectively. Non-surgical management was provided to 58% of the participants, while Staphylococcus aureus infections were significantly associated with surgical intervention (OR = 1.38, p = 0.001). Conclusion: Staphylococcus aureus, particularly MRSA, was the most prevalent pathogen in post-cesarean SSIs. Antibiotic resistance was common, and surgical intervention was significantly associated with Staphylococcus aureus infections.

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis.

To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA). Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries. This review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes. KOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.

Enhancing Acromioclavicular Rehabilitation and Functional Capacity With Blood Flow Restriction Training: A Case Report

BACKGROUND: Type V Acromioclavicular joint (ACJ) separations often require surgical stabilization to restore functional capacity of the shoulder. However, the purpose of this case study is to demonstrate non-surgical management of this condition. CASE PRESENTATION: A 32-year-old female with a radiographic Type V ACJ separation underwent non-surgical management. This case used a novel criteria-based protocol which utilized 6 weeks of upper extremity blood flow restriction (BFR) to restore the functional capacity of a radiographic type V ACJ separation. OUTCOME AND FOLLOW UP: Following non-surgical management, there was a 2.47 fold increase in external rotation strength, 97% limb symmetry on upper quarter Y-Balance, a score of 91 on American Shoulder and Elbow Surgeons assessment, and 9 mm radiographic reduction of the coracoclavicular interval. DISCUSSION: The case illustrates how clinical findings did match the radiographical findings, but the non-surgical treatment using upper extremity BFR provided a desired functional outcome.

A Systematic Review of the Long-Term Outcomes of Surgical Versus Non-surgical Management for Types A3 and A4 Thoracolumbar Spinal Fractures With No Neurological Deficits

A Systematic Review of the Long-Term Outcomes of Surgical Versus Non-surgical Management for Types A3 and A4 Thoracolumbar Spinal Fractures With No Neurological Deficits

Outcomes of bariatric surgery in obese patients with heart failure:a meta-analysis

Abstract Background Patients with heart failure possess an increased risk for adverse outcomes with noncardiac surgery (1). While bariatric surgery is frequently performed in patients with obesity, there remains a limited understanding of the impact of bariatric surgery in obese patients with heart failure. Purpose The purpose of this study was to compare outcomes of bariatric surgery versus nonsurgical management in obese patients with heart failure. Methods We searched PubMed, EMBASE, and the Cochrane Library, through February 2024, for studies evaluating outcomes in obese patients with heart failure who underwent bariatric surgery compared to nonsurgical management. Outcomes assessed were postoperative atrial fibrillation, all-cause mortality, and hospital readmission. We used a fixed-effect model to calculate hazard ratios (HR) with 95% confidence intervals (CI) in R studio for outcomes assessed. In outcomes where significant heterogeneity was found (P< 0.05 and I2 > 60%), a random effects model was used. Results A total of 3 studies were identified, consisting of 260,186 patients. Compared to nonsurgical management, bariatric surgery was associated with a significant reduction in postoperative atrial fibrillation (HR 0.72; 95% CI: 0.62-0.84), all-cause mortality (HR 0.50; 95%CI 0.35-0.72), and hospital readmission (HR 0.73; 95% CI 0.69-0.78) in obese patients with heart failure. Conclusion Our study suggests that bariatric surgery significantly reduces post-operative atrial fibrillation, mortality, and hospital readmission among obese patients with heart failure.Our findings demonstrate that bariatric surgery should be considered as a viable intervention in obese patients with heart failure. Further studies are warranted to confirm our findings.Forest Plots of Outcomes Assessed

Non-surgical Endodontic Management of a Permanent Maxillary Canine With Vertucci Type 3 Canal Configuration: A Case Report

Non-surgical Endodontic Management of a Permanent Maxillary Canine With Vertucci Type 3 Canal Configuration: A Case Report

Non-surgical management of methicillin-sensitive Staphylococcus aureus bacteremia-related mediastinitis

Background: Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus. Case presentation: In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess. Conclusion: We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach.

Distal solution for an (un)conventional radial artery complication: a Case Report

Abstract Background The European Society of Cardiology (ESC) guidelines recommend transradial access (TRA) for coronary angiography due to its advantages, including lower mortality and bleeding complications. Arterial pseudoaneurysms are rare but challenging complications of TRA, occurring in 0.009%-0.05% of procedures. Non-surgical management, especially in cases with large (>1 mm) necks or late discovery, can be difficult due to the limited effectiveness of echo-guided compression and risks of echo-guided thrombin injection, like thrombin embolization leading to necrosis. Case Summary An 82-year-old underwent successful non-surgical management of a large-neck pseudoaneurysm following TRA for a primary percutaneous coronary intervention (PCI) of the left anterior descending (LAD) artery. Clinical examination revealed a pulsatile mass at the puncture site, diagnosed via ultrasound as a pseudoaneurysm with a >1 mm neck. Through distal radial access (DRA), an initial 5Fr sheath was upsized to 8Fr based on ultrasound findings, achieving complete pseudoaneurysm exclusion. Follow-ups confirmed pseudoaneurysm sealing and radial artery patency. Discussion This case illustrates an effective non-surgical approach to managing large-neck pseudoaneurysms post-TRA, utilizing an upsized sheath technique. It underscores the importance of innovative non-surgical strategies in complex cases, providing a safe and effective alternative to traditional management methods.

Feculent Drainage from Percutaneous Endoscopic Gastrostomy Tube due to Gastrocolocutaneous Fistula Found in Emergency Department: A Case Report

Introduction Percutaneous endoscopic gastrostomy (PEG) placement is a common procedure for patients requiring non-oral feeding. One rare complication of PEG placement is the formation of a gastrocolocutaneous fistula that develops when bowel is caught between the stomach and abdominal wall during placement. This report explores an elderly patient's gastrocolocutaneous fistula development months post-PEG placement who presented with malodorous leakage from the gastrostomy tube to the Emergency Department (ED). Case Report A 73-year-old male on hospice presented to the ED with malodorous leakage from his PEG tube. He had received the PEG tube four months prior to this presentation and had it replaced once at an outside hospital due to blockages. In the ED, his PEG tube was found to have a deflated balloon stopper. The PEG tube was replaced, but the feculent discharge persisted. Imaging showed the tube's position in the transverse colon. The patient underwent non-surgical management, with PEG tube removal and nutritional support via nasogastric tube. He was discharged with improvement of PEG site. Conclusion Gastrocolocutaneous fistula should be considered in patients experiencing unexpected PEG tube drainage or feeding-related complications such as diarrhea. Careful replacement techniques after dislodgement or blockage are important. Radiologic confirmation should be considered after replacement of tubes with feculent drainage. The rarity of gastrocolocutaneous fistula cases in literature explains the lack of standardized management approaches. Clinical signs such as feculent leakage through PEG tube site should prompt recognition and diagnosis by the ED clinician.

Chinese Expert Consensus on the Whole-Course Management of Hepatocellular Carcinoma (2023 Edition)

Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Most HCC patients have the complication of chronic liver disease and need overall consideration and whole-course management, including diagnosis, treatment and follow-up. To develop a reasonable, long-term, and complete management plan, multiple factors need to be considered, including the patient's general condition, basic liver diseases, tumor stage, tumor biological characteristics, treatment requirements and economic cost. Summary: To better guide the whole-course management of HCC patients, the Chinese Association of Liver Cancer and the Chinese Medical Doctor Association has gathered multidisciplinary experts and scholars in relevant fields to formulate the “Chinese Expert Consensus on The Whole-Course Management of Hepatocellular Carcinoma (2023).” Key Messages: This expert consensus, based on the current clinical evidence and experience, proposes surgical and nonsurgical HCC management pathways and involves 18 recommendations, including perioperative treatment, systematic treatment combined with local treatment, conversion treatment, special population management, symptomatic support treatment, and follow-up management.

Non-Surgical Management and Partial Recovery of a 19-Year-Old with Low-Speed Transorbital Penetrating Brain Injury

Non-Surgical Management and Partial Recovery of a 19-Year-Old with Low-Speed Transorbital Penetrating Brain Injury

Splenic Trauma: Concepts and Technique for Interventional Management

AbstractThe spleen is the most commonly involved organ in abdominal trauma, especially in blunt mode of injury. High vascularity and a thin capsule predispose to rapid and fatal bleeding, which could be acute as well as delayed at onset. FAST is usually the first line of investigation required to see for fluid and screen patients suffering abdominal trauma. Triple-phase contrast-enhanced computed tomography of the abdomen further aids in diagnosing and grading splenic trauma as per the American Association for the Surgery of Trauma (AAST) guidelines. Hemodynamic stability and AAST grade are the main guiding parameters for management. Treatment options include surgical and nonsurgical (endovascular intervention) management. The recent concept of endovascular resuscitation and trauma management, which dwells on creating a hybrid suite, is coming up fast and will play a pivotal role in offering splenic preserving management in trauma cases. In this review article, authors have bought insights about managing splenic trauma as a multidisciplinary concept to achieve splenic preservation and maintain this vital organ's immunological functions.

The HYsteroscopic Miscarriage MaNagement (HYMMN) pilot randomized-controlled trial

ObjectiveTo evaluate the feasibility of performing a full-scale, adequately powered, multi-center randomized controlled trial (RCT) assessing the effectiveness of office hysteroscopy (OH) for the treatment of retained pregnancy tissue (RPT) after miscarriage, compared with standard treatment (ST) (expectant/medical/surgical), on future pregnancy outcome. Study designSingle-center pilot RCT performed at Birmingham Women’s Hospital, UK. Patients opting for non-surgical miscarriage management at ≤14 weeks gestation who wanted to conceive as soon as possible were recruited and offered a transvaginal ultrasound scan (TVUS) eight weeks later to check for the presence of RPT. Patients with RPT were randomized in a 1:1 ratio using a computer-generated online random allocation sequence to either OH (performed using the TruClear 5.0 hysteroscopic tissue retrieval system) or ST (the type of which was recommended based on symptoms, urinary pregnancy test and scan findings). Results158 participants were approached for inclusion into the trial, of which 149 (94.3%) agreed. Of the 126 that underwent TVUS, RPT were diagnosed in 42 patients (33.3%). 21 patients were randomized to OH, of whom 18 underwent the procedure because three fell pregnant after their TVUS. OH was deemed acceptable to all patients without any serious complications. 21 patients were randomized to ST where 16 patients (76%) were recommended expectant management and five (24%) were recommended surgical management. 115 patients (91%) were able to provide pregnancy data, however, the study was not powered to show a clinically significant difference. ConclusionA full-scale, adequately powered, randomized clinical trial investigating OH against ST for the treatment of RPT following miscarriage is clinically relevant and feasible owing to high rates of participation, acceptability and satisfaction and low rates of attrition associated with the proposed interventions.

Acute Achilles Tendon Ruptures: An Update on Current Management Strategies

Acute rupture of the Achilles tendon is a frequently encountered injury that occurs most commonly in people who participate in recreational athletics into their thirties and forties. For many years, the injury has been treated either nonsurgically or surgically using a standard open approach. More recently, a variety of new surgical techniques have emerged in the literature aiming to improve surgical outcomes while decreasing the potential complications associated with standard open repair. Nonsurgical treatment plans using early weight bearing and accelerated functional rehabilitation have also proven to be excellent management options. Achilles rupture treatment plans can include the use of orthobiologics, such as platelet-rich plasma, with mixed results. Accelerated functional rehabilitation protocols have shown to improve patient outcomes, whether used in conjunction with surgery or nonsurgical management modalities, and reduce the disparity between the injured tendon and the native Achilles.

Assessment of Knowledge and Practices Related to Non-Surgical Management of Osteoarthritis Among Patients in the Rural Community of Sri Ganganagar, Rajasthan.

Introduction: Osteoarthritis (OA) is a degenerative joint disease that represents a major public health challenge, especially in rural communities where access to advanced healthcare is limited. This study aims to assess the knowledge, attitudes, and practices (KAP) related to the non-surgical management of osteoarthritis among patients in the rural district of Sri Ganganagar, Rajasthan, India. Method: A cross-sectional descriptive study was conducted among 234 adult OA patients aged 45 and above, residing in selected rural areas of Sri Ganganagar. Participants were recruited using convenience sampling from local health centers and community clinics. The data were analyzed using descriptive statistics, Chi-square tests, and correlation analyses to explore associations between demographic variables and KAP levels. Results: The study revealed that 29.9% of participants had adequate knowledge about OA, while 18.8% had inadequate knowledge. Regarding practices, 21.4% of participants demonstrated good practices in managing their OA symptoms, whereas 20.9% exhibited poor practices. Significant associations were found between age and education level with both knowledge and practice levels (p < 0.05). A moderate positive correlation was observed between age and knowledge score (r = 0.45, p = 0.002), and a strong positive correlation was found between knowledge and practice scores (ρ = 0.60, p < 0.001). Conclusion: The findings underscore the need for targeted health education programs in rural communities like Sri Ganganagar to bridge knowledge gaps and improve adherence to non-surgical OA management practices. Enhancing patient education and integrating healthcare providers in the patient education process could significantly improve OA management and patient outcomes in rural settings.

Surgical treatment of invasive pulmonary fungal infections in immunocompromised pediatric patients: Aspergillus spp. and other emerging fungi.

Invasive Pulmonary Fungal Infections (IPFIs) represent a diagnostic and therapeutic challenge. The exact role of surgery is not well defined. This study analyzes our experience with surgical treatment of IPFI in immunocompromised pediatric patients and, secondarily, compares IPFI caused by Aspergillus spp. with other fungal infections. This is a retrospective review (2000-2019) of patients with IPFI surgically treated at our pediatric institution. Statistical analysis was used to compare data between Aspergillus spp. and non-Aspergillus IPFI. Twenty-five patients (64% female) underwent 29 lung resections. Median age at surgery was 7.19years (1.63-19.14). The most frequent underlying condition (64%) was acute leukemia. Surgical indications included persistence or worsening of symptoms and pathological image findings (52%) or asymptomatic suspicious lesions in patients scheduled for intensive cytotoxic treatments or hematopoietic stem cell transplantation (48%). All patients underwent atypical lung resections, except one lobectomy. Aspergillus spp. was the most frequently isolated pathogen (68%). Follow-up was 4.07years (0.07-18.07). Surgery-related mortality was 0%, but 4 patients died in the 100days following surgery (2 due to disseminated fungal infection); the remaining 21 did not show signs of IPFI recurrence. Non-specific consolidations on CT scan were more frequent in non-Aspergillus IPFI (p < 0.05). Surgical treatment of IPFI should be considered as a part of the treatment in selected pediatric immunocompromised patients, and it may have both diagnostic and therapeutic advantages over non-surgical management. When there is clinical suspicion of IPFI but CT scan shows unspecific alterations, the possibility of a non-Aspergillus IPFI should be considered.

5124 Increased Copeptin May Reflect Vasopressin-Related Metabolic Changes After Bariatric Surgery

Abstract Disclosure: F. Galbiati: None. A. Aulinas Maso: None. I. Becetti: None. M. Lauze: None. V. Singhal: None. E.A. Lawson: Research Investigator; Self; received research funding and study drug from Tonix Pharmaceuticals. M. Bredella: None. M. Bredella: None. M. Misra: Advisory Board Member; Self; key opinion leader for Lumos Pharma. Consulting Fee; Self; Up To Date, Receives royalties. Objective: Vasopressin (AVP) is a neurohormone that decreases fat mass, promotes muscle regeneration, improves glucose homeostasis, and protects against hypoglycemia in animals and humans. Copeptin, a stable cleavage product of AVP, is positively associated with body mass index (BMI), insulin resistance, and metabolic syndrome in adults, suggesting an adaptive increase in AVP to counteract metabolic disruption. Similarly, copeptin was positively correlated with BMI in children. Metabolic and bariatric surgery (MBS) is highly effective at reducing metabolic complications of obesity, and underlying mechanisms may provide insights into novel therapeutics for obesity management. No study has investigated copeptin pre- and post-MBS in humans. We hypothesized that after MBS, (1) copeptin would increase and (2) increased copeptin would be associated with improved metabolic parameters. Methods: Longitudinal study in 64 adolescents and young adults (78% females; age [mean±SD] 18.7±2.8 years) with obesity (BMI 45.6±6.8 kg/m2). 34 underwent MBS (sleeve gastrectomy or Roux-en-Y gastric bypass) and 30 underwent non-surgical (NS) lifestyle management. We measured fasting circulating copeptin, %fat, and lean mass by dual-energy X-ray absorptiometry, hemoglobin A1c (HbA1c), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) at baseline and 12 months. Results: Groups were similar for age, sex, race, and pubertal stage. Baseline BMI and %fat were higher in MBS (p≤.012). Baseline copeptin, %lean mass, HbA1c, and HOMA-IR did not differ across groups (p≥.103). MBS vs NS 12-month changes were [median(IQR)]: BMI -29.0 (-33.7, -16.5)% and 0.54 (-3.10, +4.37)%; %fat -8.03 (-13.33, -4.25) and -0.68 (-2.92, 0.64); %lean mass 7.73 (3.45, 12.38) and 0.83 (-.58, 2.73); HbA1c -0.40 (-0.52, -0.20) and -0.10 (-0.20, -0.02); HOMA-IR (mean±SD) -2.47±2.17 and 0.76±2.42 (ps≤.001). Baseline copeptin was correlated negatively with %fat (rho=-.25; p=.045), and positively with %lean mass (trend-level rho=.25, p=0.051). Copeptin increased in the MBS group and decreased in the NS group (time-x;-treatment effect: p=.017). Overall, copeptin change was correlated negatively with %fat change (rho=-.29; p=.025) and positively with %lean mass change (trend-level rho=0.24, p=.070). Copeptin change was positively correlated with changes in %lean mass (rho=.37, p=.045), HbA1c (rho=.46; p=.010), and HOMA-IR (rho=.53; p=.004), only after MBS. Conclusion: Overall, increase in copeptin over 12 months was associated with improved body composition, suggesting that increased AVP following MBS may contribute to its associated metabolic improvements. However, within the MBS group, improved glucose homeostasis was associated with reductions in copeptin, suggesting a possible protective mechanism against post-bariatric hypoglycemia. Presentation: 6/2/2024

Optimizing the Diagnosis and Management of Pediatric Inducible Laryngeal Obstruction.

Pediatric inducible laryngeal obstruction (ILO) is difficult to diagnose and treat. Patients often undergo multiple specialist referrals, and long-term outcomes are not well reported. To investigate the patterns of presentation, workup, and management of children who were diagnosed with ILO at the Stollery Children's Hospital. Retrospective review with a prospective cohort of pediatric patients diagnosed with ILO from 2015 to 2023. We collected the demographic data, diagnostic tests, specialist referrals, time to diagnosis, symptom burden, associated comorbidities and aggravating factors, management, and treatment outcomes. A subset of patients was followed prospectively to determine treatment outcomes. A basic descriptive analysis was performed, and factors associated with time to resolution were studied. Seventy-eight patients met the criteria for inclusion, with 22 completing prospective questionnaires. The average age was 14 years old, and 75% were female. The majority required multiple specialist referrals. The majority were associated with exercise. Thirty-two (41%) patients had a presumed diagnosis of asthma, despite only four pulmonary function tests being consistent with asthma. Abortive breathing exercises were the most commonly employed (95%) and most successful (61%) nonsurgical management technique. Surgery was highly successful in a small cohort of patients. Median time to symptom resolution was 12 months, with 36% reporting symptoms persistent beyond 3 years. Pediatric ILO often goes undiagnosed for prolonged periods. Exercise-related symptoms are the most common. Management strategies have varied levels of success and a large proportion of patients have prolonged symptoms despite treatment, as supported by other recent evidence. 3 Laryngoscope, 2024.