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Exercise-induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis.
Laryngoscope. 2020 06; 130(6):E400-E406.L

Abstract

OBJECTIVE

To identify different presentations, referral patterns, comorbidities, and laryngoscopy findings in children and young adults with exercise-induced laryngeal obstruction (EILO).

METHODS

We performed a retrospective chart review of 112 patients, age <26 years, with EILO between 2013 and 2016.

RESULTS

Of the 112 patients who met criteria, 91 were female and 21 were male. Patients were most frequently referred by pulmonologists (60.7%). The majority of patients (93%) participated in organized sports, most of them at a competitive level. The mean age at symptom onset was 13.8 ± 3.3 years, and the mean age of diagnosis was 15.4 ± 3.0 years. Sixty-seven (59.8%) patients presented with a prior diagnosis of asthma, the majority of whom had failed asthma treatment. The most common symptoms reported were dyspnea (93.8%), wheezing/stridor (78.6%), and throat tightness (48.2%). Ninety-one (81.3%) patients had spirometry performed, with 46 (51.1%) showing inspiratory loop flattening. On flexible laryngoscopy, 87 (78.4%) of 111 patients had paradoxical vocal fold motion. Supraglottic involvement was observed to obstruct the airway in 26 (23.9%) patients, with patterns of obstruction similar to those observed in children with laryngomalacia.

CONCLUSION

Most patients participated in competitive sports, were female, and presented with exertional dyspnea. Most patients were diagnosed with exercise-induced asthma but treated unsuccessfully. Almost one-quarter of our patients showed supraglottic collapse obstructing the airway. Exercise-induced laryngeal obstruction is a more descriptive term than paradoxical vocal fold motion or vocal cord dysfunction, which only describe vocal fold involvement. The time to diagnosis of EILO was shorter than previously reported, suggesting that awareness of this condition is increasing.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:E400-E406, 2020.

Authors+Show Affiliations

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A.Texas Children's Hospital, Department of Pediatric Pulmonology, Houston, Texas, U.S.A.Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31498449

Citation

Shay, Elizabeth O., et al. "Exercise-induced Laryngeal Obstruction (EILO) in Children and Young Adults: From Referral to Diagnosis." The Laryngoscope, vol. 130, no. 6, 2020, pp. E400-E406.
Shay EO, Sayad E, Milstein CF. Exercise-induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis. Laryngoscope. 2020;130(6):E400-E406.
Shay, E. O., Sayad, E., & Milstein, C. F. (2020). Exercise-induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis. The Laryngoscope, 130(6), E400-E406. https://doi.org/10.1002/lary.28276
Shay EO, Sayad E, Milstein CF. Exercise-induced Laryngeal Obstruction (EILO) in Children and Young Adults: From Referral to Diagnosis. Laryngoscope. 2020;130(6):E400-E406. PubMed PMID: 31498449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise-induced laryngeal obstruction (EILO) in children and young adults: From referral to diagnosis. AU - Shay,Elizabeth O, AU - Sayad,Edouard, AU - Milstein,Claudio F, Y1 - 2019/09/09/ PY - 2019/01/31/received PY - 2019/06/02/revised PY - 2019/08/19/accepted PY - 2019/9/10/pubmed PY - 2020/9/25/medline PY - 2019/9/10/entrez KW - Paradoxical vocal fold motion KW - exercise-induced laryngeal obstruction KW - vocal cord dysfunction SP - E400 EP - E406 JF - The Laryngoscope JO - Laryngoscope VL - 130 IS - 6 N2 - OBJECTIVE: To identify different presentations, referral patterns, comorbidities, and laryngoscopy findings in children and young adults with exercise-induced laryngeal obstruction (EILO). METHODS: We performed a retrospective chart review of 112 patients, age <26 years, with EILO between 2013 and 2016. RESULTS: Of the 112 patients who met criteria, 91 were female and 21 were male. Patients were most frequently referred by pulmonologists (60.7%). The majority of patients (93%) participated in organized sports, most of them at a competitive level. The mean age at symptom onset was 13.8 ± 3.3 years, and the mean age of diagnosis was 15.4 ± 3.0 years. Sixty-seven (59.8%) patients presented with a prior diagnosis of asthma, the majority of whom had failed asthma treatment. The most common symptoms reported were dyspnea (93.8%), wheezing/stridor (78.6%), and throat tightness (48.2%). Ninety-one (81.3%) patients had spirometry performed, with 46 (51.1%) showing inspiratory loop flattening. On flexible laryngoscopy, 87 (78.4%) of 111 patients had paradoxical vocal fold motion. Supraglottic involvement was observed to obstruct the airway in 26 (23.9%) patients, with patterns of obstruction similar to those observed in children with laryngomalacia. CONCLUSION: Most patients participated in competitive sports, were female, and presented with exertional dyspnea. Most patients were diagnosed with exercise-induced asthma but treated unsuccessfully. Almost one-quarter of our patients showed supraglottic collapse obstructing the airway. Exercise-induced laryngeal obstruction is a more descriptive term than paradoxical vocal fold motion or vocal cord dysfunction, which only describe vocal fold involvement. The time to diagnosis of EILO was shorter than previously reported, suggesting that awareness of this condition is increasing. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E400-E406, 2020. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/31498449/Exercise_induced_laryngeal_obstruction__EILO__in_children_and_young_adults:_From_referral_to_diagnosis_ L2 - https://doi.org/10.1002/lary.28276 DB - PRIME DP - Unbound Medicine ER -