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Larynx during exercise: the unexplored bottleneck of the airways.

Røksund OD, Heimdal JH, Olofsson J, Maat RC, Halvorsen T - Eur Arch Otorhinolaryngol (2014)

Bottom Line: EIIS is usually associated with some form of laryngeal obstruction.However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms.Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway, odro@helse-bergen.no.

ABSTRACT
Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.

No MeSH data available.


Related in: MedlinePlus

Continuous laryngoscopy exercise test (CLE test). Illustration: GØrill Skaale Johansen
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Fig2: Continuous laryngoscopy exercise test (CLE test). Illustration: GØrill Skaale Johansen

Mentions: We have published a method for continuous monitoring of the larynx throughout ongoing maximal cardiopulmonary treadmill exercise; i.e., continuous laryngoscopy exercise test (CLE test) (Fig. 2) [21]. The method is easy to perform and well tolerated from the age of 5 years. It allows for documentation of visible alterations and movements in laryngeal structures during all phases of the respiratory cycle throughout a complete exercise test. Synchronized cardiopulmonary exercise data and video recordings of the upper part of the body and sound tracks are stored for later review and analysis [21]. It has been argued that the CLE test is too resource intensive, and that a laryngoscope held by the hand with the patient exercising on a bike will serve the same purpose. This may be so, but the laryngoscope must be in place before onset of symptoms and throughout the full length of the exercise session. Only then can important characteristics be revealed and documented, such as which structures incited and perpetuated the events.Fig. 2


Larynx during exercise: the unexplored bottleneck of the airways.

Røksund OD, Heimdal JH, Olofsson J, Maat RC, Halvorsen T - Eur Arch Otorhinolaryngol (2014)

Continuous laryngoscopy exercise test (CLE test). Illustration: GØrill Skaale Johansen
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4526593&req=5

Fig2: Continuous laryngoscopy exercise test (CLE test). Illustration: GØrill Skaale Johansen
Mentions: We have published a method for continuous monitoring of the larynx throughout ongoing maximal cardiopulmonary treadmill exercise; i.e., continuous laryngoscopy exercise test (CLE test) (Fig. 2) [21]. The method is easy to perform and well tolerated from the age of 5 years. It allows for documentation of visible alterations and movements in laryngeal structures during all phases of the respiratory cycle throughout a complete exercise test. Synchronized cardiopulmonary exercise data and video recordings of the upper part of the body and sound tracks are stored for later review and analysis [21]. It has been argued that the CLE test is too resource intensive, and that a laryngoscope held by the hand with the patient exercising on a bike will serve the same purpose. This may be so, but the laryngoscope must be in place before onset of symptoms and throughout the full length of the exercise session. Only then can important characteristics be revealed and documented, such as which structures incited and perpetuated the events.Fig. 2

Bottom Line: EIIS is usually associated with some form of laryngeal obstruction.However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms.Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway, odro@helse-bergen.no.

ABSTRACT
Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.

No MeSH data available.


Related in: MedlinePlus