Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

Eur Arch Otorhinolaryngol. 2022 May;279(5):2511-2522. doi: 10.1007/s00405-021-07214-5. Epub 2021 Dec 26.

Abstract

Purpose: Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4-6 years later.

Methods: Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2-4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4-6 years, both groups were re-assessed with a questionnaire.

Results: We identified 116 eligible patients from the EILO-register. Response rates after 4-6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2-4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7-0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4-6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants.

Conclusion: Self-reported EILO symptoms had improved after 4-6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered.

Keywords: Dyspnea; Exercise; Inspiratory muscle training; Laryngeal obstruction; Stridor.

MeSH terms

  • Adolescent
  • Airway Obstruction* / diagnosis
  • Airway Obstruction* / etiology
  • Airway Obstruction* / therapy
  • Dyspnea
  • Humans
  • Laryngeal Diseases* / diagnosis
  • Laryngeal Diseases* / etiology
  • Laryngeal Diseases* / surgery
  • Muscles
  • Retrospective Studies