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Diagnostic work-up of exercise-induced laryngeal obstruction

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Exercise-induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. This condition affects mainly adolescent athletes. Visualization of the obstruction, while the patient is experiencing the symptoms during continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. Our study aims to evaluate the prevalence of EILO in a population presenting exercise-induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objective was to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs).

Methods

All patients referred to our center for EIIS or uncontrolled asthma with exertional symptoms were included. EILO diagnosis was made if Maat score was > 2 for patients with CLE-test or if there were inspiratory anomalies on PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as the gold standard.

Results

Sixty two patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with associated asthma in 9 patients (18%). The sensibility and specificity of LC for supraglottic anomalies were 75% and 60%, respectively. The sensibility and specificity of PFTs were 61% and 89%, respectively.

Conclusions

There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. Some clinical characteristics might guide the diagnosis. Nevertheless, CLE-test remained the gold standard for EILO diagnosis and identification of the dysfunctional upper airway site to provide specific management.

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Authors and Affiliations

  1. Otolaryngology-Head and Neck Surgery Department, Clinique Universitaire d’ORL et Chirurgie Cervico-Faciale, CHU Grenoble Alpes, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble Cedex 09, France

    Ludovic Giraud, Christol Fabre & Ihab Atallah

  2. Faculté́ de Médecine, Université́ Grenoble Alpes, Domaine de la Merci, BP 170, 38042, Grenoble Cedex 9, France

    Ludovic Giraud, Christol Fabre & Ihab Atallah

  3. Clinique de Physiologie Sommeil et Exercice, CHU Grenoble Alpes, BP 217, 38043, Grenoble Cedex 09, France

    Marie Destors & Rita Clin

  4. Inserm 1042, Laboratoire HP2, Université Grenoble-Alpes, 38000, Grenoble, France

    Rita Clin

  5. Pôle Thorax et Vaisseaux, Clinique de Physiologie Sommeil et Exercice, CHU de Grenoble-Alpes, 38000, Grenobl, France

    Rita Clin

  6. Médecine du Sport, CHU Grenoble Alpes, Hôpital Sud, 19 Avenue de Kimberley, 38130, Échirolles, France

    Stéphane Doutreleau

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  1. Ludovic Giraud
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  2. Marie Destors
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Correspondence to Ihab Atallah.

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Giraud, L., Destors, M., Clin, R. et al. Diagnostic work-up of exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol 280, 1273–1281 (2023). https://doi.org/10.1007/s00405-022-07654-7

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  • DOI: https://doi.org/10.1007/s00405-022-07654-7

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