Speech-Language Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction

Shaffer, Monica; Litts, Juliana K.; Nauman, Emily; Haines, Jemma

doi:10.1016/j.iac.2018.01.003

Cited by 37 publications

(26 citation statements)

References 31 publications

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“…It should be noted there is good evidence on the effectiveness of conservative treatment. 8,13,14 Further recommendations to the treatment of severe EILO should be gathered from prospective randomized trials.…”

Section: Discussionmentioning

confidence: 99%

“…Our results, however, contribute to the growing research that surgery is an efficient treatment modality for patients with severe supraglottic EILO who are motivated for surgery. It should be noted there is good evidence on the effectiveness of conservative treatment . Further recommendations to the treatment of severe EILO should be gathered from prospective randomized trials.…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly employed front-line treatments for EILO are breathing techniques promoting improved airflow and laryngeal relaxation strategies, typically comprising speech and language therapy (SLT) or physiotherapy-based intervention to modulate inspiratory airflow 13 AE direct biofeedback. 14,15 Ultimately, however, in some cases, EILO symptoms can remain refractory to this conservative approach.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, the most commonly reported surgical procedure performed is a supraglottoplasty, a procedure most commonly and historically employed for childhood laryngomalacia. [6][7][8][9][10][11][12][13][14][15][16][17][18] Surgical intervention in this context most typically involves the use of either a carbon dioxide laser or cold steel microlaryngeal instruments to divide the aryepiglottic fold along the lateral edge of the epiglottis. [19][20][21] There are currently approximately 100 cases reported in the literature (Table I), [17][18][19][20][21][22][23][24][25][26][27][28][29][30] with a recent systematic review concluding that this intervention has promising results, although clearly, larger more robust studies, preferably performed in a randomized controlled format, are needed.…”

Section: Introductionmentioning

confidence: 99%

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Surgical intervention for exercise‐induced laryngeal obstruction: A UK perspective

2020

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Objectives: Exercise-induced laryngeal obstruction (EILO) is a prevalent cause of exertional breathlessness and wheeze in young individuals. Typically diagnosed using the continuous laryngoscopy during exercise (CLE) test, treatment is largely based on breathing retraining promoting improved laryngeal function. In some cases, these techniques fail to alleviate symptoms, and surgical intervention with supraglottoplasty can be valuable in the supraglottic form of EILO. Globally, there is currently limited experience utilizing a surgical approach to EILO, and data regarding the optimum surgical technique and published outcomes and complication rates are thus limited. Study Design: Retrospective observational case series. Methods: In this report, we describe our experience as the only UK center undertaking supraglottoplasty for EILO. We report the surgical outcome of 19 patients (n = 16 female), mean age, 29.6 AE 13.1 years, referred for surgery with moderate to severe supraglottic EILO. Follow-up clinic AE CLE was performed within 4 months (median = 6 weeks), and CLE scores were evaluated before and following surgery. Results: We found a beneficial effect of surgery on supraglottic CLE scores (median score reducing from 3/3 to 1/3 postoperatively [P < .05] overall) with 79% (n = 15) of patients reporting an improvement in their exercise capacity. One patient developed an apparent increased tendency for glottic-level EILO following surgery; however, no voice-or swallowing-related complications were encountered. Conclusions: This study is the first to report the UK experience, surgical technique, and outcome for EILO surgery. The findings indicate that EILO surgery appears to be a safe and effective option for individuals with moderate to severe supraglottic-type EILO who have failed initial conservative treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical intervention for exercise‐induced laryngeal obstruction: A UK perspective

2020

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“…Speech-language pathology intervention has been noted to be a potential therapy since the early reports of irritant-associated ILO were published (46). Specific breathing techniques taught by speech and language pathologists may differ across centers (47–50). General relaxation and biofeedback have also been incorporated in some of the therapies (16, 51).…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Exercise-Induced Laryngeal Obstruction: When Pediatric Exertional Dyspnea Does not Respond to Bronchodilators

Olin

2019

Front. Pediatr.

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Exertional dyspnea is a common complaint in general pediatric practice. While a high proportion of the general pediatric population has asthma, other diagnoses, including exercise-induced laryngeal obstruction should be considered, especially when asthma therapy is not sufficient to control symptoms. This review describes some of the key clinical features of exercised-induced laryngeal obstruction as well as preferred diagnostic and therapeutic approaches. Importantly, current diagnostic technology has considerably improved in the last decade at specialty centers. At the same time, infrastructure for clinical trials is emerging and there is not strong evidence to support specific therapies at the current time.

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Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children

Fujiki,

Lunga,

Francis

et al. 2024

The Laryngoscope

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PurposeDiagnosing pediatric induced laryngeal obstruction (ILO) requires equipment typically available in specialist settings, and patients often see multiple providers before a diagnosis is determined. This study examined the financial burden associated with the diagnosis and treatment of ILO in pediatric patients with reference to socioeconomic disadvantage.MethodsAdolescents and children (<18 years of age) diagnosed with ILO were identified through the University of Madison Voice and Swallow Outcomes Database. Procedures, office visits, and prescribed medications were collected from the electronic medical record. Expenditures were calculated for two time periods (1) pre‐diagnosis (first dyspnea‐related visit to diagnosis), and (2) the first year following diagnosis. The Area Deprivation Index (ADI) was used to estimate patient socioeconomic status to determine if costs differed with neighborhood‐level disadvantage.ResultsA total of 113 patients met inclusion criteria (13.9 years, 79% female). Total pre‐diagnosis costs of ILO averaged $6486.93 (SD = $6604.14, median = $3845.66) and post‐diagnosis costs averaged $2067.69 (SD = $2322.78; median = $1384.12). Patients underwent a mean of 3.01 (SD = 1.9; median = 2) procedures and 5.8 (SD = 4.7; median = 5) office visits prior to diagnosis. Pharmaceutical, procedure/office visit, and indirect costs significantly decreased following diagnosis. Patients living in neighborhoods with greater socioeconomic disadvantage underwent fewer procedures and were prescribed more medication than those from more affluent areas. However, total expenditures did not differ based on ADI.ConclusionsPediatric ILO is associated with considerable financial costs. The source of these costs, however, differed according to socioeconomic advantage. Future work should determine how ILO diagnosis and management can be more efficient and equitable across all patients. Laryngoscope, 2024

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Speech-Language Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction

Cited by 37 publications

References 31 publications

Surgical intervention for exercise‐induced laryngeal obstruction: A UK perspective

Surgical intervention for exercise‐induced laryngeal obstruction: A UK perspective

Exercise-Induced Laryngeal Obstruction: When Pediatric Exertional Dyspnea Does not Respond to Bronchodilators

Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children

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