title: Supraglottoplasty as treatment of exercise induced laryngeal obstruction (EILO).
abstract: Breathing difficulties during exertion may be caused by exercise-induced laryngeal obstruction (EILO). The diagnosis depends on visualization of the larynx during exercise, i.e. by continuous laryngoscopic exercise (CLE) test. In case of severe supraglottic collapse and pronounced symptoms during strenuous exertion, surgical treatment (supraglottoplasty) has been suggested. The aims of this study were to evaluate outcome and patient satisfaction after supraglottoplasty for EILO and to compare our results with previously reported data. During the period December 2010 to October 2013, 17 patients diagnosed with moderate to severe supraglottic EILO were treated by supraglottoplasty with microlaryngoscopic laser technique at our institutions. The severity of patients symptoms (VAS score) and CLE scores was evaluated pre- and postoperatively. We found a decrease in patients symptoms from median 80 points VAS score preoperatively to 20 points postoperatively (p < 0.001) and a decrease in CLE sum score from median 4.0 points to 2.5 points (p < 0.05). Several previous studies have recommended surgery for selected patients with supraglottic involvement, but these have mainly been based on case reports or on very few patients. This study is the second larger-scale study that documents the positive effect of supraglottoplasty as treatment of EILO in terms of reduced respiratory symptoms and decreased laryngeal obstruction assessed by post-operative CLE test. We suggest that surgery is a well-tolerated and effective treatment option for selected EILO patients with moderate to severe supraglottic obstruction during exercise and a high level of physical activity.
authors.affiliation: Department of ORL, Head and Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. camilla.mehlum@rsyd.dk.
authors.forename: Camilla Slot
authors.initials: CS
authors.lastname: Mehlum
authors.affiliation: Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen K, Denmark.
authors.forename: Emil Schwarz
authors.initials: ES
authors.lastname: Walsted
authors.affiliation: Department of ORL, Head and Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
authors.affiliation: Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen K, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D003718:Denmark; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D015444:Exercise; D005080:Exercise Test / Q000009:adverse effects; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010784:Photomicrography / Q000379:methods; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Exercise-induced laryngeal obstruction; Supraglottoplasty; Surgery; Treatment