title: Therapeutic laryngoscopy during exercise: A novel non-surgical therapy for refractory EILO.
abstract: Exercise-induced laryngeal obstruction (EILO) may affect as many as 6% of the adolescent population, with some patients experiencing symptoms refractory to conservative interventions.
  
  
  
  This report describes therapeutic laryngoscopy during exercise, a novel, non-surgical intervention that harnesses real-time laryngoscopy video as biofeedback to control laryngeal aperture during high-intensity exercise. Additionally, we quantitate patient-reported perceptions of procedure safety, tolerability, learning value, and effectiveness.
  
  
  
  Clinical EILO patients with symptoms refractory to conventional respiratory retraining and other therapies were referred for the procedure which features laryngoscopy video as biofeedback during serial physician-guided 1-min exercise sprints. We quantify perceptions of procedure safety, tolerability, learning value, and effectiveness through questionnaires offered to all patients as well as observers of the procedure.
  
  
  
  Forty-one patients and 37 parent observers were approached for feedback; 88% of patients and 95% of observers consented to participation. Patients and observers reported perceptions of safety and tolerability (81% and 86%, respectively), learning value (78% and 91%, respectively), and effectiveness (58% and 80%, respectively) with patient age predicting some responses. Seventy-five percent of patients noted that "Since the procedure, my breathing during exercise has improved," and 85% of this group noted that therapeutic laryngoscopy during exercise was "the most important therapy leading to my breathing improvement." The procedure also provided insight into the psychological experience of patients, a domain not clinically apparent prior to the procedure.
  
  
  
  Our data support further study of therapeutic laryngoscopy during exercise as a possible intervention for patients with refractory EILO. Pediatr Pulmonol. 2017;52:813-819. © 2016 Wiley Periodicals, Inc.
authors: Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, Colorado.
authors: J Tod
authors: JT
authors: Olin
authors: Department of Rehabilitation Medicine, National Jewish Health, Denver, Colorado.
authors: Emily H
authors: EH
authors: Deardorff
authors: Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, Colorado.
authors: Elizabeth M
authors: EM
authors: Fan
authors: Department of Rehabilitation Medicine, National Jewish Health, Denver, Colorado.
authors: Kristina L
authors: KL
authors: Johnston
authors: Pulmonary Physiology Services, National Jewish Health, Denver, Colorado.
authors: Valerie L
authors: VL
authors: Keever
authors: Division of Biostatistics & Bioinformatics, National Jewish Health, Denver, Colorado.
authors: Camille M
authors: CM
authors: Moore
authors: Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, Colorado.
authors: Bruce G
authors: BG
authors: Bender
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging* / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000000981:diagnostic imaging; D008297:Male; D012119:Respiration; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: continuous laryngoscopy during exercise; exercise-induced laryngeal obstruction; exertional dyspnea; therapeutic laryngoscopy during exercise; vocal cord dysfunction