153:
The examiner visually evaluates the relative change of the laryngeal inlet in the patient throughout the CLE-test. One common grading system uses 4 steps (0-3) on glottic and supraglottic level respectively. Grades 0-1 are considered normal, whereas grades 2-3 on either or both levels are consistent
56:
principle states that increasing airflow through a tube creates increasing negative pressures within that tube. Complex neuromuscular functioning is required to maintain laryngeal opening and to allow the larynx to achieve a great number of tasks (i.e. speaking, airway protection, swallowing). It is
51:
EILO may arise because of a relative mechanical 'insufficiency' of the laryngeal structures that should act to maintain glottic patency. It has been proposed that a narrowing at the laryngeal inlet during the state of high airflow (e.g. when running fast), can act to cause a pressure drop across the
984:
Johnston, Kristina L.; Bradford, Hannah; Hodges, Heather; Moore, Camille M.; Nauman, Emily; Olin, J. Tod (November 2018). "The Olin EILOBI Breathing
Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise-Induced Laryngeal Obstruction".
149:
The current gold-standard means for diagnosing EILO is the continuous laryngoscopy during exercise test (CLE-test). This test involves the placement of a flexible laryngoscope via nostril, which is then secured in place and held with headgear. It allows continuous visualization of the laryngeal
845:
Walsted, Emil S.; Swanton, Laura L.; van van
Someren, Ken; Morris, Tessa E.; Furber, Matthew; Backer, Vibeke; Hull, James H. (October 2017). "Laryngoscopy during swimming: A novel diagnostic technique to characterize swimming-induced laryngeal obstruction: Laryngoscopy During Swimming".
60:
A small heredity study indicated that an autosomal dominant model of inheritance with variable expressivity and reduced penetrance in males may be relevant; because in ten families studied, there was at least one affected person in every generation in which both parents were examined.
1178:
Maat, Robert
Christiaan; Røksund, Ola D.; Halvorsen, Thomas; Skadberg, Britt T.; Olofsson, Jan; Ellingsen, Thor A.; Aarstad, Hans J.; Heimdal, John-Helge (1 December 2009). "Audiovisual assessment of exercise-induced laryngeal obstruction: reliability and validity of observations".
241:
Halvorsen, Thomas; Walsted, Emil
Schwarz; Bucca, Caterina; Bush, Andrew; Cantarella, Giovanna; Friedrich, Gerhard; Herth, Felix J.F.; Hull, James H.; Jung, Harald; Maat, Robert; Nordang, Leif; Remacle, Marc; Rasmussen, Niels; Wilson, Janet A.; Heimdal, John-Helge (September 2017).
162:
The current mainstay of treatment is therapy-based. Specialist breathing techniques, most commonly termed biphasic breathing techniques or EILOBI are recommended to reduce turbulent inspiratory airflow and thus reduce chance of laryngeal closure.
938:
Røksund, Ola Drange; Maat, Robert
Christiaan; Heimdal, John Helge; Olofsson, Jan; Skadberg, Britt Torunn; Halvorsen, Thomas (1 December 2009). "Exercise induced dyspnea in the young. Larynx as the bottleneck of the airways".
93:
The prevalence of EILO in adolescents and young adults appears to be in the range of 5â7% in northern Europe, with some indication that EILO may be more prevalent in highly trained athletes.
103:. In one study, of almost 90 athletes, with unexplained respiratory symptoms, EILO was found to be present in approximately 30% of athletes, whilst EILO and EIB co-existed in one in ten.
463:
Walsted, Emil S.; Faisal, Azmy; Jolley, Caroline J.; Swanton, Laura L.; Pavitt, Matthew J.; Luo, Yuan-Ming; Backer, Vibeke; Polkey, Michael I.; Hull, James H. (1 February 2018).
553:
Christensen, Pernille M.; Thomsen, S. F.; Rasmussen, N.; Backer, V. (September 2011). "Exercise-induced laryngeal obstructions: prevalence and symptoms in the general public".
1149:
Shaffer, Monica; Litts, Juliana K.; Nauman, Emily; Haines, Jemma (1 May 2018). "Speech-Language
Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction".
96:
Some, but not all studies report a higher female prevalence. Thus, in a study of 94 patients diagnosed using the CLE test, average age was ~15 years, and 68% were female.
35:
and often discomfort in the throat and upper chest. EILO is a very common cause of breathing difficulties in young athletic individuals but is often misdiagnosed as
512:
Johansson, Henrik; Norlander, Katarina; Berglund, Lars; Janson, Christer; Malinovschi, Andrei; Nordvall, Lennart; Nordang, Leif; Emtner, Margareta (January 2015).
150:
aperture during exercise. The CLE test can be used during indoor treadmill or cycle-ergometer exercise but also whilst rowing or swimming or exercising outdoors.
343:
655:
Maat, Robert
Christiaan; Hilland, Magnus; Røksund, Ola Drange; Halvorsen, Thomas; Olofsson, Jan; Aarstad, Hans Jørgen; Heimdal, John-Helge (October 2011).
79:
In fewer cases, the glottic (i.e. vocal cord) structures close together and this is typically what happens during exercise-induced vocal-cord dysfunction.
422:
Olin, J. Tod; Clary, Matthew S.; Fan, Elizabeth M.; Johnston, Kristina L.; State, Claire M.; Strand, Matthew; Christopher, Kent L. (October 2016).
85:
Closure of the voice box during exercise causes increased 'loading' on the breathing system and the respiratory muscles have to work much harder.
802:
Griffin, Steffan Arthur; Walsted, Emil S; Hull, James H (September 2018). "Breathless athlete: exercise-induced laryngeal obstruction".
72:
EILO is typically caused by a narrowing of the supra-glottic structures of the larynx. In severe cases, these structures, also called
514:"Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population"
1028:
Heimdal, John-Helge; Maat, Robert; Nordang, Leif (May 2018). "Surgical
Intervention for Exercise-Induced Laryngeal Obstruction".
244:"Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement"
596:
Ersson, Karin; Mallmin, Elisabet; Malinovschi, Andrei; Norlander, Katarina; Johansson, Henrik; Nordang, Leif (December 2020).
64:
Further work is needed to determine if structural deficiencies in the laryngeal tissue of individuals with EILO are present.
1120:
Nordang, Leif; Norlander, Katarina; Walsted, Emil
Schwarz (May 2018). "Exercise-Induced Laryngeal ObstructionâAn Overview".
889:
Hull, James H.; Walsted, Emil S.; Orton, Christopher M.; Williams, Parris; Ward, Simon; Pavitt, Mathew J. (February 2019).
100:
40:
753:
Hull, James H.; Walsted, Emil S.; Pavitt, Matt J.; Menzies-Gow, Andrew; Backer, Vibeke; Sandhu, Guri (15 February 2019).
293:
Røksund, Ola Drange; Heimdal, John-Helge; Olofsson, Jan; Maat, Robert
Christiaan; Halvorsen, Thomas (September 2015).
1230:
99:
In athletic individuals EILO appears to be a highly prevalent cause of cough and wheeze and can co-exist with
1225:
166:
Direct laryngeal visualisation during exercise to deliver biofeedback has been employed with success.
598:"Prevalence of exerciseâinduced bronchoconstriction and laryngeal obstruction in adolescent athletes"
465:"Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction"
194:"Exercise-induced laryngeal obstruction: a common and overlooked cause of exertional breathlessness"
53:
129:
Symptoms often start to improve from the time of exercise cessation / reducing exercise intensity
154:
with EILO. There is a need to identify other less-invasive means of making a secure diagnosis.
82:
EILO develops during intense exercise and closure develops as exercise becomes more intense.
657:"Exercise-induced laryngeal obstruction: natural history and effect of surgical treatment"
8:
73:
28:
342:
Hull, James H.; Backer, Vibeke; Gibson, Peter G.; Fowler, Stephen J. (1 November 2016).
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Walsted, Emil Schwarz; Hvedstrup, Jeppe; Eiberg, Hans; Backer, Vibeke (August 2017).
363:
324:
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223:
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The place of inspiratory muscle training (IMT) is yet to be defined in EILO therapy.
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424:"Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery"
57:
thus also possible that EILO may arise as form a degree of neuromuscular failure.
27:
that occurs during high intensity exercise. This acts to impair airflow and cause
998:
815:
722:
705:
906:
440:
423:
399:
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260:
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Surgical treatment with supraglottopasty has also been utilised with success.
952:
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359:
1192:
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1133:
1085:
1069:"Exercise induced laryngeal obstruction: a review of diagnosis and management"
1041:
672:
566:
310:
1219:
623:
106:
This condition can co-exist with other conditions, including severe asthma.
1200:
1170:
1141:
1104:
1067:
Liyanagedara, Savinda; McLeod, Robert; Elhassan, Hassan A. (1 April 2017).
1049:
1006:
970:
924:
867:
823:
788:
755:"High Prevalence of Laryngeal Obstruction during Exercise in Severe Asthma"
731:
690:
641:
574:
539:
498:
449:
408:
367:
328:
279:
270:
227:
121:
Wheeze or whistling sound; typically when breathing in when exercising hard
209:
192:
Hall, Andrew; Thomas, Mike; Sandhu, Guri; Hull, James H (September 2016).
891:"Feasibility of portable continuous laryngoscopy during exercise testing"
52:
larynx which then acts to 'pull' the laryngeal structures together. The
859:
706:"High Prevalence of Exercise-Induced Laryngeal Obstruction in Athletes"
704:
Nielsen, Emil Walsted; Hull, James H.; Backer, Vibeke (November 2013).
614:
137:
133:
961:
344:"Laryngeal Dysfunction: Assessment and Management for the Clinician"
844:
295:"Larynx during exercise: the unexplored bottleneck of the airways"
175:
Avoiding unnecessary treatment with asthma inhalers is important.
595:
552:
383:"Heredity of supraglottic exercise-induced laryngeal obstruction"
76:, can close over to almost completely close the laryngeal inlet.
32:
511:
36:
24:
1177:
752:
380:
983:
654:
1066:
937:
759:
American Journal of Respiratory and Critical Care Medicine
462:
348:
American Journal of Respiratory and Critical Care Medicine
292:
240:
1148:
888:
1119:
341:
132:
No improvement with standard asthma medication (e.g.
421:
191:
1027:
801:
703:
1217:
1122:Immunology and Allergy Clinics of North America
1030:Immunology and Allergy Clinics of North America
710:Medicine & Science in Sports & Exercise
23:) is a transient, reversible narrowing of the
1181:European Archives of Oto-Rhino-Laryngology
1073:European Archives of Oto-Rhino-Laryngology
661:European Archives of Oto-Rhino-Laryngology
555:European Archives of Oto-Rhino-Laryngology
299:European Archives of Oto-Rhino-Laryngology
1094:
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778:
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488:
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318:
269:
259:
217:
1218:
17:Exercise-induced laryngeal obstruction
115:Key clinical features often include:
109:
41:exercise-induced bronchoconstriction
198:British Journal of General Practice
13:
1060:
804:British Journal of Sports Medicine
14:
1242:
124:Throat or upper chest discomfort
1021:
977:
931:
882:
838:
795:
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697:
648:
589:
481:10.1152/japplphysiol.00691.2017
88:
1151:Immunology and Allergy Clinics
546:
505:
456:
415:
374:
335:
286:
234:
185:
118:Difficulty 'catching a breath'
1:
531:10.1136/thoraxjnl-2014-205738
469:Journal of Applied Physiology
178:
999:10.1016/j.jvoice.2017.08.020
816:10.1136/bjsports-2018-099159
723:10.1249/MSS.0b013e318298b19a
428:European Respiratory Journal
387:European Respiratory Journal
248:European Respiratory Journal
157:
144:
67:
7:
907:10.1183/23120541.00219-2018
441:10.1183/13993003.00160-2016
400:10.1183/13993003.00423-2017
261:10.1183/13993003.02221-2016
10:
1247:
953:10.1016/j.rmed.2009.05.024
771:10.1164/rccm.201809-1734LE
360:10.1164/rccm.201606-1249CI
1193:10.1007/s00405-009-1030-8
1163:10.1016/j.iac.2018.01.003
1134:10.1016/j.iac.2018.01.001
1086:10.1007/s00405-016-4338-1
1042:10.1016/j.iac.2018.01.005
673:10.1007/s00405-011-1656-1
567:10.1007/s00405-011-1612-0
311:10.1007/s00405-014-3159-3
46:
1231:Respiratory physiology
602:Pediatric Pulmonology
210:10.3399/bjgp16X687001
941:Respiratory Medicine
1226:Exercise physiology
29:shortness of breath
860:10.1002/lary.26532
615:10.1002/ppul.25104
204:(650): e683âe685.
1187:(12): 1929â1936.
947:(12): 1911â1918.
895:ERJ Open Research
854:(10): 2298â2301.
810:(18): 1211â1212.
716:(11): 2030â2035.
667:(10): 1485â1492.
608:(12): 3509â3516.
110:Clinical features
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1079:(4): 1781â1789.
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987:Journal of Voice
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524:(1): 57â63.
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89:Epidemiology
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20:
16:
15:
1220:Categories
179:References
138:albuterol)
134:salbutamol
74:arytenoids
962:1956/5337
624:8755-6863
158:Treatment
145:Diagnosis
68:Mechanism
54:Bernoulli
1209:24927101
1201:19585139
1171:29631737
1142:29631735
1113:15546663
1105:27730324
1050:29631739
1015:36324540
1007:29050661
971:19782550
925:30740460
876:45634351
868:28236311
824:29669719
789:30570393
732:23657163
691:21643933
642:33002318
583:23253671
575:21528411
540:25380758
499:29097629
450:27418554
409:28818875
368:27575803
329:25033930
280:28889105
228:27563141
1096:5340851
916:6360209
832:4930495
780:6376624
740:6603638
682:3166603
633:7702091
490:5867370
320:4526593
219:5198683
33:stridor
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47:Causes
37:asthma
25:larynx
1205:S2CID
1109:S2CID
1011:S2CID
901:(1).
872:S2CID
828:S2CID
736:S2CID
579:S2CID
1197:PMID
1167:PMID
1138:PMID
1101:PMID
1046:PMID
1003:PMID
967:PMID
921:PMID
864:PMID
820:PMID
785:PMID
728:PMID
687:PMID
638:PMID
620:ISSN
571:PMID
536:PMID
495:PMID
446:PMID
405:PMID
364:PMID
325:PMID
276:PMID
224:PMID
21:EILO
1189:doi
1185:266
1159:doi
1130:doi
1091:PMC
1081:doi
1077:274
1038:doi
995:doi
957:hdl
949:doi
945:103
911:PMC
903:doi
856:doi
852:127
812:doi
775:PMC
767:doi
763:199
718:doi
677:PMC
669:doi
665:268
628:PMC
610:doi
563:doi
559:268
526:doi
485:PMC
477:doi
473:124
436:doi
395:doi
356:doi
352:194
315:PMC
307:doi
303:272
266:hdl
256:doi
214:PMC
206:doi
101:EIB
39:or
1222::
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