Inducible laryngeal obstruction
ICD-10 J38.5 · ICD-11 CA0H.4

Treatment of Severe Exercise-Induced Laryngeal Obstruction with Supraglottic (Aryepiglottic Fold) Involvement

This page addresses management in patients with severe exercise-induced laryngeal obstruction (EILO) where supraglottic involvement — specifically of the aryepiglottic folds — has been confirmed on continuous laryngoscopy during exercise (CLE testing), and who present with clinically significant breathing problems.

Clinical Scenario

Supraglottic EILO confirmed by CLE testing, with aryepiglottic fold involvement and clinically significant respiratory symptoms on exertion. CLE testing is essential in this scenario: it establishes the structural anatomical cause — supraglottic versus glottic — which directly shapes the management path taken.

Management Approach

Management is primarily non-invasive and multimodal, centred on specialised speech and language therapy, respiratory physiotherapy, and structured breathing retraining. Several further intervention types are part of the full protocol for this scenario — selection depends on the confirmed anatomical pattern and individual triggers.

Treatment goal: relief or resolution of respiratory symptoms — dyspnoea, wheeze, and stridor — associated with ILO.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/13993003.02221-2016

Based on the finding that supraglottic ILO during exercise shows similarities to laryngomalacia in infants, several ENT surgeons have performed supraglottic surgery in patients with severe EILO and clinically significant breathing problems.

By nature, supraglottoplasty is a treatment for supraglottic EILO (i.e. not for glottic forms of EILO); therefore underpinning the importance of CLE testing to establish the structural anatomical cause underlying each case of EILO.

Speech therapy ILO treatments have applied various techniques with different reported outcomes.

Examples are nasal breathing, panting and diaphragmatic breathing.

Case reports describe the application of inspiratory muscle strength training.

Inhaled anticholinergics (ipratropium) have been reported to reduce symptoms in exercise-induced VCD.

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