Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction
Sandnes, Astrid; Andersen, Tiina Maarit; Clemm, Hege Synnøve Havstad; Hilland, Magnus; Heimdal, John-Helge; Halvorsen, Thomas; Røksund, Ola Drange; Vollsæter, Maria
Peer reviewed, Journal article
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Date
2021Metadata
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Original version
Sandnes, A., Andersen, T., Clemm, H. H., Hilland, M., Heimdal, J.-H., Halvorsen, T., . . . Vollsæter, M. (2021). Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction. European Archives of Oto-Rhino-Laryngology. 10.1007/s00405-021-07214-5Abstract
Purpose
Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4–6 years later.
Methods
Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2–4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4–6 years, both groups were re-assessed with a questionnaire.
Results
We identified 116 eligible patients from the EILO-register. Response rates after 4–6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2–4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7–0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4–6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants.
Conclusion
Self-reported EILO symptoms had improved after 4–6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered.