A Unique Method for Diagnosing and Treating EILO

Exercise-induced laryngeal obstruction (EILO) is often confused with asthma, as the two respiratory diseases share similar symptoms. A new and unique technique being used to diagnose and help in the treatment of EILO, previously referred to as vocal cord dysfunction was the topic of a session at the ACAAI annual meeting.

EILO is characterized by involuntary closure of the upper airway during high-intensity exercise. It causes shortness of breath during exercise and reduced exercise performance. Monica Shaffer, MA, CCC-SLP, a speech language pathologist at National Jewish Health in Denver, shared video of a teenage patient experiencing an episode of EILO to demonstrate its noisy and frightening nature for patients and bystanders.

“This is a common but challenging patient demographic,” she said, adding that her institution is implementing and studying unique  diagnosis and treatment techniques. In the case study Shaffer presented, the teenage athlete had already seen an ear, nose, and throat specialist, who had said that the vocal cords were healthy. However, the examination was performed when the patient was at rest.

Schaffer said that there is a need for a better diagnostic tool that that can preproduce symptoms and is observable to the patient, family, and healthcare team. National Jewish Health is using continuous laryngoscopy during exercise—they fit a patient with a helmet that has a small camera attached to it. The camera is fed through the patient’s nose and positioned just above the throat. Once the camera is in place, the patient performs a strenuous workout on a stationary bicycle, treadmill, or other exercise modality. Real-time throat images from the camera are displayed on video, for the patient, family, and healthcare team to observe. In this study, the researchers studied the technique in 80 patients.

Although they had a few negative exams, the study observed laryngeal obstruction over exercise and recovery. The results suggested that timing is key: In most patients, not much happened until 80 percent of maximal exertion, and laryngeal obstruction peaked at 100%. During the recovery phase, most patients returned nearly to baseline quickly. The results were similar among conditioned athletes and not as conditioned patients. Shaffer said the study showed that the peak of glottic obstruction is often happening at 100% exertion, and that physicians may miss the true peak or the problem entirely if they are looking only at the recovery phase, or not bringing a patient to full exertion.

The research group is using continuous laryngoscopy during exercise to facilitate the development and teaching of the Olin exercise-induced laryngeal obstruction biphasic inspiration techniques (EILOBI) techniques that help athletes open their obstructed airways during high-intensity exercise. To date, two-thirds of subjects have reported EILOBI to be effective in treating symptoms, and 79 percent have said the techniques can be implemented during a variety of sporting activities.