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. 2025 Mar;282(3):1345-1354.
doi: 10.1007/s00405-024-09190-y. Epub 2025 Jan 21.

Speech therapy for exercise-induced laryngeal obstruction

Kristine Vreim  1   2 , Tom Karlsen  1 , Petter Helø Carlsen  1 , Valgjerd Helene Nistad  2 , Ola Drange Røksund  1   2   3 , Thomas Halvorsen  4   5   6 , Maria Vollsæter  1 , John-Helge Heimdal  3   7   8 , Hege Clemm  1   9 , Mette Engan  1
Affiliations

Speech therapy for exercise-induced laryngeal obstruction

Kristine Vreim et al. Eur Arch Otorhinolaryngol. 2025 Mar.

Abstract

Introduction: Exercise- Induced Laryngeal Obstruction (EILO) can lead to disabling exercise related dyspnea and hamper participation in physical activity. In this study, we aimed to investigate the effects of a standardized speech therapy protocol as treatment for EILO.

Methods: Patients diagnosed with EILO at our institution were invited to participate. We compared laryngeal findings obtained during a continuous laryngoscopy exercise (CLE) test and questionnaire based self-reported breathing symptoms, before vs. after the treatment intervention. The laryngeal obstruction was characterized using a standardized CLE scoring system (0-12 points).

Results: A total of 28 patients were evaluated. Following speech therapy, the mean reduction in the CLE score was 1.5 (95% confidence interval: 1.1-2.0) points, with the improvement primarily associated with decreased glottic-level obstruction. Twenty-four (86%) patients reported reduced symptoms during exercise. A moderate correlation was observed between changes in CLE scores and subjective symptom improvements.

Conclusion: This study suggests that a standardized speech therapy protocol reduces observed laryngeal obstruction during the CLE test, with the most notable improvement occurring at the glottic level, alongside a parallel reduction in self-reported symptoms of EILO.

Keywords: Dyspnea; EILO; Exercise; Laryngeal obstruction; Speech therapy; Vocal Cord Dysfunction.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Notation of prior abstract presentation/publication: None. Patient consent for publication: Obtained. Ethics approval: Protocols for ethical approvals have been submitted and granted. REK has approved to use and analyze patient data from 2013 to 2023 and to send questionnaires to previous patients to assess long-term effect of speech therapy (ID 2016-01898).

Figures

Fig. 1
Fig. 1
Grading system of laryngeal obstruction according to Maat et al., reproduced with permission
Fig. 2
Fig. 2
Mean CLE subscores with 95% confidence intervals at moderate and at maximum exercise intensity pre and post speech therapy in the 28 included patients from the EILO register at Haukeland University Hospital, Bergen, Norway
Fig. 3
Fig. 3
Correlations between Self-reported subjective improvement and Changes in CLE sumscore in the 28 patients after speech therapy. Self-reported subjective improvement: 1 = no improvement, 2 = some improvement, 3 = much improvement, 4 = complete recovery. Change in CLE sumscore = CLE sumscore before treatment – CLE sumscore after treatment. Pearson correlation coefficient: 0.445, p = 0.18
See this image and copyright information in PMC

References

    1. Johansson H, Norlander K, Berglund L, Janson C, Malinovschi A, Nordvall L et al (2015) Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population. Thorax 70(1):57–63 - PubMed
    1. Christensen PM, Thomsen SF, Rasmussen N, Backer V (2011) Exercise-induced laryngeal obstructions: prevalence and symptoms in the general public. Eur Arch Otorhinolaryngol 268(9):1313–1319 - PubMed
    1. Liyanagedera S, McLeod R, Elhassan HA (2017) Exercise induced laryngeal obstruction: a review of diagnosis and management. Eur Arch Otorhinolaryngol 274(4):1781–1789 - PMC - PubMed
    1. Maat RC, Røksund OD, Halvorsen T, Skadberg BT, Olofsson J, Ellingsen TA et al (2009) Audiovisual assessment of exercise-induced laryngeal obstruction: reliability and validity of observations. Eur Arch Otorhinolaryngol 266(12):1929–1936 - PubMed
    1. Christensen PM, Heimdal JH, Christopher KL, Bucca C, Cantarella G, Friedrich G et al (2015) ERS/ELS/ACCP 2013 international consensus conference nomenclature on inducible laryngeal obstructions. Eur Respir Rev 24(137):445–450 - PMC - PubMed