Clinical Case Study: Pediatric Exercise-Induced Laryngeal Obstruction.

Clinical scenario: Exercise-induced laryngeal obstruction (EILO) consists of exertion-induced laryngeal adduction that constricts the airway and causes dyspnea. Respiratory retraining (i.e., therapy) with a speech-language pathologist (SLP) is the primary treatment for EILO, yet there is limited work describing typical treatment course in adolescents.

Clinical question: What are some clinical procedures and considerations for treating EILO in an adolescent?

Study sources: This study describes a clinical case of EILO in a 13-year-old female. Case history, self-reported outcomes, and laryngeal imaging findings are reported with reference to current EILO literature.

Primary results: A 13-year-old female presented to the clinic with a 2-year history of episodic dyspnea. Symptoms included inhalation difficulty, throat tightness, and biphasic stridor. Symptoms were triggered by physical exertion, the scents of cleaners, and high humidity. Symptom onset following trigger exposure was rapid and resolved quickly upon exercise cessation or trigger removal. Symptoms prevented participation in athletic activities and caused emotional distress. Laryngeal imaging revealed arytenoid twitching and paradoxical vocal fold motion upon inhalation. Laryngeal adduction upon inhalation ranged from partial to complete. Respiratory retraining with an SLP was recommended. Following three treatment sessions, the patient demonstrated proficiency with rescue breathing techniques and reported improved EILO symptoms. Posttherapy Dyspnea Index score reflected a 14-point improvement when compared with baseline. Diagnostic procedures, treatment course, and implications are discussed in detail.

Conclusion: This case supports previous study and describes both the nature of EILO and the implications for clinical practice.