caa a22 4500 606183515 CHVBK 20210128100821.0 cr unu---uuuuu 210128e20150901xx s 000 0 eng 10.1007/s00405-014-3159-3 doi (NATIONALLICENCE)springer-10.1007/s00405-014-3159-3 Larynx during exercise: the unexplored bottleneck of the airways [Elektronische Daten] [Ola Røksund, John-Helge Heimdal, Jan Olofsson, Robert Maat, Thomas Halvorsen] Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3-15min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes. The Author(s), 2014 Larynx nationallicence Exercise capacity nationallicence Exercise-induced asthma nationallicence Exercise-induced laryngeal obstruction nationallicence Vocal cord dysfunction nationallicence Exercise testing nationallicence Respiratory measurement nationallicence CLE test : Continuous laryngoscopy exercise test nationallicence EIA : Exercise-induced asthma nationallicence EIIS : Exercise-induced inspiratory symptoms nationallicence EILO : Exercise-induced laryngeal obstruction nationallicence FEF50/FIF50 : The ratio between forced expiratory flow at 50% of forced expiratory vital capacity and the forced inspiratory flow at 50% of forced inspiratory vital capacity nationallicence FEV1 : Forced expiratory flow in the first second nationallicence FVL : Flow volume loop nationallicence GERD : Gastroesophageal reflux disease nationallicence IMT : Inspiratory muscle strength training nationallicence LPR : Laryngopharyngeal reflux nationallicence MIF50/MEF50 : The ratio between maximal inspiratory flow at 50% of forced inspiratory vital capacity and the maximal expiratory flow at 50% of forced expiratory vital capacity nationallicence PCA-muscle : Posterior cricoarytenoideus muscle nationallicence PFT : Pulmonary function test nationallicence PPI : Proton pump inhibitor nationallicence PVCM : Paradoxical vocal cord motion nationallicence RSI : Reflux symptom index nationallicence VCD : Vocal cord dysfunction nationallicence Røksund Ola Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway aut Heimdal John-Helge Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway aut Olofsson Jan Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway aut Maat Robert Department of Otolaryngology, Röpcke-Zweers Hospital, Hardenberg, The Netherlands aut Halvorsen Thomas Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway aut European Archives of Oto-Rhino-Laryngology Springer Berlin Heidelberg 272/9(2015-09-01), 2101-2109 0937-4477 272:9<2101 2015 272 405 https://doi.org/10.1007/s00405-014-3159-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 review-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00405-014-3159-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Røksund Ola Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway aut NATIONALLICENCE 700 1- Heimdal John-Helge Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway aut NATIONALLICENCE 700 1- Olofsson Jan Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway aut NATIONALLICENCE 700 1- Maat Robert Department of Otolaryngology, Röpcke-Zweers Hospital, Hardenberg, The Netherlands aut NATIONALLICENCE 700 1- Halvorsen Thomas Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway aut NATIONALLICENCE 773 0- European Archives of Oto-Rhino-Laryngology Springer Berlin Heidelberg 272/9(2015-09-01), 2101-2109 0937-4477 272:9<2101 2015 272 405