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Exercise-Induced Laryngeal Obstruction (EILO) in Athletes

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Voice Disorders in Athletes, Coaches and other Sports Professionals

Abstract

Exercise-induced laryngeal obstruction (EILO) occurs primarily in athletes following exercise and is characterized by intermittent dyspnea and stridor associated with vocal fold adduction. Voice changes are common in patients with EILO mostly due to phonotrauma and increased collision forces between the vocal folds. As a result, there is formation of nodules, polyps, granuloma, and/or ulceration in 11–25% of the cases. EILO is diagnosed best using provocative maneuvers with continuous laryngoscopy. Spirometry shows evidence of extra-thoracic obstruction with truncation of the inspiratory phase of flow-volume loop. In the absence of asthma, the methacholine challenge test is usually negative, and affected patients rarely respond to anti-asthmatic medications. Laryngeal electromyography also is useful in diagnosing EILO and in differentiating between its various etiology, namely, respiratory dystonia vs. psychogenic causes vs. laryngopharyngeal reflux disease.

Several pathophysiologic mechanisms for EILO are suggested. These include mechanical factors, laryngeal hypersensitivity, psychogenic predisposition, autonomic nervous system dysfunction, excessive laryngeal tension, respiratory dystonia, and/or laryngopharyngeal reflux disease. The diversity in the pathophysiology of EILO alludes to the need for individualized treatment after improving patients’ education about the nature of their condition. The basic treatment options are voice therapy focused on abdominal and nasal breathing, cognitive therapy with visual feedback for enhancement of laryngeal muscle control, botulinum toxin therapy, reflux therapy, psychotherapy, and hypnosis. The treatment must be comprehensive and guided toward the patient’s unique condition.

This chapter reviews the prevalence of EILO in athletes, its pathophysiology, and its management. The authors discuss the associated comorbidities of EILO, such as asthma and exercise-induced asthma, and stress the multifaceted nature of this condition and the management of affected patients.

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Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Abdul-Latif Hamdan

  2. Adjunct Professor, Department of Otolaryngology – Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA

    Abdul-Latif Hamdan

  3. Department of Otolaryngology – Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA

    Robert Thayer Sataloff & Mary J. Hawkshaw

  4. Lankenau Institute for Medical Research, Wynnewood, PA, USA

    Robert Thayer Sataloff

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  1. Abdul-Latif Hamdan
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Correspondence to Abdul-Latif Hamdan .

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Hamdan, AL., Sataloff, R.T., Hawkshaw, M.J. (2021). Exercise-Induced Laryngeal Obstruction (EILO) in Athletes. In: Voice Disorders in Athletes, Coaches and other Sports Professionals. Springer, Cham. https://doi.org/10.1007/978-3-030-69831-7_8

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