Introduction
The larynx represents a slim and complicated valve that controls entry to the decrease airways and modulates giant proportions of complete airway resistance throughout respiration. The larynx serves important and partly opposing bodily features, similar to sustaining maximal opening throughout train to facilitate excessive quantity air flow, closing tightly whereas consuming to stop aspiration, and performing fine-tuned actions throughout phonation (1–3). The larynx additionally performs a basic function throughout cough and clearance of secretions (4–6). The understanding of how the larynx influences respiration throughout train in well being and illness is at an early stage.
Respiration issues brought on by an inappropriate reversible laryngeal adduction in an in any other case apparently regular larynx, is labelled inducible laryngeal obstruction (ILO) (7). When train is the inducer of ILO, the acronym EILO is often used (8, 9). EILO has beforehand been labelled in a wide range of methods, usually utilizing the phrases paradoxical vocal wire movement or vocal wire dysfunction (7). Prevalence charges of 5%–7% are reported in unselected adolescent populations (10, 11), and even increased in teams the place train is especially vital (12, 13).
Research point out that EILO responds to remedy interventions; nevertheless, we lack randomized managed research to verify this (9, 14–18). Therapy algorithms for EILO typically begin with a correct diagnose adopted by some type of respiratory schooling as instructed by Determine 1. Non-surgical remedy contains methods similar to respiration recommendation (19), speech remedy (20, 21), biofeedback (22, 23), inspiratory muscle coaching (IMT) (16, 24), laryngeal management remedy (21, 25) and pharmacological remedy (26). Speech remedy has historically been thought-about mainstay remedy for inducible laryngeal obstruction (ILO), with research reporting symptom decision or enchancment in as many as 89% of sufferers (27). Looking the literature, it turns into evident that speech remedy on this context has been carried out in several methods and in line with a wide range of protocols. Nevertheless, the strategies utilized are sometimes insufficiently described, and subsequently troublesome to breed by others (28). Moreover, remedy is usually customised to particular person sufferers, additional complicating a seek for strategies with a extra common utility (29). The speech remedy program used at our hospital to deal with sufferers with EILO through the previous years has been standardized to be utilized in a potential randomized managed trial (RCT) referred to as HelpILO (30). This system rests on basic speech remedy rules mixed with expertise obtained with these sufferers through the previous many years. We acknowledge there are a number of attainable approaches to speech remedy on this context. Moreover, we acknowledge latest literature suggesting that EILO includes at the very least two distinct classes (glottic and supraglottic) more likely to reply in a different way to speech remedy, which is able to nonetheless be administered uniformly to all sufferers.
Determine 1. Therapy algorithm for EILO (8).
The purpose of the HelpILO examine is to check results of various remedy approaches to EILO in a randomized managed design in sufferers consecutively recognized with EILO. This text supplies in-depth info on the speech remedy protocol used on this examine.
Strategies
HelpILO-study—a randomized managed remedy trial for sufferers with EILO
The speech remedy protocol described on this article is a part of the HelpILO-study performed at Haukeland College Hospital throughout 2021–2024. The examine assessments generally used remedy approaches to EILO in a randomized managed design, enrolling sufferers consecutively recognized with EILO at our establishment (Determine 2). Speech remedy constitutes one component of this set-up, along with inspiratory muscle coaching, and fundamental info and respiration recommendation guided by visible biofeedback. To evaluate modifications within the larynx, video recordings obtained throughout train earlier than and after interventions can be analysed. The HelpILO examine is ethically permitted by the Regional Committee for Medical and Well being Analysis Ethics (REK 2020/134444). All individuals will present written knowledgeable consent earlier than enrolment.
Determine 2. Stream chart of HelpILO (8).
EILO diagnostics and grading of outcomes
EILO is recognized by steady laryngoscopy carried out throughout train (CLE-test) from relaxation to peak train (7, 9, 31). The CLE-test supplies visualization of the extent of obstruction throughout the larynx (i.e., glottic, supraglottic or each), and permits timing of the occasions (i.e., what buildings begin the adduction, when it happens, and in what sequence). Analysis of the laryngeal obstruction, the CLE-score, relies on a categorical scale from 0 to three assessing the relative diploma of inspiratory adduction of the supraglottic and vocal folds throughout rising train from a resting situation through reasonable to peak train (Determine 3) (33). Research addressing the validity of this CLE scoring system has reached considerably variable conclusions (33–35). Though the CLE scoring system has its shortcomings, it’s up to now essentially the most goal measure of EILO severity, it’s usually utilized in on a regular basis clinic worldwide, and can be used on this current examine.
Determine 3. The CLE-scoring system. Reproduced with permission from Fretheim-Kelly et al. (32).
Creating a speech remedy remedy protocol for EILO over a decade
When speech remedy is used to deal with train associated respiration issues, a spread of approaches and manoeuvres could be utilized, and the remedy is usually tailor-made to particular person sufferers. At our establishment, a remedy protocol for this goal has slowly been developed over the past 10 years by our communicate and language therapist. With the intention to be clear and reproducible on this current HelpILO RTC, we have now standardized our protocol in order that the set of manoeuvres used could be reproduced in a verifiable approach additionally in teams of sufferers exterior our personal surroundings.
The speech remedy utilized to deal with EILO within the HelpILO examine is based on basic rules used within the remedy of voice issues, laryngeal reflexes, and respiratory issues. It focuses on reprogramming concerned muscle groups, and selling belly respiration, with the final word purpose to facilitate free airflow by the larynx at excessive quantity air flow induced by train. Whereas getting ready the remedy technique, we have now emphasised discovering approaches that make the most of laryngeal reflexes to advertise laryngeal patency throughout inspiration. We subsequently examined a number of manoeuvres whereas on the identical time performing versatile nasal laryngoscopy. This work was commenced in 2009 by our speech therapist (TK) along with two of the co-authors of this text (ODR and JHH). A versatile laryngoscope was used to evaluate the laryngeal responses to all manoeuvres used within the protocol.
The evolution of our protocol has progressed by 4 distinct phases over the previous decade:
Part 1. The speech therapist (TK) examined totally different manoeuvres/methods and assessed the laryngeal responses by versatile laryngoscope of his personal larynx.
Part 2. We initially examined 4 totally different manoeuvres in 21 wholesome college students in relation to a speech remedy grasp thesis, which regrettably just isn’t accessible on-line. The 4 manoeuvres explored had been (1) “sniff”, the place quick inspiration by the nostril was utilized to make the larynx open, using a reflex (36) (2) “sob”, loosely primarily based on the “Estill method”, the place the purpose is to decrease the larynx within the throat to develop the supraglottic space (37), (3) “breathe across the tongue with pursed lips”, a way that slows down laryngeal airflow throughout inspiration, thereby creating much less laryngeal pressure which probably may cut back the chance of laryngeal adduction or collapse, and (4) “Karlsen’s manoeuvre (KM)” the place the test-subject inhales by almost closed tooth with expanded corners of the mouth, a way that additionally slows down laryngeal airflow throughout inspiration, probably with related constructive results on laryngeal patency. All individuals carried out the listed manoeuvres throughout video laryngoscopy at relaxation, and 4 individuals moreover carried out the manoeuvres throughout a CLE-test. All individuals retrospectively rated the diploma of complexity of the manoeuvres and gave suggestions on the directions supplied. The video recordings had been then evaluated in a blinded randomized style by skilled raters (ODR and JHH) to see which manoeuvres effectively opened up the larynx. Based mostly on this analysis, the manoeuvres “sob” and “breath round tongue with pursed lips” had been rejected, as a consequence of each complexity and failure to open the larynx throughout inspiration as supposed.
Moreover, throughout this preliminary work, two new manoeuvres had been included, examined and located appropriate by way of the laryngeal response and sufferers’ evaluation of their feasibility. These had been “yawning” and “dew-breathing-on-a-imaginary mirror” primarily based on the impact of laryngeal responses noticed. Thus, lastly there have been 4 manoeuvres discovered to be appropriate and possible for our goal: sniff, KM, yawning, and dew-breathing.
Additional, aiming for a completely complete remedy method targeted on being conscious of the opening and shutting of the larynx, a broadly used speech remedy maneuver referred to as “semi occluded vocal tract voice coaching and remedy” was included in this system, utilizing a bottle stuffed with water and a tube. To extend consciousness of the larynx, sufferers are requested to provide an extended “F-sound” throughout exhalation (later known as “f-out”), adopted by one of many inspiratory maneuvers. Modifications between the maneuvers inside one respiration cycle is used to acquire higher management over the larynx. Additional, actively producing “stridor-like” sounds whereas inhaling is used to boost the affected person’s consciousness relating to abduction vs. adduction of the larynx.
Part 3. The 4 manoeuvres (sniff, KM, yawning, and dew-breathing) had been used for a number of years by our speech therapist to deal with EILO at our establishment. Aiming to check the feasibility of a standardized coaching method, seven sufferers (females, 16–19 yr of age) with verified EILO examined a preset program utilizing these maneuvers. This system was primarily based on one go to on the hospital as soon as every week over a 6-week interval, supervised by our speech therapist (TK), and moreover observe at dwelling thrice every day in between. This was adopted by 6 weeks of implementing the methods throughout bodily exercise, whereas slowly rising the train load.
Part 4. On account of lengthy journey distances for some sufferers, it turned obvious {that a} extra time-intensive protocol was required. Due to this fact, another extra condensed method was developed to be accomplished inside 2–3 days. Ten sufferers with verified EILO (age 15–29 years, two males) examined this time-intensive method underneath the supervision of our speech therapist (TK), with alternating directions and self-training. This was adopted by 4 weeks of practising the methods at dwelling thrice every day and regularly implementing the methods in bodily actions. All affected person reported the diploma of self-training. We noticed on this section that some sufferers engaged in self-training extra steadily, suggesting that this might result in higher outcomes. Sufferers supplied steady suggestions on the remedy and requested questions that had been applied into the affected person schooling, in addition to info vital to incorporate within the anamneses. Anecdotally, enhancements in EILO signs had been noticed with each approaches (section 3 and section 4), according to findings from the same examine (38).
Finally, 5 manoeuvres had been discovered appropriate for the HelpILO examine: (a) the “sniffing” manoeuvre the place quick inspiration by the nostril is utilized to make the larynx open as a reflex (36), (b) a manoeuvre that we have now labelled the “Karlsen’s manoeuvre” (KM)” the place the affected person inhales by closed tooth with prolonged corners of the mouth, which is a way meant to decelerate airflow throughout inspiration, proven to have a constructive impact on laryngeal patency, (c) the yawning manoeuvre, to concentrate on stretching and widening of the larynx, (d) the dew-breathing manoeuvre (each out and in) to concentrate on controlling the opening of the larynx, and (e) the “semi occluded vocal tract voice coaching and remedy” manoeuvre, a well known method to “warm-up” the vocal folds. Whereas practising these methods, sufferers are requested to provide an extended (39) “F-sound” throughout exhalation (later known as “f-out”), adopted by one of many 5 inspiratory maneuvers. Modifications between the maneuvers inside one breath cycle can be used to acquire higher management. Lastly, actively producing “stridor-like” sounds whereas inhaling is used to boost the affected person’s consciousness relating to abduction vs. adduction of the larynx.
The speech remedy method as it’s utilized within the HelpILO-study
Because the HelpILO-study follows an RCT design, the entire speech remedy program needed to be standardized and related in all collaborating sufferers. At first of “COVID-pandemic”, we had been pressured to do many of the remedy supervision by way of on-line steerage at our EILO-outpatient clinic. Based mostly on our medical expertise (with sufferers not included within the HelpILO examine), we discovered that the outcomes from on-line steerage didn’t clinically differ from the outcomes obtained in sufferers guided face-to-face. On-line steerage subsequently turned the routine set-up within the HelpILO examine.
The speech remedy program within the HelpILO examine begins with offering the affected person with details about the pathophysiology of EILO, as understood from the viewpoint of a speech therapist, with explanations supported by figures exhibiting the anatomy of the larynx. The essential rules of an applicable respiration sample is defined (3). Thereafter, the affected person is guided by a typical train program for belly respiration, the way to receive and keep a great posture with a straight again, low shoulders and holding the pinnacle excessive. The affected person can be guided by basic rules of the way to launch tensions within the larynx (40). Belly respiration is skilled by asking the affected person to actively contract the belly muscle groups whereas exhaling by pursed lips for resistance after which to loosen up the belly muscle groups and widening the thorax whereas inhaling (Supplementary Video S1).
Additional, this system consists of 5 steps carried out throughout 5 weeks with rising complexity at every step to take care of development. Every step lasts 1 week and contains amongst different parts practising the 5 totally different maneuvers listed within the earlier paragraph. The maneuvers are carried out in periods of 15 breaths which can be repeated 5–8 occasions. The respiration workout routines at every new step are introduced to the affected person as soon as every week in a 1 h supervised session underneath steerage by the speech therapist. Thereafter, the affected person is predicted to observe individually at dwelling. The final step contains implementing the workout routines in bodily actions. Development from one step to the following is decided by the affected person’s potential to take care of management on the earlier step regardless of the shift in focus that happens when introducing new parts.
The 5 steps utilized in our speech remedy protocol for EILO
Gear used on this protocol is a silicone tube, 35 cm lengthy with 12/16 mm interior/outer diameter. Along with a plastic bottle of 5 dl stuffed with roughly 3 dl of water. It’s emphasised that sufferers mustn’t use these maneuvers to deal with themselves with out prior steerage by an skilled therapist (Desk 1 for overview).
Desk 1. Schematic overview of the remedy.
Step 1:
1. The primary train focuses on the “semi occluded vocal tract voice coaching and remedy” maneuver the place he/she use a large tube to blow right into a bottle of water (39). This generates a constructive airway stress, widening the larynx throughout expiration (Supplementary Video S2).
2. Respiration “f-out” and yawn in, i.e., inhaling all through the yawn (Supplementary Video S3).
Step 2:
This step focuses on the earlier two workout routines along with three new ones.
1. “Semi occluded vocal tract voice coaching and remedy”
2. “F-out, yawn in”
3. “F-out, sniff in”. Inhalation by sniffing in by the nostril (Supplementary Video S4).
4. “F-out, KM in” (Supplementary Video S5).
5. “Dew out, dew in”. Inhaling with out making any modifications on the articulatory place (Supplementary Video S6).
Step 3:
The target of this step is to make the affected person conscious of the sensation relating to abduction vs. adduction of the larynx. The next maneuvers are used within the coaching:
1. “Semi occluded vocal tract voice coaching and remedy”
2. “F-out, stridor in”; “f-out, yawn in” (Supplementary Video S7).
3. “F-out, stridor in”; “f, out, sniffing in” (Supplementary Video S8).
4. “F-out, stridor in”; “f-out, KM in” (Supplementary Video S9).
5. “F-out, stridor in”; “dew-out, dew-in” (Supplementary Video S10).
The affected person will concentrate on stream and execution first. When efficiency is ample, the affected person focuses on the contrasts within the sensation of stridor and opening of the larynx.
Step 4:
The target of this step is to make use of the methods to cease an assault of EILO. The experiences from Step 3 are reviewed. This step will concentrate on making “stridor-like noise” after which subsequently modifications to creating no noise, utilizing the methods practiced within the prior periods:
1. “Semi occluded vocal tract voice coaching and remedy”
2. F-out, stridor in; begin by inhaling stridor in, then terminate by inhaling “sniffing in” (Supplementary Video S11).
3. F-out, stridor in; begin by inhaling stridor in, then terminate by inhaling “KM in” (Supplementary Video S12).
4. F-out, stridor in; begin by inhaling stridor in, then terminate by inhaling “yawn in” (Supplementary Video S13).
Step 5:
The target of this step is to begin implementing the maneuvers throughout bodily exercise. The affected person is knowledgeable to begin practising the totally different respiration methods whereas performing low to reasonable depth train and regularly enhance the depth whereas sustaining belly respiration and laryngeal management. It’s the sense of respiration management that ought to decide the diploma of bodily exercise. The purpose is to assist the affected person develop a technique on the way to management his/her larynx throughout train, and to have the ability to proceed exercising with out experiencing EILO incidents. It’s emphasised that the adopted respiration methods have to be repeated till they grow to be tailored as part of their automated respiration sample.
Statistical strategies
The HelpILO-study has been described intimately in a earlier communication, additionally encompassing energy calculations to make sure that the deliberate variety of enrolled individuals (N = 350) can be ample to detect clinically vital results (30). Speech remedy can be in comparison with easy info and respiration recommendation and inspiratory muscle coaching. Sub-analyses can be carried out to check if the therapies execute in a different way in glottic vs. supraglottic EILO, as instructed beforehand for inspiratory muscle coaching in an uncontrolled examine (19). As secondary outcomes, individuals will fill in standardized questionnaires earlier than and after remedy, to judge symptom scores.
Dialogue and abstract
Given the excessive prevalence of EILO, we’re involved by the restricted understanding of the function performed by the larynx throughout train and the dearth of evidence-based remedy approaches. We right here current our speech remedy remedy protocol for EILO, which constitutes an vital component within the giant potential randomized managed HelpILO examine. This represents a primary try and generate structured speech remedy remedy algorithms for sufferers with EILO. Based mostly on the outcomes, we hope to have the ability to generate extra scientifically strong remedy algorithms, and knowledgeable decisions as regards remedy of EILO. Speech and language remedy represents a complete occupation, and the instruments used fluctuate by custom between establishments and nations (41). We acknowledge that there are numerous approaches that could possibly be possible and efficient for the remedy of EILO, with notable examples together with the EILOBI method (42) and the remedy for respiration sample dysfunction not too long ago described by Milstein et al. (43). The protocol used on this current examine relies on a set of maneuvers that are anticipated to have the specified impact on the sufferers’ respiration downside. Thus, we can not distinguish if particular maneuvers or remedy parts is extra vital than others in particular person sufferers.
Additional, EILO might be not a definite phenotype, however more likely to include subgroups characterised by totally different pathophysiology which most likely additionally reply in a different way to remedy (16, 44). Furthermore, sufferers with EILO differ as regards age, gender, comorbidities, degree of bodily exercise, expectations, and ambitions in relation to bodily efficiency, in addition to motivation and compliance with remedy, features which can be certain to affect the efficacy of the remedy supplied by well being care suppliers. Within the HelpILO examine, all enrolled sufferers can be handled equally, opening for sub-grouping by remedy responses. To acquire these targets, we needed to method speech remedy in a standardized and non-flexible approach, making use of maneuvers which we empirically have discovered possible and efficient in clinics.
Ethics assertion
The research involving people had been permitted by Regional Committee for Medical and Well being Analysis Ethics (REK 2020/134444). The research had been performed in accordance with the native laws and institutional necessities. Written knowledgeable consent for participation on this examine was supplied by the individuals’ authorized guardians/subsequent of kin.
Writer contributions
TK: Conceptualization, Investigation, Methodology, Mission administration, Visualization, Writing – authentic draft. KV: Validation, Writing – overview & modifying. OR: Conceptualization, Supervision, Writing – overview & modifying. MV: Supervision, Writing – overview & modifying. PM: Investigation, Writing – overview & modifying. TE: Visualization, Writing – overview & modifying. J-HH: Conceptualization, Investigation, Methodology, Supervision, Writing – overview & modifying. TH: Conceptualization, Supervision, Writing – overview & modifying. HC: Conceptualization, Funding acquisition, Mission administration, Supervision, Writing – overview & modifying.
Funding
The writer(s) declare monetary help was acquired for the analysis, authorship, and/or publication of this text.
The main funding for HelpILO is a strategic funding grant from Western Norway Regional Well being Authority (F-12564-D10550). As well as, concerned professors, related professors, PhD-candidates, grasp’s diploma (MSc) candidates, and postdoctoral researchers obtain salaries from the College of Bergen, Western Norway College of Utilized Science, Haukeland College Hospital and Western Norway Regional Well being Authority. The HelpILO-study was supported by the Western Norway Regional Well being Authority.
Battle of curiosity
The authors declare that the analysis was performed within the absence of any business or monetary relationships that could possibly be construed as a possible battle of curiosity.
Writer’s word
All claims expressed on this article are solely these of the authors and don’t essentially characterize these of their affiliated organizations, or these of the writer, the editors and the reviewers. Any product which may be evaluated on this article, or declare which may be made by its producer, just isn’t assured or endorsed by the writer.
Supplementary materials
The Supplementary Materials for this text could be discovered on-line at: https://www.frontiersin.org/articles/10.3389/fped.2024.1356476/full#supplementary-material
References
2. Roksund OD, Maat RC, Heimdal JH, Olofsson J, Skadberg BT, Halvorsen T. Train induced dyspnea within the younger. Larynx because the bottleneck of the airways. Respir Med. (2009) 103(12):1911–8. doi: 10.1016/j.rmed.2009.05.024
PubMed Summary | Crossref Full Textual content | Google Scholar
3. Sataloff RT. Skilled Voice, Fourth Version: The Science and Artwork of Scientific Care, 3-Quantity Set. San Diego, CA: Plural Publishing, Integrated (2017).
Google Scholar
4. Fretheim-Kelly Z, Halvorsen T, Heimdal JH, Strand E, Vollsaeter M, Clemm H, et al. Feasibility and tolerability of measuring translaryngeal stress throughout train. Laryngoscope. (2019) 129:2748–53. doi: 10.1002/lary.27846
PubMed Summary | Crossref Full Textual content | Google Scholar
6. Terzi N, Orlikowski D, Aegerter P, Lejaille M, Ruquet M, Zalcman G, et al. Respiration–swallowing interplay in neuromuscular sufferers. Am J Respir Crit Care Med. (2007) 175(3):269–76. doi: 10.1164/rccm.200608-1067OC
PubMed Summary | Crossref Full Textual content | Google Scholar
7. Christensen PM, Heimdal JH, Christopher KL, Bucca C, Cantarella G, Friedrich G, et al. ERS/ELS/ACCP 2013 worldwide consensus convention nomenclature on inducible laryngeal obstructions. Eur Respir Rev. (2015) 24(137):445–50. doi: 10.1183/16000617.00006513
PubMed Summary | Crossref Full Textual content | Google Scholar
8. Clemm HH, Olin JT, McIntosh C, Schwellnus M, Sewry N, Hull JH, et al. Train-induced laryngeal obstruction (EILO) in athletes: a story overview by a subgroup of the IOC consensus on “acute respiratory sickness within the athlete”. Br J Sports activities Med. (2022) 56(11):622–9. doi: 10.1136/bjsports-2021-104704
PubMed Summary | Crossref Full Textual content | Google Scholar
9. Halvorsen T, Walsted ES, Bucca C, Bush A, Cantarella G, Friedrich G, et al. Inducible laryngeal obstruction: an official joint European respiratory society and European laryngological society assertion. Euro Respir J. (2017) 50(3):1602221. doi: 10.1183/13993003.02221-2016
Crossref Full Textual content | Google Scholar
10. Christensen PM, Thomsen SF, Rasmussen N, Backer V. Train-induced laryngeal obstructions: prevalence and signs in most people. Eur Arch Otorhinolaryngol. (2011) 268(9):1313–9. doi: 10.1007/s00405-011-1612-0
PubMed Summary | Crossref Full Textual content | Google Scholar
11. Johansson H, Norlander Ok, Berglund L, Janson C, Malinovschi A, Nordvall L, et al. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a basic adolescent inhabitants. Thorax. (2015) 70(1):57–63. doi: 10.1136/thoraxjnl-2014-205738
PubMed Summary | Crossref Full Textual content | Google Scholar
13. Nielsen EW, Hull JH, Backer V. Excessive prevalence of exercise-induced laryngeal obstruction in athletes. Med Sci Sports activities Train. (2013) 45(11):2030–5. doi: 10.1249/MSS.0b013e318298b19a
Crossref Full Textual content | Google Scholar
14. Heimdal JH, Maat R, Nordang L. Surgical intervention for exercise-induced laryngeal obstruction. Immunol Allergy Clin North Am. (2018) 38(2):317–24. doi: 10.1016/j.iac.2018.01.005
PubMed Summary | Crossref Full Textual content | Google Scholar
15. Maat RC, Roksund OD, Olofsson J, Halvorsen T, Skadberg BT, Heimdal JH. Surgical remedy of exercise-induced laryngeal dysfunction. Eur Arch Otorhinolaryngol. (2007) 264(4):401–7. doi: 10.1007/s00405-006-0216-6
PubMed Summary | Crossref Full Textual content | Google Scholar
16. Sandnes A, Andersen T, Clemm HH, Hilland M, Vollsaeter M, Heimdal JH, et al. Train-induced laryngeal obstruction in athletes handled with inspiratory muscle coaching. BMJ Open Sport Exerc Med. (2019) 5(1):e000436. doi: 10.1136/bmjsem-2018-000436
PubMed Summary | Crossref Full Textual content | Google Scholar
17. Sandnes A, Hilland M, Vollsaeter M, Andersen T, Engesaeter IO, Sandvik L, et al. Extreme exercise-induced laryngeal obstruction handled with supraglottoplasty. Entrance Surg. (2019) 6:44. doi: 10.3389/fsurg.2019.00044
PubMed Summary | Crossref Full Textual content | Google Scholar
18. Siewers Ok, Backer V, Walsted ES. A scientific overview of surgical remedy for supraglottic exercise-induced laryngeal obstruction. Laryngoscope Investig Otolaryngol. (2019) 4(2):227–33. doi: 10.1002/lio2.257
PubMed Summary | Crossref Full Textual content | Google Scholar
19. Sandnes A, Andersen T, Clemm HH, Hilland M, Heimdal JH, Halvorsen T, et al. Scientific responses following inspiratory muscle coaching in exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol. (2022) 279(5):2511–22. doi: 10.1007/s00405-021-07214-5
PubMed Summary | Crossref Full Textual content | Google Scholar
20. De Guzman V, Ballif CL, Maurer R, Hartnick CJ, Raol N. Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold movement. JAMA Otolaryngol Head Neck Surg. (2014) 140(9):823–8. doi: 10.1001/jamaoto.2014.1405
PubMed Summary | Crossref Full Textual content | Google Scholar
21. Shaffer M, Litts JK, Nauman E, Haines J. Speech-language pathology as a main remedy for exercise-induced laryngeal obstruction. Immunol Allergy Clin North Am. (2018) 38(2):293–302. doi: 10.1016/j.iac.2018.01.003
PubMed Summary | Crossref Full Textual content | Google Scholar
22. Panchasara B, Nelson C, Niven R, Ward S, Hull JH. Lesson of the month: rowing-induced laryngeal obstruction: a novel explanation for exertional dyspnoea: characterised by direct laryngoscopy. Thorax. (2015) 70(1):95–7. doi: 10.1136/thoraxjnl-2014-205773
PubMed Summary | Crossref Full Textual content | Google Scholar
23. Olin JT, Deardorff EH, Fan EM, Johnston KL, Keever VL, Moore CM, et al. Therapeutic laryngoscopy throughout train: a novel non-surgical remedy for refractory EILO. Pediatr Pulmonol. (2017) 52(6):813–9. doi: 10.1002/ppul.23634
PubMed Summary | Crossref Full Textual content | Google Scholar
24. Clemm HSH, Sandnes A, Vollsaeter M, Hilland M, Heimdal JH, Roksund OD, et al. The heterogeneity of train induced laryngeal obstruction. Am J Respir Crit Care Med. (2018) 197(8):1068–9. doi: 10.1164/rccm.201708-1646IM
PubMed Summary | Crossref Full Textual content | Google Scholar
25. Chiang T, Marcinow AM, deSilva BW, Ence BN, Lindsey SE, Forrest LA. Train-induced paradoxical vocal fold movement dysfunction: analysis and administration. Laryngoscope. (2013) 123(3):727–31. doi: 10.1002/lary.23654
PubMed Summary | Crossref Full Textual content | Google Scholar
26. Muralitharan P, Carlsen P, Hilland M, Delestre-Levai I, Vollsæter M, Hufthammer KO, et al. Use of inhaled ipratropium bromide to enhance exercise-induced laryngeal obstruction can’t be really helpful. ERJ Open Res. (2023) 9(1):00308-2022. doi: 10.1183/23120541.00308-2022
PubMed Summary | Crossref Full Textual content | Google Scholar
27. Liyanagedera S, McLeod R, Elhassan HA. Train induced laryngeal obstruction: a overview of analysis and administration. Eur Arch Otorhinolaryngol. (2017) 274(4):1781–9.27730324
PubMed Summary | Google Scholar
28. Patel RR, Venediktov R, Education T, Wang B. Proof-based systematic overview: results of speech-language pathology remedy for people with paradoxical vocal fold movement. Am J Speech Lang Pathol. (2015) 24(3):566–84. doi: 10.1044/2015_AJSLP-14-0120
PubMed Summary | Crossref Full Textual content | Google Scholar
29. George S, Suresh S. Vocal wire dysfunction: evaluation of 27 instances and up to date overview of pathophysiology & administration. Int Arch Otorhinolaryngol. (2019) 23(2):125–30. doi: 10.1055/s-0038-1661358
PubMed Summary | Crossref Full Textual content | Google Scholar
30. Clemm H, Roksund OD, Andersen T, Heimdal JH, Karlsen T, Hilland M, et al. Train-induced laryngeal obstruction: protocol for a randomized managed remedy trial. Entrance Pediatr. (2022) 10:817003. doi: 10.3389/fped.2022.817003
PubMed Summary | Crossref Full Textual content | Google Scholar
31. Heimdal JH, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J. Steady laryngoscopy train check: a technique for visualizing laryngeal dysfunction throughout train. Laryngoscope. (2006) 116(1):52–7. doi: 10.1097/01.mlg.0000184528.16229.ba
PubMed Summary | Crossref Full Textual content | Google Scholar
32. Fretheim-Kelly ZL, Halvorsen T, Clemm H, Roksund O, Heimdal JH, Vollsaeter M, et al. Train induced laryngeal obstruction in people and equines. A comparative overview. Entrance Physiol. (2019) 10:1333. doi: 10.3389/fphys.2019.01333
PubMed Summary | Crossref Full Textual content | Google Scholar
33. Maat RC, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J, Ellingsen TA, et al. Audiovisual evaluation of exercise-induced laryngeal obstruction: reliability and validity of observations. Euro Arch Otorhinolaryngol. (2009) 266(12):1929–36. doi: 10.1007/s00405-009-1030-8
Crossref Full Textual content | Google Scholar
34. Norlander Ok, Christensen PM, Maat RC, Halvorsen T, Heimdal JH, Moren S, et al. Comparability between two evaluation strategies for exercise-induced laryngeal obstructions. Eur Arch Otorhinolaryngol. (2016) 273:425–30. doi: 10.1007/s00405-015-3758-7
PubMed Summary | Crossref Full Textual content | Google Scholar
35. Walsted ES, Hull JH, Hvedstrup J, Maat RC, Backer V. Validity and reliability of grade scoring within the analysis of exercise-induced laryngeal obstruction. ERJ Open Res. (2017) 3(3):00070-2017. doi: 10.1183/23120541.00070-2017
PubMed Summary | Crossref Full Textual content | Google Scholar
37. Steinhauer Ok, Klimek MM, Estill J. The Estill Voice Mannequin: Principle & Translation. Pittsburgh, Pa: Estill Voice (2017).
Google Scholar
38. Meerschman I, Claeys S, Bettens Ok, Bruneel L, D’haeseleer E, Van Lierde Ok. Massed versus spaced observe in vocology: impact of a short-term intensive voice remedy versus a long-term conventional voice remedy. J Speech Lang Hear Res. (2019) 62(3):611–30. doi: 10.1044/2018_JSLHR-S-18-0013
PubMed Summary | Crossref Full Textual content | Google Scholar
39. Titze IR. Voice coaching and remedy with a semi-occluded vocal tract: rationale and scientific underpinnings. J Speech Lang Hear Res. (2006) 49(2):448–59. doi: 10.1044/1092-4388(2006/035)
PubMed Summary | Crossref Full Textual content | Google Scholar
40. Gilman M. The affect of postural modifications on extralaryngeal muscle stress and vocal manufacturing. Perspect ASHA Spec Curiosity Teams. (2018) 3(3):82–7. doi: 10.1044/persp3.SIG3.82
Crossref Full Textual content | Google Scholar
41. Walsted ES, Famokunwa B, Andersen L, Rubak SL, Buchvald F, Pedersen L, et al. Traits and affect of exercise-induced laryngeal obstruction: a global perspective. ERJ Open Res. (2021) 7(2):00195-2021. doi: 10.1183/23120541.00195-2021
PubMed Summary | Crossref Full Textual content | Google Scholar
42. Johnston KL, Bradford H, Hodges H, Moore CM, Nauman E, Olin JT. The Olin EILOBI respiration methods: description and preliminary case sequence of novel respiratory retraining methods for athletes with exercise-induced laryngeal obstruction. J Voice. (2018) 32(6):698–704. doi: 10.1016/j.jvoice.2017.08.020
PubMed Summary | Crossref Full Textual content | Google Scholar
43. Milstein CF, Patel RR, Laurash E, Kampert M. Identification of respiration sample dysfunction in athletes with exercise-induced laryngeal obstruction: a novel evaluation instrument. J Voice. (2023) S0892-1997(23)00006-1. doi: 10.1016/j.jvoice.2023.01.006
PubMed Summary | Crossref Full Textual content | Google Scholar
44. Jansrud Hammer I, Halvorsen T, Vollsaeter M, Hilland M, Heimdal JH, Roksund OD, et al. Conundrums within the breathless athlete; exercise-induced laryngeal obstruction or bronchial asthma? Scand J Med Sci Sports activities. (2022) 32(6):1041–9. doi: 10.1111/sms.14137
PubMed Summary | Crossref Full Textual content | Google Scholar
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