Exercise Induced Laryngeal Obstruction in a Collegiate Runner: A Case Report of a Novel Therapy

Abstract

A 23-year-old male Division I distance runner presented with several years of exertional stridor (high-pitched inspiratory noise caused by airflow obstruction), previously diagnosed as exercised-induced laryngeal obstruction (EILO), a condition formerly known as vocal cord dysfunction and exercised-induced paradoxical vocal fold motion.  Over the course of roughly 3 years, the patient had previously failed conventional and invasive respiratory therapies for EILO including respiratory retraining, inspiratory muscle training, reflux suppression, allergy suppression, amitriptyline, performance psychology, and injection of botulinum toxin to the larynx.  At a referral center that specializes in the treatment of EILO, the patient's diagnosis was confirmed through the use of a new procedure called continuous laryngoscopy during exercise.  He underwent three sessions of a unique procedure called therapeutic laryngoscopy during exercise (which relies on real-time laryngoscopy footage as biofeedback during exercise) and learned novel breathing techniques to address the problem. It is common to misdiagnose exercise induced respiratory problems based on patients-described symptoms alone. Athletic trainers should be able to recognize EILO cases and feel comfortable contacting and collaborating with expert providers on appropriate treatment.  This case is also important in that it documents a treatment failure of laryngeal injection of botulinum toxin for EILO, something not previously reported in the literature.