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Master Thesis

Prise en charge diagnostique de l’obstruction laryngée Induite par l’effort (OLIE)

Abstract : Introduction: Exercise induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. Visualization of the obstruction while the patient is experiencing the symptoms during a continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. The challenge for any otolaryngologist is to identify patients highly suspicious of EILO on history taking and physical examination for further diagnostic workup. Our study aims to evaluate the prevalence of EILO in a population presenting exercise induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objectives were to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs) while considering continual laryngoscopy during exercise (CLE-test) as the gold standard examination and to seek for clinical predictive characteristics of the diagnostic. Materials and Methods: All patients referred to our center for EIIS or uncontrolled asthma from January 1st, 2018 to March 31st, 2020 were included. Subglottic stenosis, vocal cord paralysis or tracheobronchomalacia were excluded. All patients had LC and PFTs to detect asthma. EILO diagnosis was made if Maat score was >2 for patients with CLE-test or if there were inspiratory anomalies at PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as gold standard. Results: During this period, 62 patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with asthma associated with 9 patients (18%). CLE-test confirmed the diagnosis in 18 patients. Within this population, 6 patients had severe obstruction, 6 patients had glottic EILO and 12 patients had subglottic EILO. The sensibility and specificity of LC for subglottic anomalies were 75% and 60% respectively. The sensibility and specificity of PFTs were 61% and 89% respectively. There were significant statistical differences for cough (OR = 0,22 [IC 95, 0,06-0,81]), wheezing (OR = 0,09 [IC 95, 0,001-0,85]) and burning in the throat (OR = 5,25 [IC 95, 1,38-19,92]) and presence of morphologic anomalies in laryngoscopy (OR = 6 [IC 95, 1,6-22,3]) between both groups EILO+ and EILO-. Conclusion: There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. LC and PFTs were highly effective in the diagnostic management of EILO. Some anamnestic characteristics and laryngoscopic findings might guide to diagnosis. Nevertheless CLE-test remained the gold standard tool for EILO diagnosis and for identification of the dysfunctional upper airway site in order to provide specific conservative and surgical management.
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Master Thesis
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Submitted on : Thursday, October 8, 2020 - 5:33:10 PM
Last modification on : Thursday, October 15, 2020 - 2:09:48 PM

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  • HAL Id : dumas-02961846, version 1

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Ludovic Giraud. Prise en charge diagnostique de l’obstruction laryngée Induite par l’effort (OLIE). Médecine humaine et pathologie. 2020. ⟨dumas-02961846⟩

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