Dataset Information

A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction.

ABSTRACT:

Objectives

Exercise-induced laryngeal obstruction (EILO) is a condition causing breathing difficulties and stridor during exercise. The condition has in severe cases been treated surgically with supraglottoplasty. The purpose of this systematic review is to assess the evidence and recommendations for surgical intervention in treating patients with EILO.

Methods

A systematic search was performed in PubMed and Embase to identify relevant studies describing surgical treatment of patients diagnosed with severe EILO. According to eligibility criteria, data were independently extracted by two reviewers. To assess the risk of bias of each included study, the Newcastle-Ottawa scale (NOS) was used.

Results

The screening process identified 11 observational studies with a total of 75 patients. Findings indicated that many beneficial outcomes are to be found in surgical treatment for EILO. These indications were found both on visual verification of improvement of the laryngeal obstruction during exercise and patient self-reported symptom severity. The average NOS score (4.3) indicated low level of evidence in the included studies.

Conclusion

Studies reporting effects of surgical treatment of EILO have shown promising results in patients with laryngeal obstruction. However, the heterogeneity of study methodologies and the level of evidence precludes definitive recommendations for or against supraglottoplasty at this time; prospective and methodologically robust studies are now needed.

Level of evidence

SUBMITTER: Siewers K

PROVIDER: S-EPMC6476268 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction.

Siewers Karina K Backer Vibeke V Walsted Emil Schwarz ES

Laryngoscope investigative otolaryngology 20190306 2

<h4>Objectives</h4>Exercise-induced laryngeal obstruction (EILO) is a condition causing breathing difficulties and stridor during exercise. The condition has in severe cases been treated surgically with supraglottoplasty. The purpose of this systematic review is to assess the evidence and recommendations for surgical intervention in treating patients with EILO.<h4>Methods</h4>A systematic search was performed in PubMed and Embase to identify relevant studies describing surgical treatment of pati ...[more]

PMID: 31024992

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Project description:Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video and gastric, esophageal, and transdiaphragmatic pressures, diaphragm electromyography, and respiratory airflow. The EILO and control groups had similar peak work rates and minute ventilation (V?e) (work rate: 227 ± 35 vs. 237 ± 35 W; V?e: 103 ± 20 vs. 98 ± 23 l/min; P > 0.05). At submaximal work rates (140-240 W), subjects with EILO demonstrated increased work of breathing ( P < 0.05) and respiratory neural drive ( P < 0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure ( P < 0.05). Unexpectedly, a ventilatory increase ( P < 0.05), driven by augmented tidal volume ( P < 0.05), was seen in subjects with EILO before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video, we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation. NEW & NOTEWORTHY Exercise-induced laryngeal obstruction is a prevalent cause of exertional dyspnea in young individuals; yet, how laryngeal closure affects breathing is unknown. In this study we synchronized endoscopic video with respiratory physiological measurements, thus providing the first detailed commensurate assessment of respiratory mechanics and neural drive in relation to laryngeal closure. Laryngeal closure was associated with increased work of breathing and respiratory neural drive preceded by an augmented tidal volume and a rise in minute ventilation.

Project description:BackgroundMultiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach.MethodsA systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques.ResultsA total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR?=?0.09, 95%CI:0.05-0.19; p <?0.001; LP: OR?=?0.51, 95%CI:0.31-0.84; p =?0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR?=?0.62; 95%CI:0.41-0.95; p =?0.027; RP: OR?=?0.41; 95%CI:0.22-0.79; p =?0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean?=?102.87?min, 95%CI:41.79?min-163.95?min, p =?<?0.001). Further significant differences in operating times were detected when comparing LP to EP (mean?=?115.13?min, 95%CI:65.63?min-164.63?min, p =?<?0.001) and OP to EP (mean?=?91.96?min, 95%CI:32.33?min-151.58?min, p =?0.003).ConclusionsMultiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

Dataset Information

A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction.

Objectives

Methods

Results

Conclusion

Level of evidence

Publications

A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction.

Similar Datasets

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