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Related Experiment Video

Updated: May 10, 2026

Minimally Invasive Murine Laryngoscopy for Close&#45;Up Imaging of Laryngeal Motion During Breathing and Swallowing
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Eucapnic voluntary hyperventilation in diagnosing exercise-induced laryngeal obstructions.

Pernille M Christensen1, Niels Rasmussen

  • 1Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark, piller82@yahoo.com.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|June 5, 2013
PubMed
Summary

The eucapnic voluntary hyperventilation (EVH) test can induce exercise-induced laryngeal obstructions (EILOs), similar to exercise tests. However, adjustments are needed to improve laryngeal visualization during EVH for better diagnosis of these respiratory symptoms.

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Area of Science:

  • Sports Medicine
  • Respiratory Physiology
  • Otolaryngology

Background:

  • Exercise-induced laryngeal obstructions (EILOs) are a key differential diagnosis for exercise-related respiratory symptoms (ERRS), often mistaken for exercise-induced asthma.
  • Current diagnostic approaches for EILOs involve provocation to induce obstruction, followed by laryngoscopic verification.
  • The efficacy of eucapnic voluntary hyperventilation (EVH) as a diagnostic tool for EILOs requires further investigation.

Purpose of the Study:

  • To evaluate if the eucapnic voluntary hyperventilation (EVH) test can induce laryngeal obstructions with subtypes and developmental patterns comparable to those observed during exercise testing.
  • To assess the diagnostic accuracy and usability of EVH compared to exercise testing for identifying EILOs.

Main Methods:

  • A comparative study involving continuous laryngoscopy during both EVH and exercise testing in national athletic teams (n=67).
  • Laryngoscopic recordings were analyzed for obstruction subtypes, severity (using Eilomea and CLE-score), and overall usability.
  • Participants reported on their exercise-related respiratory symptoms (ERRS) and symptom match between provocation tests and regular training.

Main Results:

  • No significant differences were found in EILO subtypes, symptom experience, sensitivity, or specificity between EVH and exercise testing.
  • Exercise testing yielded significantly more usable recordings than EVH, primarily due to mucus interference with the fiber-laryngoscope during EVH.
  • The Eilomea method, requiring high-quality recordings, was only applicable to six athletes from both tests, but showed a linear correlation for glottic obstruction.

Conclusions:

  • Eucapnic voluntary hyperventilation (EVH) is capable of inducing exercise-induced laryngeal obstructions (EILOs) with similar characteristics to those seen during exercise.
  • The current EVH test protocol requires modifications to enhance laryngeal visualization, addressing issues like mucus buildup, for improved diagnostic reliability.
  • Further refinement of the EVH test is necessary to establish it as a robust and consistent diagnostic method for EILOs and exercise-related respiratory symptoms.