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Optimizing the Diagnosis and Management of Pediatric Inducible Laryngeal Obstruction
Alaa Alanazi1, Carolin Aizouki2, Janelle Sloychuk1
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Insights
Pediatric inducible laryngeal obstruction (ILO) is challenging to diagnose and treat, often leading to prolonged symptoms. Exercise-induced symptoms are common, and while some treatments show success, many children experience persistent issues.
Area of Science:
- Pediatric Pulmonology
- Laryngology
- Respiratory Medicine
Background:
- Pediatric inducible laryngeal obstruction (ILO) presents diagnostic and therapeutic challenges.
- Patients frequently experience delayed diagnosis and limited data on long-term outcomes.
Purpose of the Study:
- To analyze the presentation, diagnostic workup, and management of pediatric ILO cases.
- To identify factors influencing diagnosis and treatment outcomes in children with ILO.
Main Methods:
- Retrospective and prospective review of pediatric patients diagnosed with ILO from 2015-2023.
- Data collection included demographics, diagnostic tests, referrals, symptom burden, management, and outcomes.
- Descriptive analysis and study of factors affecting time to symptom resolution.
Main Results:
- 78 pediatric patients were included; 75% were female, average age 14 years.
- Most cases were exercise-related, and many were initially misdiagnosed as asthma.
- Breathing exercises were the most common and successful non-surgical treatment; surgery was effective in a small group. Median resolution time was 12 months, with 36% experiencing persistent symptoms beyond 3 years.
Conclusions:
- Pediatric ILO is often diagnosed late, with exercise triggers being most frequent.
- Current management strategies show variable success, and a significant proportion of patients endure prolonged symptoms.
- Further research is needed to optimize diagnostic and therapeutic approaches for pediatric ILO.
Background:
Pediatric inducible laryngeal obstruction (ILO) is difficult to diagnose and treat. Patients often undergo multiple specialist referrals, and long-term outcomes are not well reported.
Objectives:
To investigate the patterns of presentation, workup, and management of children who were diagnosed with ILO at the Stollery Children's Hospital.
Methods:
Retrospective review with a prospective cohort of pediatric patients diagnosed with ILO from 2015 to 2023. We collected the demographic data, diagnostic tests, specialist referrals, time to diagnosis, symptom burden, associated comorbidities and aggravating factors, management, and treatment outcomes. A subset of patients was followed prospectively to determine treatment outcomes. A basic descriptive analysis was performed, and factors associated with time to resolution were studied.
Results:
Seventy-eight patients met the criteria for inclusion, with 22 completing prospective questionnaires. The average age was 14 years old, and 75% were female. The majority required multiple specialist referrals. The majority were associated with exercise. Thirty-two (41%) patients had a presumed diagnosis of asthma, despite only four pulmonary function tests being consistent with asthma. Abortive breathing exercises were the most commonly employed (95%) and most successful (61%) nonsurgical management technique. Surgery was highly successful in a small cohort of patients. Median time to symptom resolution was 12 months, with 36% reporting symptoms persistent beyond 3 years.
Conclusions:
Pediatric ILO often goes undiagnosed for prolonged periods. Exercise-related symptoms are the most common. Management strategies have varied levels of success and a large proportion of patients have prolonged symptoms despite treatment, as supported by other recent evidence.
Level Of Evidence:
3 Laryngoscope, 135:1207-1211, 2025.
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