Exercise-Induced Laryngeal Obstruction: A Randomized Controlled Trial of Surgical Treatment

Surgery is used to treat exercise-induced laryngeal obstruction (EILO), but high-quality evidence remains limited. We therefore conducted a surgical randomized controlled trial (RCT) evaluating full supraglottoplasty (FSP), minimally invasive supraglottoplasty (MISP), and a wait-and-see control group.

Patients with symptomatic supraglottic EILO despite conservative management were randomized to FSP, MISP, or control. FSP involved aryepiglottic fold incisions including the tip of the cuneiform tubercle, whereas MISP included six laser punctures in the aryepiglottic folds. Continuous laryngoscopy during exercise (CLE) was performed before and after interventions. Laryngeal obstruction was graded at glottic and supraglottic levels during moderate and maximal exercise (CLE scores). Breathing problems were assessed using patient-reported outcome measure (PROM).

Forty-one patients were randomized to FSP (n = 13), MISP (n = 15), or control (n = 13). Between-group comparisons showed that FSP was superior to controls regarding supraglottic CLE scores at moderate intensity (p = 0.036), glottic and supraglottic CLE scores at maximum intensity (p = 0.047 and p < 0.001, respectively). FSP was also superior to MISP for supraglottic CLE scores at maximal intensity (p < 0.001). MISP did not differ from controls for any CLE outcomes. FSP reduced PROM for general breathing difficulties compared to controls (p < 0.001), and MISP (p = 0.042); both FSP and MISP reduced breathing-related PROM during activity (p = 0.039 and p = 0.022, respectively), without corresponding improvements in CLE outcomes for MISP.

In patients with supraglottic EILO refractory to conservative management, FSP improved both CLE scores and patient-reported outcomes. These findings provide support for FSP in carefully selected patients considered for surgical treatment, while the role of MISP remains uncertain.