Skip to main content
Log in

Audiovisual assessment of exercise-induced laryngeal obstruction: reliability and validity of observations

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Variable obstruction to airflow at the laryngeal level may cause respiratory distress during exercise. The Continuous Laryngoscopy Exercise (CLE)-test enables direct visualization of the larynx during ongoing exercise. The aims of this study were to establish a scoring system for laryngeal obstruction as visualized during the CLE-test as well as to assess reliability and validity of this scoring system. Continuous video recording of the larynx was performed in parallel with continuous video recording of the upper part of the body, and recording of breath sounds in 80 patients and 20 symptom-negative volunteers, running on a treadmill to respiratory maximal tolerable distress or exhaustion. Each participant scored the degree of symptoms during exercise. The scoring system contains four sub-scores, each graded from 0 to 3. Two independent laryngologists, blinded to clinical data, scored the video recordings of the larynx twice. The proportion of inter- and intra-observer agreement (equal scores) for each sub-score through these four sessions varied between 70 and 100% (weighted κ values varied from 0.49 to 1.00 correspondingly). A positive correlation was found between CLE-test sum score and symptom score (ρ = 0.75, P < 0.001). There was a significant difference in CLE-test sum score between patients (3.34 ± 1.34) and volunteers (0.65 ± 0.66) (P < 0.001). The single CLE-test sub-score that correlated most strongly with symptom score was glottic adduction at maximal effort (ρ = 0.75, P < 0.001). The presented scoring system is reliable and valid, and we suggest that it can be used when laryngeal function during exercise is evaluated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cole P, Savard P, Miljeteig H, Haight JS (1993) Resistance to respiratory airflow of the extrapulmonary airways. Laryngoscope 103:447–450

    Article  CAS  PubMed  Google Scholar 

  2. England SJ, Bartlett D Jr (1982) Changes in respiratory movements of the human vocal cords during hyperpnea. J Appl Physiol 52:780–785

    CAS  PubMed  Google Scholar 

  3. Bent JPIII, Miller DA, Kim JW, Bauman NM, Wilson JS, Smith RJ (1996) Pediatric exercise-induced laryngomalacia. Ann Otol Rhinol Laryngol 105:169–175

    PubMed  Google Scholar 

  4. Beaty MM, Hoffman HT (1999) Impact of laryngeal paralysis and its treatment on the glottic aperture and upper airway flow characteristics during exercise. Otolaryngol Head Neck Surg 120:819–823

    Article  CAS  PubMed  Google Scholar 

  5. Heimdal JH, Roksund OD, Halvorsen T, Skadberg BT, Olofsson J (2006) Continuous laryngoscopy exercise test: a method for visualizing laryngeal dysfunction during exercise. Laryngoscope 116:52–57

    Article  PubMed  Google Scholar 

  6. Maat RC, Roksund OD, Olofsson J, Halvorsen T, Skadberg BT, Heimdal JH (2007) Surgical treatment of exercise-induced laryngeal dysfunction. Eur Arch Otorhinolaryngol 264:401–407

    Article  PubMed  Google Scholar 

  7. Andrianopoulos MV, Gallivan GJ, Gallivan KH (2000) PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it? J Voice 14:607–618

    Article  CAS  PubMed  Google Scholar 

  8. Appelblatt NH, Baker SR (1981) Functional upper airway obstruction. A new syndrome. Arch Otolaryngol 107:305–306

    CAS  PubMed  Google Scholar 

  9. Bjornsdottir US, Gudmundsson K, Hjartarson H, Brondbo K, Magnusson B, Juliusson S (2000) Exercise-induced laryngochalasia: an imitator of exercise-induced bronchospasm. Ann Allergy Asthma Immunol 85:387–391

    Article  CAS  PubMed  Google Scholar 

  10. Mandell DL, Arjmand EM (2003) Laryngomalacia induced by exercise in a pediatric patient. Int J Pediatr Otorhinolaryngol 67:999–1003

    Article  PubMed  Google Scholar 

  11. Smith RJ, Bauman NM, Bent JP, Kramer M, Smits WL, Ahrens RC (1995) Exercise-induced laryngomalacia. Ann Otol Rhinol Laryngol 104:537–541

    CAS  PubMed  Google Scholar 

  12. Gessler EM, Simko EJ, Greinwald JH Jr (2002) Adult laryngomalacia: an uncommon clinical entity. Am J Otolaryngol 23:386–389

    Article  PubMed  Google Scholar 

  13. Rundell KW, Spiering BA (2003) Inspiratory stridor in elite athletes. Chest 123:468–474

    Article  PubMed  Google Scholar 

  14. Carlsen KH, Carlsen KC (2002) Case 3: assessment. Exercise-induced inspiratory laryngeal stridor. Paediatr Respir Rev 3:162–164

    PubMed  Google Scholar 

  15. Christensen P, Thomsen SF, Rasmussen N, Backer V (2007) Exercise-induced inspiratory stridor. An important differential diagnosis of exercise-induced asthma. Ugeskr Laeger 169:4047–4050

    PubMed  Google Scholar 

  16. Lakin RC, Metzger WJ, Haughey BH (1984) Upper airway obstruction presenting as exercise-induced asthma. Chest 86:499–501

    Article  CAS  PubMed  Google Scholar 

  17. Landwehr LP, Wood RPII, Blager FB, Milgrom H (1996) Vocal cord dysfunction mimicking exercise-induced bronchospasm in adolescents. Pediatrics 98:971–974

    CAS  PubMed  Google Scholar 

  18. Altman DG (1991) Inter-rater agreement. Practical statistics for medical research. Chapman & Hall, London, pp 403–412

    Google Scholar 

  19. Morris MJ, Deal LE, Bean DR, Grbach VX, Morgan JA (1999) Vocal cord dysfunction in patients with exertional dyspnea. Chest 116:1676–1682

    Article  CAS  PubMed  Google Scholar 

  20. Maschka DA, Bauman NM, McCray PB Jr, Hoffman HT, Karnell MP, Smith RJ (1997) A classification scheme for paradoxical vocal cord motion. Laryngoscope 107:1429–1435

    Article  CAS  PubMed  Google Scholar 

  21. Hurbis CG, Schild JA (1991) Laryngeal changes during exercise and exercise-induced asthma. Ann Otol Rhinol Laryngol 100:34–37

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The major funding institution is Haukeland University Hospital, 5021 Bergen, Norway. The Innovest research program gave support in order to fulfill this project. The equipment for transnasal flexible laryngoscopy, video and sound recordings were for a period borrowed from Olympus, Norway.

Conflict of interest statement

Sponsors were not involved and had no impact on the study design, in the collection, analysis, and interpretation of data, in the writing of the report, nor in the decision to submit the article for publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert Christiaan Maat.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maat, R.C., Røksund, O.D., Halvorsen, T. et al. Audiovisual assessment of exercise-induced laryngeal obstruction: reliability and validity of observations. Eur Arch Otorhinolaryngol 266, 1929–1936 (2009). https://doi.org/10.1007/s00405-009-1030-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-009-1030-8

Keywords

Navigation