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P22 Inducible laryngeal obstructions causing breathing problems: a study classifying patients’ laryngoscopic presentations according to the ers/els/accp 2013 international consensus conference nomenclature
  1. C Slinger1,
  2. J Blakemore1,
  3. R Slinger2,
  4. A Vyas1
  1. 1Lancashire Teaching Hospitals, Preston, UK
  2. 2Lancaster University, Lancaster, UK


Introduction and Objectives An international task force proposed the term ‘Inducible Laryngeal Obstruction’ (Ilo) to describe a group of conditions which, in the literature, has over 40 descriptive terms, including, vocal cord dysfunction (VCD). The resultant nomenclature describes and details a range of laryngeal manifestations that create an obstruction to inspiratory or expiratory airflow. This study aims to trial the use of the ‘laryngeal findings’ aspect of the nomenclature to describe features of Ilo and to gain insight into the practicality of using these definitions in clinical practice.

Method Twenty-two prospective and twenty-eight retrospective analyses of video laryngoscopic assessments for Ilo were classified in a cohort of patients referred to our Tertiary Airways service who had no uncontrolled underlying respiratory symptoms. These video-laryngeal recordings were classified according to the consensus laryngeal nomenclature. The assessments were classified according to: onset of obstruction (glottic, supraglottic, or both), phase of respiratory cycle (inspiratory, expiratory, or both), onset timing (fast or slow) and resolution of symptoms (fast or slow). These classifications were conducted by two respiratory speech and language therapists and a consultant respiratory physician with extensive experience of completing such assessments to obtain diagnosis, with consensus being achieved before final rating.

Results Forty percent of patients had combined glottic and supraglottic presentation, 31% supraglottic and 29% glottic only. The majority of patients (61%) had sole inspiratory obstruction, and 67% had a fast onset of symptoms. Sixty-seven percent also had a fast resolution of symptoms; although this could not be reliably documented, as in our laryngoscopy protocol, when symptomatic, the SLT demonstrates to the patient how to reverse the obstruction with laryngeal control techniques following challenge testing to minimise patient distress, and begin therapy.

Conclusion This classification system can be useful to accurately describe laryngoscopic findings during Ilo assessment. This system is now incorporated into our reporting practices to increase capture of Ilo diagnosis. The inclusion of supraglottic presentation with symptoms supports accurate diagnosis and treatment and further understanding of Ilo.

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