Exercise-Induced Laryngeal Obstruction: A Randomized Controlled Trial of Surgical Treatment
In brief
Full supraglottoplasty improves obstruction scores and breathing symptoms in EILO
In a randomized trial of 41 patients with supraglottic exercise-induced laryngeal obstruction, full supraglottoplasty lowered laryngoscopic obstruction scores at both moderate and maximal exercise and markedly reduced patient-reported breathing difficulty compared with watchful waiting. Minimal-invasive supraglottoplasty showed no objective benefit, leaving its role unclear.
- Journal
- The Laryngoscope (Q1)
- Published
- 19 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Lorentz Sandvik, Sivert Veseth Helland, Haakon Kristian Kvidaland, Hans Jørgen Aarstad, Petter Helø Carlsen, Hege H Clemm, et al.
- PMID
- 42615212
- DOI
- 10.1002/lary.70820
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 23 August 2026): RCT of surgical treatment for exercise‑induced laryngeal obstruction
Abstract
OBJECTIVE: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.