FRCS (ORL-HNS) · SECTION 1 SBA

Inducible laryngeal obstruction

A competitive athlete has abrupt inspiratory difficulty and throat tightness at peak exercise. Spirometry is normal between attacks and asthma therapy has failed. Which test best establishes the diagnosis?

CHOOSE ONE ANSWER

Best of five

  1. A. Resting chest radiography
  2. B. Methacholine challenge alone
  3. C. Resting flexible nasendoscopy only
  4. D. Continuous laryngoscopy during exercise
  5. E. Empirical tracheostomy
ANSWER AND REASONING

D. Continuous laryngoscopy during exercise

Because inducible laryngeal obstruction is episodic, diagnosis requires visualising the larynx during symptoms; this also guides breathing retraining or selected surgery.

Why every option is right or wrong

A. Resting chest radiography: This does not show episodic glottic/supraglottic closure.

B. Methacholine challenge alone: It tests bronchial hyperresponsiveness and cannot visualise laryngeal obstruction.

C. Resting flexible nasendoscopy only: The larynx may look normal outside the trigger.

D. Continuous laryngoscopy during exercise: Real-time visualisation during the provoking activity demonstrates the level and timing of inappropriate closure.

E. Empirical tracheostomy: This is unjustified without diagnosis and conservative therapy.

What if the scenario changed?

If expiratory wheeze, reduced FEV1 and bronchodilator reversibility were present, exercise-induced bronchoconstriction would become more likely.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.

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