Fujiki Robert Brinton, Venkatraman Anumitha, Thibeault Susan L
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.
Department of Surgery, University of Wisconsin-Madison.
Am J Speech Lang Pathol. 2025 May 6;34(3):1269-1288. doi: 10.1044/2025_AJSLP-24-00430. Epub 2025 Apr 21.
The goal of this study was to examine current speech-language pathologist (SLP) practice patterns in the diagnosis and treatment of induced laryngeal obstruction (ILO; both exercise- and irritant-induced variants: exercise-induced laryngeal obstruction [EILO]/ILO).
One hundred ninety-one SLPs from throughout the United States were surveyed regarding practice patterns for diagnosing and treating EILO/ILO. SLPs were queried regarding diagnostic procedures, treatment practices, outcome measures, rescue breathing strategies utilized, and discharge criteria employed within their clinical practice. SLPs rated their confidence in treating EILO/ILO using a visual analog scale. Clinician confidence was compared across SLPs working in different settings, with different populations, and with varying access to diagnostic equipment/collaborators. Median income of facility neighborhood and clinician experience were also considered.
Most SLPs reported that patients with EILO/ILO were diagnosed using laryngoscopy (with or without videostroboscopy) either at rest or following exercise. Only 4.7% of respondents indicated that their patients had access to continuous laryngoscopy during exercise (CLE) for diagnosing EILO. The Dyspnea Index was the most common patient-reported outcome measure for both EILO and ILO. SLPs reported high confidence levels in rescue breathing techniques, and informal patient report was the most common method of tracking therapeutic progress. Forty-one percent of SLPs voiced the need for increased access to diagnostic equipment (CLE or laryngoscopy), and 51.8% expressed the need for exercise facilities (i.e., treadmills or places to have patients run). Clinicians reported significantly higher levels of confidence treating EILO as opposed to ILO ( < .001). Collaborating with a laryngologist ( < .001), more years of experience ( = .025), and wealthier median income of practice setting ( = .014) predicted increased confidence in treating EILO/ILO.
SLPs may have limited access to the most effective facilities and diagnostic equipment designed to identify EILO/ILO. Continuing research is needed to provide SLPs with evidence-based diagnostic procedures, treatment strategies, and outcome measures to enhance EILO/ILO intervention for all patients.
本研究的目的是调查当前言语语言病理学家（SLP）在诱导性喉梗阻（ILO；包括运动性和刺激性诱导变体：运动性诱导喉梗阻 [EILO]/ILO）诊断和治疗方面的实践模式。
对来自美国各地的191名SLP进行了关于EILO/ILO诊断和治疗实践模式的调查。询问了SLP在其临床实践中有关诊断程序、治疗方法、结果测量、所采用的急救呼吸策略以及出院标准等问题。SLP使用视觉模拟量表对他们治疗EILO/ILO的信心进行评分。比较了在不同环境、针对不同人群以及使用不同诊断设备/合作者的SLP之间的临床医生信心。还考虑了医疗机构所在社区的中位数收入和临床医生经验。
大多数SLP报告称，EILO/ILO患者通过在静息状态或运动后进行喉镜检查（有或无视频频闪喉镜检查）来诊断。只有4.7%的受访者表示他们的患者在运动期间能够进行连续喉镜检查（CLE）以诊断EILO。呼吸困难指数是EILO和ILO患者报告的最常见结果测量指标。SLP报告在急救呼吸技术方面信心较高，非正式的患者报告是跟踪治疗进展的最常见方法。41%的SLP表示需要增加使用诊断设备（CLE或喉镜检查）的机会，51.8%表示需要运动设施（即跑步机或让患者跑步的场所）。临床医生报告称，与治疗ILO相比，治疗EILO时的信心水平显著更高（<0.001）。与喉科医生合作（<0.001）、更多年的经验（=0.025）以及医疗机构所在社区更高的中位数收入（=0.014）预示着治疗EILO/ILO的信心增加。
SLP可能难以获得用于识别EILO/ILO的最有效设施和诊断设备。需要持续开展研究，为SLP提供基于证据的诊断程序、治疗策略和结果测量方法，以加强对所有患者的EILO/ILO干预。
