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Shembel, Adrianna (2018) EXERCISE-INDUCED EPISODIC LARYNGEAL BREATHING DISORDERS: CLINICAL FEATURES AND MECHANISMS. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Introduction: Exercise-induced episodic laryngeal breathing disorders (E-ELBD) are frequently misdiagnosed, leading to protracted periods of mismanagement (Bernstein, 2014; Traister, Fajt, & Petrov, 2016). These shortcomings are due to gaps in differential diagnosis of ELBD. A poor understanding of underlying mechanisms driving clinical expression further complicates ELBD management. Therefore, objectives of the proposed dissertation study were to (1) identify clinical benchmarks indicative of E-ELBD and (2) investigate two potential mechanisms driving E-ELBD: autonomic imbalance and stress reactivity (temperament).

Methods: 13 adolescent athletes with E-ELBD and 14 athletic volunteers participated in an exercise challenge and simultaneous flexible laryngoscopy. Participants were asked to rate their symptoms at rest and exercise from a list of symptoms associated with ELBD using a visual analog scale. Participants were then asked to complete the Early Adolescent Temperament Questionnaire (EATQ-R) Fear Subscale to measure perceived stress reactivity. Cardiovascular measures were taken throughout the protocol to evaluate autonomic responses. Glottal configuration and supraglottic responses at rest and exercise were analyzed post hoc using recorded endoscopic videos.

Results: Statistical differences between group and condition were seen with dyspnea severity and glottal configuration (p < .05). Other clinical features prevalent in the E-ELBD cohort—arytenoid prolapse, throat tightness, and stridor—were variably present amongst individuals with and without E-ELBD. Smaller sympathetic responses to vigorous exercise and faster parasympathetic reactivation post-exertion were observed in the E-ELBD group compared to controls. However, differences were not statistically significant (p > 0.05). Finally, responses on the Fear Subscale of the EATQ-R showed stress reactivity to be similar between the two groups, with significant differences between the athletes and the general adolescent population (p < .001).

Conclusion: Results showed inspiratory glottal configuration (> 8° adduction) and dyspnea (> 30/100 on VAS) with provocation to be good diagnostic indicators of E-ELBD. Blunted expiratory abduction responses in the E-ELBD group (< 32° abduction) suggests respiratory compensation. Sympathovagal balance may play a role in E-ELBD and should be further investigated. Caution should be exercised when extrapolating the role of temperament in E-ELBD pathogenesis. Outcomes can improve clinical management and sensitivity of inclusionary criteria for future studies.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ContributionContributors NameEmailPitt UsernameORCID
Committee Co-ChairVerdolini-Abbott, Katherinekittie@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee Co-ChairShaiman, Susanshaiman@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberCoyle, Jamesjcoyle@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberYaruss, J. Scottjsy@msu.eduUNSPECIFIEDUNSPECIFIED
Committee MemberVan Swearingen, Jessiejessievs@pitt.eduUNSPECIFIEDUNSPECIFIED
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee CoChairShaiman,
Committee CoChairVerdolini-Abbott,
Committee MemberCoyle,
Committee MemberVan Swearingen,
Committee MemberYaruss, Scott
Date: 10 January 2018
Date Type: Publication
Defense Date: 15 November 2017
Approval Date: 10 January 2018
Submission Date: 4 December 2017
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 256
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Communication Science and Disorders
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Paradoxical vocal fold motion disorder, quantitative methods, exercise induced laryngeal obstruction, temperament, autonomic function, sympathovagal balance
Date Deposited: 10 Jan 2018 15:12
Last Modified: 10 Jan 2018 15:12

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