The evaluation of Exercise Induced Laryngeal Obstruction (EILO) performed by inexperienced physicians

Abstract

Introduction: Exercise Induced Laryngeal Obstruction (EILO) is a common cause of exertional breathing problems. The Continuous laryngoscopy exercise test (CLE test) is recognized as the gold standard for the diagnosis of EILO. It is a real time subjective evaluation of the laryngeal obstruction, quantified by the CLE score, ranging from 0 to 3 at the glottic and supraglottic level at moderate and maximum intensity. Studies addressing the validity of the CLE score have reached variable conclusions, but it remains the most practical scoring system to classify EILO severity.

Aim: To compare the CLE-scores set by inexperienced versus experienced clinicians.

Methods: Thirty CLE test videos were randomly selected from more than 1500 CLE-tests in the EILO Registry at Haukeland University Hospital. Two experienced clinicians evaluated the films by consensus. Blinded to the experts’ evaluation, two resident doctors at the Children and Youth Clinic with relatively short experience with EILO, evaluated the same recordings by consensus.

Results: The residents set higher CLE scores than the experts, with a mean difference sum score of -0.6 (SD 1.22). The score on the glottic level at maximum effort was most diverging, with a mean difference score 0.4 (SD 0.67), whereas the supraglottic score at maximum effort had a mean difference score of 0.07 (SD 0.52).

Conclusion: The glottic score at maximum intensity differed the most compared to the other scores. We argue that CLE-evaluation needs practice of at least 30 evaluations in addition to supervision. Evaluation done by the inexperienced doctors may be sufficient for clinical use, but not adequate for research.