In hospital – conservative versus surgical
The indication, timing, and nature of surgical intervention have been
largely dictated based on single centre case series. There is thus great
heterogeneity with the surgical approach(4,5). Bent et al(6) reviewed 77
patients with laryngeal trauma and concluded that conservative treatment
of Schaefer group 1 and 2 injuries was 100% effective and surgical
repair within 48 hours for those requiring surgery improved outcomes.
Our patient was Becker group 2 with no indication for early surgical
intervention. The later development of trauma induced EILO necessitated
arytenoidectomy. EILO is a cause of exertional breathing
difficulties(7). The vast majority of cases are caused by supraglottic
closure of the laryngeal inlet(8). It is diagnosed using CLE(3), which
allows visualisation of the larynx during incremental bouts of exercise.
Treatment options vary greatly by centre and include specialist SLT for
laryngeal control, physiotherapy for breathing pattern work and
surgery(9). Due to the severity of the EILO and the lack of full symptom
resolution with conservative treatment, our patient was deemed to be a
candidate for surgery. We believe this to be the first case of trauma
induced EILO treated with arytenoidectomy.