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.