Heredity of supraglottic exercise-induced laryngeal obstruction

Respiratory symptoms on exertion, such as shortness of breath and wheezing, are commonly associated with asthma, but might also arise from the larynx [1–3]. In recent years, the emergence of exercise laryngoscopy [4] has led to a better understanding of laryngeal movement during exercise, and inspiratory supraglottic collapse on exertion has been established as a common cause of exertional breathlessness [5] that is correlated with exercise intensity [6]. Both glottic and supraglottic inspiratory closure are more commonly seen in females and most often in adolescents or young adults [7–11]. This predominance has yet to be explained; however, gender differences in larynx size/growth and consequently higher “Bernoulli forces” in females for a given respiratory demand could be a contributing factor [5]. Thus, an inherited disorder affecting laryngeal growth could also explain why the condition usually presents in adolescence [12, 13]. A recent study by Hilland and colleagues [14] describing an association between congenital laryngomalacia and (mainly supraglottic) laryngeal closure in adolescence, points out a likely predisposition for supraglottic exercise-induced laryngeal obstruction (EILO), whereas case studies have demonstrated that congenital laryngomalacia can be inherited [15, 16].