Establishing an EILO/CLE Service in a Clinic

Establishing an EILO/CLE service is an evidence-based way to provide assessment and treatment for individuals with EILO. The approach has been shown to improve diagnosis, reduce symptoms and foster clinical and research capability. However the global availability of such services is limited.

As with any clinical service, EILO testing requires suitable facilities and resources as well as skilled personnel. Here are some key considerations:

It is crucial to promote the availability of these services among patients, referring physicians, trainers, and other relevant stakeholders. Disseminating awareness of the service accessibility is essential within environments where patients with EILO may seek assistance.

Ensure the availability of skilled personnel with necessary expertise in EILO as well as in exercise testing, respiratory medicine, laryngology, and exercise physiology. It may be advantageous for the test to be conducted by two core individuals, one being an overseeing physician and the other a technician/physiologist.

An adequate administrative infrastructure for efficient diagnostic services, treatment and follow-up is preferable.

A record-keeping system that can handle not only written information but also the video recordings generated from the CLE test, is preferable This is important for downstream evaluation and documentation of findings.

• Ensure that suitable physical facilities are present.
• Ensure that the necessary equipment is in place:
  • Pulmonary function test equipment. Important for excluding other diagnoses.Laryngoscope: Discomfort increases with scope diameter, which should preferably be kept below 3.5 mm.
  • Fixation equipment (headgear and mask – if chosen for use).
  • Local anaesthetic and constrictive nasal spray.
  • Ergometer (preferably treadmill or bicycle).
  • Equipment for washing and disinfection, particularly important and sometimes costly for the scope.
  • Miscellaneous supplies like tape, scissors, etc.
• CPET equipment if it is to be conducted alongside the CLE test.
• Consider the need for emergency resuscitation equipment.

Clarify funding and financial parameters.

Note that in some European countries, ICD-10 has adopted specific codes (J38.8) for EILO. Note: These codes offer a detailed classification, allowing for specific billing based on the nature of EILO. In Australia there are currently no specific codes, however ILO/VCD clinic funding information can be found here. 

ICD-10 Codes for EILO:

J38.8 Inducible laryngeal obstruction (ILO)

J38.80 Exercise-induced combined glottic/supraglottic inducible laryngeal obstruction (EILO)

J38.81 Irritant-induced combined glottic/supraglottic inducible laryngeal obstruction

J38.82 Psychogenic combined glottic/supraglottic inducible laryngeal obstruction

J38.83 Exercise-induced glottic inducible laryngeal obstruction (EILO)

J38.84 Irritant-induced glottic inducible laryngeal obstruction

J38.85 Psychogenic glottic inducible laryngeal obstruction

J38.86 Exercise-induced supraglottic inducible laryngeal obstruction (EILO)

J38.87 Irritant-induced supraglottic inducible laryngeal obstruction

J38.88 Psychogenic supraglottic inducible laryngeal obstruction

In the US, some insurers cover the combination of laryngoscopy and exercise testing.

In Australia, the Medical Benefits Schedule contains item numbers covering consultation and diagnostic services, and multidisciplinary meetings. Alternatively, service-specific, state, territory or hospital based funding arrangements may be possible.

If laryngeal closure or medial movement of the vocal folds and/or supraglottic narrowing are obvious, the laryngoscopic equipment may be left in place, providing an opportunity for biofeedback.

The test recordings may be contemporaneously reviewed or reviewed at convenient later date.