Biofeedback vs Respiratory Retraining for Inducible Laryngeal Obstruction

Importance Inducible laryngeal obstruction (ILO) presents as episodic shortness of breath that can range in severity and may greatly impact daily life. Respiratory retraining therapy (RRT) provided by speech-language pathologists is the standard of care. Limited data exist on treatment effectiveness, with no published randomized clinical trials comparing treatments. Objective To evaluate the effectiveness of video biofeedback (directly showing participants their laryngeal anatomy as they perform breathing exercises) compared with RRT in the treatment of episodic, inhalational dyspnea attributed to ILO. Design, Setting, and Participants This pilot randomized clinical trial was conducted at a single-institution laryngology clinic. Patients with inhalational dyspnea attributed to ILO were included. Data were collected from March 2023 to July 2024, and data were analyzed from July 2024 to March 2025. Interventions Video biofeedback and RRT. Main Outcomes and Measures The primary end point was the difference in the Dyspnea Index (DI) score at 1 month posttreatment compared with pretreatment. The Clinical Global Impressions–Improvement scale was also used to assess patients’ perceived response to treatment. Results A total of 54 patients newly diagnosed with episodic shortness of breath attributed to ILO were evenly randomized to biofeedback or RRT. Of these, 25 participants in the biofeedback group, and 20 in the RRT group completed the full assigned intervention. The mean (SD) age was 46.4 (16.2) years in the biofeedback group and 49.4 (20.0) years in the RRT group. A total of 42 patients (78%) were female. DI score was reduced by a mean (SD) of 3.54 (4.75) points in the biofeedback group and 4.15 (4.44) points in the RRT group, representing a mean difference of 0.61 (95% CI, −2.21 to 3.43) between the 2 groups. Most patients in both groups (14 of 22 64% in the biofeedback group and 12 of 19 63% in the RRT group) self-reported at least some improvement. Conclusions and Relevance In this randomized clinical trial, video biofeedback and RRT were not different in the treatment of ILO. Biofeedback presents potential advantages, as it is easily accessible and imposes no additional cost to patients. Physicians should be thoughtful in selection of which treatment they recommend to patients, taking individual patient factors, such as comorbidities and access to care, into account. Trial Registration ClinicalTrials.gov Identifier: NCT05770518