Inducible Laryngeal Obstruction in Hypermobile Patients

OBJECTIVE: To determine whether patients with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD) and inducible laryngeal obstruction (ILO) have more voice, cough, swallowing, GI issues, and MC activation than patients without ILO. METHODS: This retrospective study of 2162 patients meeting 2017 diagnostic criteria for hEDS (n = 507) or HSD (n = 1655) who were seen at the EDS Clinic in Mayo Clinic Florida from November 2019 to June 2025 compared patients who screened positive for ILO to those who screened negative. Patients were examined for self-reported symptoms of voice, cough, swallow, and GI issues as well as MC activation. RESULTS: Among patients with hEDS or HSD, 23.1% and 17.1% respectively screened positive for ILO. Patients with ILO had significantly more voice, cough, and swallow issues than patients without ILO (all p ≤ 0.007). Both diagnoses had more gastroesophageal reflux disease (GERD) (hEDS: 55.6% vs. 40.9%, p = 0.004; HSD: 55.8% vs. 42.2%, p < 0.0001). Additionally, both hEDS and HSD patients with ILO self-reported 18 allergy-related symptoms more often than those without ILO and had higher MC scores indicating widespread MC activation (all p < 0.0001). Cough, dysphagia, and elevated MC score were statistically significant predictors of ILO in both hEDS and HSD within a logistic regression analysis. CONCLUSIONS: Chronic cough, dysphagia, and elevated MC symptom burden were the strongest independent predictors of ILO across both hEDS and HSD, underscoring the need for routine multidisciplinary laryngeal assessment in this population.