Laryngospasm

The medical condition known as laryngospasm is characterized by the sudden and uncontrolled contraction of the vocal cords. The involuntary contraction of the muscles can be quite scary, especially since it happens for no apparent reasons. The level of intensity for the spasm can range from mild to severe, impairing the airflow into the lungs. As the airflow is blocked, the person might experience difficulties breathing or talking. The condition can awake a person from sleep and, even though it is scary, it will disappear in a short period of time. Medical literature presents few cases of laryngospasm.

Laryngospasm Symptoms

These are the most common symptoms of laryngospasm:

• The onset of the condition is sudden, with no tell-tale signs
• Difficult breathing, talking or swallowing; the person might try to clear his/her throat, with no success
• Feeling of suffocation
• Fainting (loss of consciousness)
• Modification of the voice – sounds caused by the re-opening of the airways and the relaxation of the vocal cords (inspiration not only noisy but also difficult)
  • Hoarseness
  • Stridor
• Pain in the chest
• The person can experience coughing or he might himself gasping for air
• GERD symptoms
  • Heartburn
  • Nausea
• Sore throat
• Episodes can occurs in the middle of the night, waking the person from sleep
• When this condition occurs in children, one can notice retractions in the suprasternal or supracostal area
• Nasal flaring is often encountered in children as well
• The person can enter into a state of panic
• Lasts under a minute
• Trying to breathe in more often will only aggravate the condition

Causes of Laryngospasm

These are the most common causes of laryngospasm:

• Gastroesophageal reflux – most common cause
  • Acidic reflux from the stomach into the esophagus
  • Irritation of the gastrointestinal tract
  • Often associated with poor diet (fatty, spicy or acidic foods)
• Laryngopharyngeal reflux
  • Acidic reflux from the stomach into the larynx
  • High risk of tissue injury (acid)
  • Increased risk with respiratory infections present
• Respiratory disorders – asthma, viral infections
  • These can act as triggers of the condition as well
• Allergies – allergic terrain
• Physical exercise – more of a trigger than a cause
• Substances that irritate the nasal passages
• Emotional stress
• High levels of anxiety
• Reduced Calcium levels
• Nerve trauma/injury/paralysis
  • Injury of the nerves of the voice box (neck surgery)
  • Laryngospasm can be caused by paralyzed nerves, as the vocal cords are tighter
• Surgery
  • Laryngospasm appears as a postoperative complication
  • Most common cause – anesthesia – irritation of the vocal cords
  • Children present the highest risk for such complications, as they are highly sensitive to anesthesia
  • Occurs most often after tracheal extubation has been performed
  • It is a medical emergency and it requires immediate medical attention (cardiac arrest can occur)
• Other causes (laryngospasm – reflexive response)
  • Contents aspired into the larynx
  • Oral secretions reach the larynx, irritating the area
  • Drowning – when a person is drowning, the larynx shuts in order to prevent the entry of water (this eventually will lead to the death of the person, being known as ‘dry drowning’)
  • Sensation of foreign body in the windpipe.

Laryngospasm Treatment

In general, if the laryngospasm is minor, it will resolve on its own, without any treatment being necessary. However, for serious cases, these are the most common methods of treatment for laryngospasm:

• Partial laryngospasm
  • Identification and removal of triggering factor/foreign body
  • Jaw thrust maneuver
  • Intubation of the patient
  • Oxygen ventilation
• Symptomatic treatment for GERD
  • Proton-pump inhibitors – reduce the production of acid at the level of the stomach
  • Prokinetic agents – stimulate the movements of the stomach, reducing the level of acid present
• When the laryngospasm appears as a complication of a surgery:
  • Hyperextension of the patient’s neck
  • Assisted ventilation (100% oxygen)
  • Intravenous administration of muscle relaxant
  • Re-intubation
  • Lidocaine – can be administered as transtracheal injection
  • Sometimes, the laryngospasm can be solved by deepening the anesthesia level
• Breathing techniques
  • For repeating cases, the patient is taught to breathe slowly, instead of gasping for air (as this can aggravate the condition)
• Calcium supplements
  • Can solve hypocalcaemia, which is a frequent cause of laryngospasm.

Management

If laryngospasm occurs frequently, the patient must learn not to panic and breathe slowly. Often times, the person will gasp for air and this will only make the condition worse. Breathing techniques can be quite useful, as they will teach the patient to breathe gradually and slowly. This will allow for the airways to relax and the voice to recover. The patient is also instructed to allow for the voice to come back and not be scared by the sounds that are produced during the recovery.

The breathing techniques are commonly taught by a speech language pathologist and they are often blended with relaxation techniques. The latter are important, as they can prevent the patient from entering into a state of panic when the spasms occur. The relaxation techniques are going to reduce the intensity of the symptoms and also the frequency of the spasms.

The ENT doctor can also provide useful information about the management of the condition. It is important for the patient to understand that the laryngospasm will disappear in a minute. Apart from the breathing techniques, one can also drink water. If the laryngospasm has been caused by an irritating substance, then drinking water will allow for that substance to be washed away. Once the irritating substance is washed away, the condition will improve and the symptoms will subside.

The management of the acid reflux is also important and patients are instructed to take anti-acidic medication on a regular basis. Tea is also recommended, as it can help relax the esophageal musculature. Drinking water is indicated as well, as it is important for the patient to stay hydrated at all times.

Prevention

Laryngospasm is a condition that can be prevented, especially in patients who are suffering from GERD. Patients are instructed to avoid the substances that trigger upsetting symptoms, such as spicy or fatty foods, fruits (fruit juice including), caffeine and even peppermint. The recommendation is that the patient ingests a smaller quantity of food with each meal and that one learns to have dinner with at least two or three hours before going to bed. Patients are instructed to quit smoking and to reduce their alcohol levels, as these can aggravate the condition as well and increase the frequency of laryngospasms. The bed should be raised, so as to avoid the gastro-esophageal reflux.

If you know that you are allergic to certain types of food or different substances, be sure to avoid them as much as you possibly can. For those of you who suffer from respiratory infections, it is important to take medication for coughing. Try to refrain from coughing, as this can only lead to a new spasm. Drink plenty of fluids to keep the tissues hydrated – keep in mind that dryness can also lead to coughing, which in turn can lead to a new episode of laryngospasm. Tea is also recommended, as the warm temperature can guarantee an increased level of relaxation in the tissues. Saline drops can also be used for the same purposes; these are highly effective and they can be used without worrying about consequences.

In children or adolescents who are undergoing surgery, there are certain preventive measures that can be taken. First of all, if the teenager is smoking, then he/she should quit with at least two weeks before the surgery. Children should receive anesthesia through a face mask, as this guarantees a reduced irritation of the vocal cords. The parents should also inform the doctor whether the children is subject to passive smoking or not, about the history of respiratory infections, asthma, previous surgeries (with/without anesthesia). The assessment of these risk factors is important, as it will reduce the occurrence of laryngospasm.

In conclusion, laryngospasm can be successfully treated and managed. If its primary cause is GERD, then the patient must learn how to manage the condition and avoid triggering factors. Preventive measures are highly important and they should be taken regardless of the age of the patient. The patient should also be taught how to go through laryngospasm without panicking. Breathing and relaxation techniques are highly important, as they allow the patient to learn controlled breathing and they reduce the panic experienced during a new episode. Moreover, it can help one be prepared for a future episode and handle the spasm in a more efficient manner.

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