|Other names: Munchausen stridor, spastic vocal cord adduction, episodic laryngeal dyskinesia|
|A drawing of closed vocal cords such as would be seen in laryngospasm|
|Specialty||ENT surgery, anesthesia|
|Symptoms||Stridor, increased effort to breath, tracheal tug|
|Complications||Low oxygen, slow heart rate, pulmonary edema, cardiac arrest|
|Risk factors||Airway irritation, history of asthma, certain medications, smoking|
|Diagnostic method||Based on symptoms|
|Differential diagnosis||Apnea, breath holding, bronchospasm, pulmonary aspiration|
|Treatment||Jaw thrust, positive pressure ventilation, laryngospasm notch pressure|
|Frequency||1% of general anesthesia|
Laryngospasm is a partial or complete closure of the vocal cords which is prolonged and results in a decreased ability to breath. Symptoms may include stridor, an increased effort to breath, or tracheal tug. While it typically lasts less 2 minutes, it can be more prolonged. Complications can include low oxygen, slow heart rate, pulmonary edema, and cardiac arrest.
It is a normal airway reflex that helps prevents foreign material from entering the lungs. While it most commonly occurs due to laryngopharyngeal reflux, it may also occur as a complication of anesthesia. Risk factors include airway irritation, history of asthma, certain medications, and smoking. Diagnosis is based on symptoms.
Treatment may involve a jaw thrust, providing positive pressure ventilation, and suctioning the back of the throat. Applying pressure in the laryngospasm notch (behind the earlobe) may also be useful. If this is not effective propofol or succinylcholine may be used.
It occurs in about 1% of people undergoing general anesthesia, though occurs more frequently in children and may occur in up to 25% of certain cases. Some people have frequent episodes. In drowning, laryngospasm may reduce the amount of water that enters the persons lungs; this is temporary in 90%.
Signs and symptoms
The main symptom is choking and difficulty or inability to breathe or speak, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness. As the airway reopens, breathing may cause a high-pitched sound called stridor. The episode seldom lasts over a couple of minutes before breathing is back to normal.
Various stimuli including asthma, allergies, exercise, stress, and irritants such as smoke, dust, fumes, liquids, and food can trigger laryngospasm. It is common in drowning, both as a direct response to inhalation of water, and as a complication during rescue and resuscitation due to aspiration of vomit.
In some individuals laryngospasm can occur spontaneously or as a result of reflux or impaired swallowing. Gastroesophageal reflux disease (GERD) is a common cause of spontaneous laryngospasm. Treating GERD can lessen the frequency of spasms. The onset of spasms may be caused by a viral infection.
It is also a complication associated with anesthesia. The spasm can happen often without any provocation, but tends to occur after tracheal extubation. In children, the condition can be particularly deadly, leading to cardiac arrest within 30–45 seconds, and is a possible cause of death associated with the induction of general anesthesia in the pediatric population. These situations are not to be confused with the benign laryngospam events seen in infants after feeding or due to reflux.
It can sometimes occur during sleep, waking up the sufferer. This usually occurs when the person has gastric acidity and develops re-flux during sleep, where the gastric acid causes irritation which will cause the spasm attack.
The DDx for laryngospasm is the following:
Due to the shape of the stomach and position of the esophagus, sleep-related laryngospasms may be prevented by sleeping on the left side, which can help in keeping stomach acid from entering the esophagus and reaching the vocal cords.
Minor laryngospasm will generally resolve spontaneously in most cases.
Laryngospasm from anesthesia may be treated by providing a jaw thrust and administering assisted ventilation with 100% oxygen. In more severe cases propofol at a dose of 0.5 mg/kg or succinylcholine at a dose of 1.5 mg/kg may be used. Smaller doses of 0.1 mg/kg intravenous of succinylcholine has also been shown to help. If an intravenous is not available succinylcholine can be given intramuscular (IM) at a dose of 4 mg/kg.
When gastroesophageal reflux disease (GERD) is the trigger, treatment with a proton pump inhibitors such as esomeprazole or pantoprazole to reduce the production of stomach acids may help. Prokinetic agents reduce the amount of acid available by stimulating movement in the digestive tract.
People who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux.
For acute context, making an upright position of the upper part of the body has been shown to shorten the spasm episodes. Fixation of the arms on stabilization of the body and slowing of breathing is also recommended.
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