Laryngospasm is an uncontrolled or involuntary muscular contraction (
spasm
A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ such as the bladder.
A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a muscle c ...
) of the
vocal folds
In humans, vocal cords, also known as vocal folds or voice reeds, are folds of throat tissues that are key in creating sounds through vocalization. The size of vocal cords affects the pitch of voice. Open when breathing and vibrating for speech ...
.
The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder
inspiration, while
exhalation
Exhalation (or expiration) is the flow of the breath out of an organism. In animals, it is the movement of air from the lungs out of the airways, to the external environment during breathing.
This happens due to elastic properties of the lungs, ...
remains easier. It may be triggered when the
vocal cords
In humans, vocal cords, also known as vocal folds or voice reeds, are folds of throat tissues that are key in creating sounds through vocalization. The size of vocal cords affects the pitch of voice. Open when breathing and vibrating for speech ...
or the area of the
trachea
The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...
below the vocal folds detects the entry of water, mucus, blood, or other substance. It is characterized by
stridor or
retractions.
Some people have frequent laryngospasms, whether awake or asleep. In an ear, nose, and throat practice, it is typically seen in people who have
silent reflux disease. It is also a well known, infrequent, but serious
perioperative
The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and posto ...
complication.
It is likely that more than 10% of
drowning
Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer a ...
s involve laryngospasm, but the evidence suggests that it is not usually effective at preventing water from entering the trachea.
Signs and symptoms
Laryngospasm is characterized by involuntary spasms of the laryngeal muscles. It is associated with difficulty or inability to breathe or speak, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.
It may be followed by paroxysmal coughing and in partial laryngospasms, a stridor may be heard.
It requires prompt identification to avoid possibly fatal complications. It may present with loss of end-tidal carbon dioxide (for mechanically ventilated patients), chest or neck retractions and paradoxical chest wall movements.
Causes
Laryngospasm is a primitive protective airway reflex that functions to protect against
aspiration. However, it may be detrimental if there is sustained closure of the
glottis
The glottis is the opening between the vocal folds (the rima glottidis). The glottis is crucial in producing vowels and voiced consonants.
Etymology
From Ancient Greek ''γλωττίς'' (glōttís), derived from ''γλῶττα'' (glôtta), va ...
resulting in blockage of respiration that hinders the free flow of air.
It is most often reported 1) post-operatively after endotracheal extubation or 2) after sudden reflux of gastric contents.
It is common in drowning. It is estimated that in 10% of cases of drowning as a response to inhalation of water, death occurs due to asphyxia due to laryngospasm without any water in the lungs. It is also a symptom of
hypoparathyroidism
Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH). This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary m ...
. It can sometimes occur during sleep, waking up the affected person. These episodic interruptions of sleep have been attributed to acute irritation due to gastro-oesophageal reflux.
In children, rapid detection and management are imperative to prevent deadly complications such as cardiac arrest, hypoxia and bradycardia.
Patients with a history of significant aspiration, asthma, exposure to airway irritants (smoke, dust, fumes, use of
Desflurane
Desflurane (1,2,2,2-tetrafluoroethyl difluoromethyl ether) is a highly fluorinated methyl ethyl ether used for maintenance of general anesthesia. Like halothane, enflurane, and isoflurane, it is a racemic mixture of (''R'') and (''S'') optical i ...
), upper respiratory infections, airway anomalies, light anesthesia and patients with acute mental status depression may be at increased risk.
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]
Prevention
When gastroesophageal reflux disease (GERD) is the trigger, treatment of GERD can help manage laryngospasm. Proton pump inhibitors such as Dexlansoprazole
Dexlansoprazole, sold under the trade name Dexilant among others, is a medication which reduces stomach acid. It is used to treat gastroesophageal reflux disease. Effectiveness is similar to other proton pump inhibitors (PPIs). It is taken by mou ...
(Dexilant), Esomeprazole
Esomeprazole, sold under the brand name Nexium among others, is a medication which reduces stomach acid. It is used to treat gastroesophageal reflux disease, peptic ulcer disease, and Zollinger–Ellison syndrome. Effectiveness is similar to ...
(Nexium), and Lansoprazole
Lansoprazole, sold under the brand name Prevacid among others, is a medication which reduces stomach acid. It is used to treat peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. Effectiveness is similar to ...
(Prevacid) reduce the production of stomach acids, making reflux fluids less irritant. Prokinetic agent
A prokinetic agent (also gastroprokinetic agent, gastrokinetic agent or propulsive) is a type of drug which enhances gastrointestinal motility by increasing the frequency or strength of contractions, but without disrupting their rhythm. They are ...
s reduce the amount of acid available by stimulating movement in the digestive tract.
Patients 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.
Incidence
Incidence has been estimated at approximately 1% in both adult and pediatric populations. Its incidence is reported to be more than triple in the very young (birth to 3 months of age), increasing to 10% in those with reactive airways. Other sub-populations with high incidence of laryngospams include patients undergoing tonsillectomy and adenoidectomy (25%).
Treatment
Minor laryngospasm will resolve spontaneously in the majority of cases.
Laryngospasm is one of the most common intraoperative complications. It may be life-threatening as it involves reflex closure of the laryngeal muscles and thus results in inability to ventilate the patient. Treatment requires clearing secretions from the oropharynx, applying continuous positive airway pressure
Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ap ...
with 100% oxygen, followed by deepening the plane of anaesthesia with propofol
Propofol, marketed as Diprivan, among other names, is a short-acting medication that results in a decreased level of consciousness and a lack of memory for events. Its uses include the starting and maintenance of general anesthesia, sedation f ...
, and/or paralyzing with succinylcholine
Suxamethonium chloride, also known as suxamethonium or succinylcholine, or simply sux by medical abbreviation, is a medication used to cause short-term paralysis as part of general anesthesia. This is done to help with tracheal intubation or ele ...
.
See also
* Laryngotracheal stenosis
Laryngotracheal stenosis refers to abnormal narrowing of the central air passageways. This can occur at the level of the larynx, trachea, carina or main bronchi.
In a small number of patients narrowing may be present in more than one anatomical l ...
References
Further reading
*
External links
{{Underwater diving, divmed
Anesthesia
Larynx disorders