What Is Laryngospasm?

Overview

Laryngospasm comes from the Latin word ‘laryngo’, meaning larynx or voice box. Spasm in Latin is defined as cramps or convulsions.

The larynx protects the lower respiratory tract from food aspiration into the trachea and lungs during eating while simultaneously situating our vocal cords; that is, the voice box plays an essential part in our daily life as it produces sounds, aiding us while talking and having conversations in our everyday life. The larynx comprises three main parts. The upper part is called the supraglottis; the middle part is called the glottis, where the vocal cords are, and the lower part is the subglottis (Figure 1).

Laryngospasm is a potentially life-threatening condition caused by a spasm of the vocal cord that can lead to incomplete or complete obstruction of airways and, subsequently, difficulty breathing. During laryngospasm, a muscle group known as a laryngeal muscle (muscle around the voice box) suddenly tightens and contracts as the muscle spasm occurs. This can happen in a split second, and upon muscle contractions, these can temporarily block your airway, making breathing difficult. In many cases, laryngospasm could revert naturally and allow normal breathing. However, some instances where laryngospasms could occur frequently and cause distress warranted further investigations by healthcare professionals. 

Causes of laryngospasm

There could be a few reasons why laryngospasm could occur. These are:

• Allergies - allergies occur when there is a presence of allergens that could trigger the activation of specific immune mechanisms. Severe allergies could lead to anaphylactic shock, requiring immediate treatment with an adrenaline shot as allergens could irritate respiratory airways and induce laryngospasm.
• Infections - respiratory infections such as viral or bacterial pneumonia and bronchitis, and patients with underlying diseases such as asthma, could experience laryngospasm.
• Gastroesophageal Reflux (GERD) - People with gastritis or GERD could have laryngospasm as their stomach acid reflux and irritate vocal cords.¹
• Inhalation of irritants - breathing irritants such as smoke or fumes, pesticides, and other pollutants could irritate respiratory airways and cause laryngospasm.
• Intubation and airway manipulations - laryngospasm could occur during planned surgical interventions requiring general anaesthesia or any Ear, Nose and Throat (ENT) procedures.

Signs and symptoms of laryngospasm

Laryngospasm can present with sudden coughing, noisy breathing or inspiratory stridor with airway obstructions. The person facing laryngospasm could complain of shortness of breath, chest tightness, a sense of doom or feelings of panic and anxiety. Their voice could also change to become hoarse or shaky due to the nature of the condition that is affecting the vocal cords. Upon physical examinations by healthcare professionals, complete airway obstructions could be present, with no chest wall movement or breathing sound upon listening to the chest.²

Complications of laryngospasm can be severe as it can lead to hypoxia if there is complete airway obstruction. Hypoxia could lead to ischemic end-organ injuries such as stroke, hypoxic encephalopathy and potentially death if the condition is not attended to immediately.

Management and treatment for laryngospasm

As laryngospasm is usually due to symptoms of an underlying disease, it is best to treat the underlying issue causing laryngospasm. A few interventions can be done to manage and treat laryngospasm. These are: 

• Lifestyle modifications - laryngospasm that is caused by allergies due to exposure towards allergens, as well as laryngospasm that is caused by inhalations of irritants such as smoke and pollutants would hugely benefit from controlling the symptoms of laryngospasm when lifestyle modifications are adapted. Such lifestyle modifications include taking antihistamines and avoiding allergens and irritants that cause laryngospasm.
• Hydration - maintaining good hydration of the body with good water intake would help prevent laryngospasm.
• Managing acid reflux - a few medications, such as Proton Pump Inhibitors, would ease up the symptoms of GERD, consequently preventing laryngospasm.
• Speech therapy and breathing exercises - speech therapy can teach techniques like diaphragmatic breathing and pursed-lip breathing to reduce the risk of spasms and manage the symptoms during the attack, especially in cases related to vocal cord dysfunction. Breathing exercises will also help individuals to calm down and reduce anxiety during the occurrence of laryngospasm.
• Laryngospasm notch manoeuvre - is also called Larson’s manoeuvre over Larson’s point (Figure 2). Larson’s manoeuvre is done by applying pressure over the soft tissue just behind the earlobes and above the jaw. The mechanism of how this manoeuvre works is still unclear, but it has been proven with a few case studies that it helps with relaxing vocal cords during laryngospasm. This manoeuvre is believed to work as a jaw thrust manoeuvre, and applying pressure on it activates pain stimuli that cause the vocal line to relax.³
• Emergency measures - laryngospasms during intubation, extubation, and ENT procedure warranted immediate termination. The administration of oxygen will help force the opening of the vocal cord to prevent hypoxia. Larson’s manoeuvre could also be performed in this situation, as well as increasing or deepening the sedation or anaesthesia so the patient is more relaxed and reduces laryngospasm.

Diagnosis

Diagnosing laryngospasm could involve several examinations - physical, laboratory, or procedural testing. It could also involve multidisciplinary teams such as speech therapists, gastroenterologists, physicians and laryngologists. These are a few steps to diagnose laryngospasm:

• Medical and Symptoms History - medical and healthcare professionals will initially enquire regarding medical history that might be related to laryngospasm, such as asthma, allergic reactions, gastritis symptoms or any vocal cord dysfunction, before proceeding further on enquiring regarding the symptoms, including frequency and durations of laryngospasm occurrence.
• Physical Examination - Physical examination will help to identify any abnormalities of the throat, neck and respiratory system to point out the cause of laryngospasm.
• Allergic testing - it is crucial to identify the allergens and irritants that could trigger laryngospasm. Allergic testing, such as skin tests and blood tests, may be conducted to specify the allergens.
• Speech therapy assessment - might be valuable and helpful in evaluating breathing and vocal cord function in suspected vocal cord dysfunction cases.
• Pulmonary function test, laryngoscopy and imaging studies - Test to assess lung function and direct or flexible laryngoscopy that involves using a small camera to examine the vocal cord and its surrounding structures might be helpful to visualise any existing irritants, foreign bodies or abnormalities that could induce laryngospasm. Imaging tests such as barium swallow or CT scans could help detect abnormalities of the oesophagus or upper digestive tract.

FAQs

How can I prevent laryngospasm? 

Laryngospasm can be prevented with some great tips. It is essential to stay hydrated to maintain moisture and avoid drying over the vocal cords area, which could irritate it and induce laryngospasm. Practising good vocal hygiene, such as preventing excessive yelling and straining of the voice, is also a good measure for protecting your vocal cords. Avoiding allergens and irritants, controlling allergies such as smoking, and quitting smoking reduce the risk of spasms. 

Maintaining a good, balanced, healthy lifestyle with regular exercise and a balanced diet and implementing stress-reducing techniques such as meditation, yoga, and breathing exercises could improve overall health, reducing the risk and symptoms of laryngospasm. It is also important to follow medical expertise advice to stick to medications that could help with the underlying issues causing laryngospasm, such as taking GERD and allergic medications.

How common is laryngospasm?

Laryngospasms are not extremely common, but they can occur. The prevalence of laryngospasm varies depending on factors such as age, overall health condition, lifestyle and underlying conditions.

The research found that laryngospasms more commonly happen in children than adults and are even more common in infants. In children, laryngospasm could be associated with a condition like croup and in adults, it mainly occurs in people with acid reflux, allergies and respiratory infections.⁴

The frequency of laryngospasms could differ from person to person. Some could experience laryngospasm rarely, and others could have more frequent episodes. However, most people find the symptoms of laryngospasm to occur temporarily, which is a manageable issue. Unfortunately, some experience frequent laryngospasm that disturbs their daily activities and creates worrisome anxiety; hence, seeking medical evaluation and guidance is essential.

Who is at risk of laryngospasm?

Children are more prone to laryngospasm than adults, so kids with croup or respiratory infections are at higher risk of getting it. Smoking adults and adults who work and are exposed to occupational inhalation of smoke are also at risk of laryngospasm. Individuals with gastritis or GERD, allergic history, and a history of anxiety and chronic stress have a higher risk of getting laryngospasm. People with vocal cord dysfunction are also prone to getting laryngospasm. 

Summary

Laryngospasm is a sudden contraction of the laryngeal muscles that could cause airway obstructions. It is often triggered by allergies, infections, GERD and irritant inhalations. It is more common in children or paediatric patients and is usually associated with diseases like croup. Symptoms of laryngospasm could include sudden coughing, chest tightness, and changes in voice, with severe cases leading to hypoxia and other possible complications. 

Managing laryngospasm involves modification of lifestyles, including adherence to specific medications to treat diseases that could cause laryngospasm. It could also include a multidisciplinary approach considering medical history and physical, laboratory, or imaging investigations.

Prevention of laryngospasm includes maintaining body hydrations to keep moisture over the larynx area, avoiding yelling or voice straining and allergens and irritants. Understanding and addressing the triggers of laryngospasm, as well as awareness regarding the symptoms of laryngospasm, is crucial for effective management and prevention.