Laryngospasm

Laryngospasm is a rare but frightening experience. When it happens, the vocal cords suddenly seize up or close when taking in a breath, blocking the flow of air into the lungs. People with this condition may be awakened from a sound sleep and find themselves momentarily unable to speak or breathe. Though it can be scary while it's happening, laryngospasm typically goes away within a couple of minutes.

What Causes Laryngospasm?

Laryngospasm may be associated with different triggers, such as asthma, allergies, exercise, irritants (smoke, dust, fumes), stress, anxiety or commonly gastroesophageal reflux disease, or GERD. GERD is a condition that occurs when the ring-like muscle that normally closes to keep the stomach's contents from backing up doesn't work right. With reflux, harsh acids from the stomach rise up into the esophagus and cause irritation.

Regular exposure to stomach acids can damage and inflame the delicate lining of the esophagus. This damage can lead to momentary spasms of the vocal cords, which close the airway and prevent air and oxygen from getting into the lungs.

When stomach acids reach the larynx, the condition is called laryngopharyngeal reflux or LPR. The tissues of the larynx are even more delicate and prone to injury than the esophagus. Coughs from a cold can push more acid into the larynx, so a recent or current upper respiratory infection may increase the likelihood of developing laryngospasm.

Laryngospasm may also be a complication of surgery. Anesthesia used during the surgery can irritate the vocal cords, especially in children. Laryngospasm caused by anesthesia can be life-threatening.

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What Are the Symptoms of Laryngospasm?

When laryngospasm occurs, people describe the sensation of choking and are unable to breathe or speak. Sometimes, the episodes occur in the middle of the night. A person may suddenly awaken feeling as though he or she is suffocating. This condition is called sleep-related laryngospasm. It also is often related to GERD. Some people will actually lose consciousness during these episodes.

As the airways slowly open, the person will make a high-pitched breathing sound (called stridor). The entire episode lasts only a minute or two before breathing returns to normal. But the experience can be terrifying.

In addition to experiencing laryngospasm episodes, people with this condition will typically have symptoms of GERD, which include:

Experts say that in infants with GERD, laryngospasm might be involved in sudden infant death syndrome (SIDS).

How Is Laryngospasm Treated?

If GERD is the problem, treating the condition can help manage laryngospasm. Doctors often prescribe proton pump inhibitors such as Dexlansoprazole (Dexilant), Esomeprazole (Nexium), and Lansoprazole (Prevacid). These reduce the production of stomach acids, so that fluids from the stomach that do back up into the esophagus are less corrosive. Another option is prokinetic agents. These stimulate movement in the digestive tract to reduce the amount of acid available.

Patients who don't respond to these treatments may need surgery. One surgical option is fundoplication, a procedure that wraps the upper part of the stomach (fundus) around the esophagus to prevent acids from backing up. Also, a ring of titanium beads can be placed around the outside of the lower esophagus. It strengthens the valve between the esophagus and stomach while still allowing food and liquids to pass through.

You can also relieve GERD and LPR, and help prevent laryngospasm, by following these lifestyle tips:

  • Avoid common heartburn triggers, such as fruit and fruit juices, caffeine, fatty foods, and peppermint.
  • Eat smaller meals, and stop eating two to three hours before bedtime.
  • If you smoke, quit. Also, limit alcohol consumption.
  • Raise the head of your bed a few inches by putting wood blocks under the bedpost.
  • Avoid allergies triggers.
  • Breathing techniques including slow breathing and staying calm also may help.

In children who develop laryngospasm as a complication of anesthesia during surgery, treatment usually involves moving the head and neck to open the airway. It also involves using a machine (continuous positive airway pressure, or CPAP) to deliver air directly into the airway. Some children need to have a tube placed into the throat to assist with breathing.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on August 7, 2018

Sources

SOURCES:
GI Motility Online: "Laryngeal and pharyngeal complications of gastroesophageal reflux disease."
Maceri, D, Zim, S. Laryngoscope, 2001; vol. 111: pp. 1976-1979.
Hideto S, Seiji N, Toshiaki Y. Larynx Japan, 2002; vol. 14: pp. 25-28.
Burgoyne L, Anghelescu D. Pediatric Anesthesia, 2008; vol. 18: pp. 297-302.
News release, FDA.

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