Understanding and managing laryngospasms

2014-01-01 01:47

Symptoms of Laryngospasm vary from person to person however most people describe it with any of the following descriptions.

According to Edward C. Rosenow III, M.D. with the Mayo clinic, Laryngospasm (luh-RING-go-spaz-um) is a brief spasm of the vocal cords that temporarily makes it difficult to speak or breathe. With words like brief and temporary if actually sounds quite innocuous. For those who experience it however it is nothing less than terrifying.

Imagine waking up in the middle of the night terrified. Your throat feels as though it is closing up and you are choking. Some people describe it as if you are drowning. Or perhaps you start to cough and instead of the coughing spell ending, all of a sudden your throat closes up and you feel as though you are gasping for air and breathing through the tiniest of tubes. That is what a laryngospasm feels like. I cannot imagine any greater fear than not being able to breathe. The larynx is the pathway to your lungs and is ever so important. It is not something you want to have spasm.

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The larynx is the area in the neck that contains your vocal cords. It is approximately 2 inches long and is located below your pharynx and above your trachea. We use it to breathe, talk, and swallow. It is protected by the Adam’s apple. As you inhale, air goes into the nose and or mouth, then through the larynx, down to the trachea, and then into the lungs. The openings of the esophagus (food tube) and the larynx are in close proximity in the throat. When you swallow, the epiglottis closes off the larynx to keep food out of the windpipe and in your esophagus where it belongs. When everything works as it should it is a marvelous process. Air goes in from the atmosphere and into lungs and back out. You can speak through air passing through your vocal cords. However if you have a spasm in your larynx it can be terrifying. You cannot speak. You cannot swallow. You are unable to “catch your breath”.

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Symptoms of Laryngospasm
The symptoms vary from person to person however most people describe it with any of the following descriptions:

  • Abrupt and swift onset. No warning.
  • Typically, it lasts less than 60 seconds, however it feels much, much longer when it occurs.
  • Occurs anytime (day or night) but is most noticeable when eating and something feels like it “went down the wrong way”. It causes a feeling of choking.
  • May occur in the middle of the night, causing you to be awakened unable to breathe.

There are many theories. Here are the more common causes:

GERD (Gastroesophageal reflux disease)
Even small amounts of exposure to gastric acid may cause significant laryngeal damage. It can result in hoarseness, increased coughing, increased throat clearing and laryngospasm. Individuals with Gastroesophageal reflux disease may benefit from adopting the following habits:

  • No eating within two - three hours of bedtime or lying down to rest.
  • Sleep on your left side may prevent food from pressing on the opening to your esophagus.
  • Lose weight if you are overweight.
  • Elevate the head of your bed using blocks of at least 6 inches.
  • Avoid overeating.
  • Reduce fatty, fried, spicy, or acidic foods.
  • Reduce caffeine, carbonated beverages and alcohol.
  • Stop smoking.

Nerve damage
Nerve injury can occur either from a surgical procedure such as removal of your thyroid or from complications with anesthesia or tracheal intubation. Being on a ventilator via an endo-tracheal tube in your throat for greater than 10 days increases your risk.

Because of the inflammation and swelling that is common during the flu laryngospasms can occur. In February 2005, Pope John Paul II was hospitalized after a bout with the flu with a larynospasm. Papal spokesman Joaquin Navarro-Valls said the decision to have the 84-year-old Pontiff admitted to hospital was "mainly precautionary". He added: "The flu condition that has afflicted the Holy Father for the past three days deteriorated with an acute laryngospasm.” So if the Pope can suffer from it because of having the flu, it is safe to say anyone can.

Other theories as to causes include exposure to cold, anxiety and panic attacks, allergies and others.

After evaluating subjectively what your symptoms are and what makes them worse a physical evaluation needs to be done. A through exam is necessary that includes a fiber-optic exam to view your larynx and vocal chords. Some doctors will request a pulmonary function test as well to evaluate your pulmonary status. A Sleep study to see how you breathe at night might be helpful. An endoscopic exam to evaluate your esophagus may sometimes be done as well. The treatment plan will depend upon the cause.

If you are diagnosed with having spasms at night a CPAP machine may be helpful by forcing air continually through your larynx into your lungs.

Laryngospasms worsens with strong attempts at inhaling. That is what you would instinctively want to do too. The faster the air flow moves through a narrowed area, the lower the pressure. This act of rapid breathing in effect, more easily makes the vocal cords become tighter. This makes matters worse!

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Breathing Technique
As soon as one feel a spasm coming on, instead of breathing faster, SLOWLY breath in through the NOSE not your mouth. Some people find that holding their breath for 5 seconds prior to nasal inhalation helpful.
After completing your slow nasal inhalation you then need to quickly exhale out the mouth with pursed lips like your mouth is around a straw.
Continue this process until the episode resolves.

If you don’t feel you would have the ability to think through the process in a time of panic try the straw method instead.

Straw method
The straw method forces a person to decrease the speed of breathing. This allows for vocal cord relaxation. It is simple to do. You cut a regular straw to half its length. When an attack starts, you make a tight seal with your lips and breath thru the straw until attack passes. It would be simple enough to keep one in your purse, car and night stand.

Some find that if they tilt their head backwards during an attack it is helpful as it made the slow breathing easier to do and may prevent the vocal cord muscles from clamping down.


Some physicians have injected botulinum toxin into the closing muscles of the voice box with some success. This worked well with patients with laryngeal nerve injuries.
Individuals that have a “throat tickle” as a precursor to the spasms may benefit from Amitriptylline. It can reduce the tickle sensation in some people.

Alternative healing
Yoga, guided imagery, meditation and anything that provides relaxation may help with symptoms.
Since Magnesium is a natural muscle relaxer, there are those that feel that it is helpful in laryngeal spasms as well.

DGL (licorice)
Deglycyrrhizinated licorice is an herbal extract and not candy. It acts by increasing the mucous coating in your GI tract and protecting it from irritation from acid. You can find DGL at health food stores. Usual dose is two 75 mg tablets before meals. It is not to be used by anyone with diabetes, high blood pressure or heart disease.

For use in those with spasmodic constriction, tickling and burning. Inspiration provokes coughing and it is more difficult than expiration.
For use in those with spasms of the glottis and trachea. There is shortness of breath due to spasms of vocal cords. Unlike Bromium, the Chlorum type patient can breath in easily but there is difficulty in expiration.

PRANAYAM Nostril yoga

1 – Close off right nostril with index finger, inhale through left. Then block left, release right, exhale through right
2 - Inhale through right nostril while left side stays blocked
3 - Release left, block right, exhale through left

It is important there are no gaps between the three steps. It is a smooth continual process.
Repeat steps 1-3, two to five times a day as a preventative measure.

Take home message:
Understanding the disorder decreases the panic usually associated with it. Treatment may diminish the episodes or at the very least make them tolerable.

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  • Gaynor, E.B. (2000). Laryngeal complications of GERD. Journal of Clinical Gastroenterology, 30(3 Suppl), S31-34.
  • Wong, R.K., Hanson, D.G., Waring, P.J., & Shaw, G. (2000). ENT manifestations of gastroesophageal reflux.
  • American Journal of Gastroenterology, 95(8 Suppl), S15-22.
  • ABC Homeopathy
  • Dystonia Foundation


excellent article, gives great detail about what is happening ....very informative .....surprised at the end...there are holistic and homeopathic way to help this?.....THANK YOU Tracy.......I always know to ask you and you never ever fail to deliver!
Glad to be of assistance Deb. I am always looking for article ideas so keep them coming!
I suffer from VCD attacks/laryngospasms a few times a year for the past 20 years or so. You mention that swallowing is not possible during an attack, but I have never experienced a problem with swallowing during one. I can't breathe during one, but I can definitely swallow. I'm curious where this information came from?
I just experienced this for the 3rd or 4th time in 6 months and yes I myself couldn't swallow I've never heard of this diagnosis b4. I Google unable to breathe or swallow
Depending on the cause there are different symptoms. If it is associated more with GERD swallowing is difficult. If it is more associated with a vocal cord issue breathing is more affected then swallow. It is a terrible situation to deal with...esp if your doctor does not understand. How have you been able to deal with this for 20 years. Any suggestions? I am just curious.
Another consideration for Lorelei might be bronchospasm versus laryngospasm. Lorelei, what does your doctor tell you about your symptoms? Tracy, do you agree that might be possible since the problem is breathing? Either way, Lorelei, are you under care for this? It is a long time to deal with such a difficult issue.
Coupled with my chronic sinus issues, the ENT said the laryngospasms suggested a diagnosis of LPR and has been treating me with PPIs. They have not improved my sinus symptoms, though. I never realized before that my choking spells were something treatable so I just assumed I was prone to choking and never looked into it. It wasn't until I happened to have a choking spell just prior to a scheduled doctor's visit that I was able to describe it in enough detail that she immediately suggested laryngospasm. I had mentioned these spells to other doctors over the years and none of them thought anything of it. I had an endoscopy and the gastroenterologist says my throat looks healthy, with no obvious signs of a problem. I do not have heartburn, and on the rare occasions I get a reflux episode, it does not cause a laryngospasm. My gut feeling is dehydration is the biggest culprit for me, since it feels like my throat dries out and seals shut. During an attack, I swallow air compulsively, so I know my swallowing isn't affected. Thank you both for your suggestions. I hope I can get this figured out someday.
Yes! I too have worse symptoms and more frequent attacks when I'm dehydrated, in a poorly circulated environment, too warm, or stuffy, or have over done it with food or alcohol. When I'm grain and dairy free, I also get relief.
This is me too. Wake up, so dry, throat feels like it stuck together. Can't stop swallowing, involuntary. Like a reflex. Then eyes and nose starts running, phlegm coats my throat. Can't breathe in. Have to calm down in order to inhale. Any answers?
Lorelei, Are there any dental issues? Sometimes sinusitis, swallowing issues and dental or gum problems are tied together also. It is amazing how mouth bacteria can affect so much. Just wondering if that's something that has also been explored.
Very true Kathleen. Laryngospasm due to Vocal Cord Disorder however has different presenting symptoms then GERD or viral presentation. I have had patients that I have cared for that have had symptoms for decades and have had to learn "to deal with it". Because unless you are having the episode in front of your doctor too often you are not taken seriously. Frustrating I am sure.
I have had this problem for over 20 years and have found the best way to deal with it is to grasp the front of my neck and hold it tightly until the spasm stops. I don't know how this works but it has helped me.
Hi, I've had similar experiences over the last 2yrs or so, my throat would literally without warning close up and a sharp tingling unpleasant sensation would occur on either side of my throat and immediately it goes into spasm, it may seem like a long time but as stated probably only lasts a minute, I would have a sensation that its going to happen again for at least 20mins after it has stopped!! it scarey as heck, the choking and coughing I do is unreal, it happened to me as I was driving and found it hard to concentrate on controlling the car :o ... Happened during the night too, now that was horrific!! spoke to my doctor he told me it was caused by gastric reflux, probably is?!! but he didn't advise or suggest anything only that unless it happens daily he can't do anything for me. I already take gasro resistant tablets but they don't do much for the spasms, I also would have a constant 'clearing' of my throat daily its really annoying especially in public when you have the sudden urge to have a big cough to help clear your throat but it really don't help!!! any advice would be helpful :)
what works for me is drinking water , drink it like it goes the wrong way then cough it up , that clears the irritation
This started, very suddenly, about 5 weeks ago and as everyone says, was really frightening. Reading the other comments has helped me realise it has probably been caused by the large number of flights I've been on. It is known that the air in planes is very dry. My symptoms have improved, although not gone, by drinking a lot more water.
I am so thankful that I stumbled on this information because I have experienced my throat closing for many years. I thought I was just choking, but now I know without a shadow of a doubt that it is Laryngospasms. Decide to get serious to find out about what it was due to having an extra long bout of it recently and would prefer not to experience them again. I'm not sure if I could do the pursed lip breathing as my vocal folds do not allow any air in for awhile and it feels as if I am going to pass out, just glad to know there are more techniques and possibilities for them not to occur, wishfully never again. They are terrifying to say the least.
Thank you so much for this article. I have experienced episodes of this for about 30 years! Awake and from sleep, at home and out and about, alone and with others. Every time it happens it is terrifying, I am in a state of real fear that I am going to die every time and have even dashed out into the street to get help as so frightened. Last night, however, I had a particularly nasty on and decided that I really needed to find out what was happening. I will see the doctor, but as you wisely said, understanding what is happening makes you less fearful of the experience. It is this sort of initial information re medical matters on the web that is a huge help to some people (e.g. it's difficult for me to see a doctor as I have M.E.). Knowing what is happening, and why, has reassured me. Grateful also to those who share their own experieces - we're not alone in having this!
I never had a name for this, thank you. Mine started years ago, a few times a year, and it seems like it is happening more often. I will be honest that I find it happening when I'm eating too quickly, but not food, liquid, or candy. Super sweet, powdery candy like mints can trigger it. When it happens my throat totally closes up and in a panic that I cannot breath ( as I seem to suffer panic on other things as well), I try and take small gasps of air. My children will run up and say what is it, or what can I do, and of course I cannot talk. The last time it happened, I mentally made myself slow down my gasps for air, and that seemed to help. Also when it is almost done, a sip of something cold seems to help it finish. I hate it..it scares me to death, and I'm started to worry that my fear will trigger it to happen more :(
This started happening to me in 2009. Every once in awhile if I swallowed while turning my head a certain way at the same time my throat would close up and it would feel like I was inhaling through a pinhole. It was always terrifying. But I could exhale normally and even speak while I was exhaling. It was finally discovered by MRI that I had 2 large tumors attached to the backside of my thyroid. I had thyroid cancer. When they removed my thyroid in 2011 I stopped having these episodes - until today. I was in a restaurant and I took a sip of water and couldn't breathe at all - not even the pinhole. I tried to breathe in several times and couldn't get any air in. I think I terrified everyone around me. This time when I finally could get a tiny bit of air in I couldn't speak while exhaling. I'm very upset that this happened again and am wondering if maybe I have a lot of scar tissue that may be causing the problem. I'm also wondering if there's anything like an epi pen that would help open the airway faster.
Breathing exercises are fine IF you are able to breathe, but when it happens to me, I cannot breathe in or out! What do I do when this happens? I have tried to turn on the shower and get the steam flowing in the bathroom, or sometimes have been alone and begun to panic and desperately get outside to moist air hoping it will help. Mine usually occur after I have been sick, with sore throat or sinus, and always occur when I'm sleeping, so I get no rest for a few days. I have tried a humidifier by my bedside, but that doesn't work. When I'm conscious I can prevent them, when I'm asleep is when I fall victim... help?
Thank you for this information. I am recivering frim a respiratory illness and when I told the doctor about not being able to breath in after coughing spells she just looked at me like I was crazy . I cough then in a effort to breath end up sucking any mucus I coughed into my throat back into my lungs. Its truly scary. My doctor gave me the " your getting older speach and its not as bad as you imagine". Yes it is!!! I hope I recover soon. I cant imagine those of you who live with this every day. I also can swallow and gulp large amounts of air . I guess my mind tries to get air however it can. This happens in my sleep so afraid to go to bed now.
My first time having a Laryngospasm was last Monday morning; March 2, 2015. I woke up and was laying in bed just talking to my husband. I had a strong tickle on the whole left side of my neck. I coughed once, then decided I needed to use the restroom, I jumped up and got in the bathroom, then coughed hard, almost a big gag. As soon as I coughed, I couldn't breathe at all. My vocal cords totally locked tight. Of course I panic, I started stomping my feet on the floor because I could not speak or breathe. My husband asked me if I was ok? I kept stomping my feet. Then decided to get up and get to the phone and dial 911. My husband is very slow at getting up and walks with a cane. He met me in the living room. Hit me on the back once, then one more time harder. I did finally get a very small squeaky airway. I pushed him away then, I felt he was going to try to give me the Heimlich maneuver, and I knew if I had an airway, to not do anything else, as you could block it again. Finally, it seemed FOREVER, it was just like a blob moved over and I just started talking normally. 911 of course called us back, my husband had hung up the phone once I started talking. I called the Gastroenterologist that I had seen one time last November 2014. I have had a Nissan procedure which is a loop at the top of your stomach to try to prevent acid reflux from coming into the Esophoghus. Of course, his receptionist says to call my family doctor. I have also only seen my family doctor twice, because my doctor of 30+ years has retired. My doctor’s nurse, said I should have my heart checked out, beings it was on the left side and could not breathe. Well, I had seen a Cardiologist last April and did the tread mill, etc. So, I called them and begged to get in, because I did not know what happened or why. Luckily, I could see a heart doctor who had just returned to the practice after 3 years. He decided I needed to be observed for 24 hrs. So, they admitted me upstairs into the hospital. I had been up there for like less than an hour, and I sat up in bed, through the blanket off and was going to go to the restroom. As soon as I sat up, another laryngospasm, just like my other one. Total shut off of air. A nurse in training was in the room, the other nurse came into the room. As soon as she did, she said COUGH, so I tried, still nothing. I tried again to cough, then I put my hand on my back and patted it, to get her to pat my back, they had picked up the phone to call for a CODE BLUE, then the nurse finally said cancel it. I just got a squeak at first, just like before, then finally it just felt like someone moved a glob over and I could breathe again. I was afraid to try to clear my throat, cough, even swallow. I had that spasm feeling over and over, every time I swallowed. I had some spasms go probably half way or more, but immediately tried to close my eyes, clinch my teeth together and only breathe through my nose. Then it would finally pass again. This went on until about 8:30 PM. When the heart doctor, physician’s assistant came in. I told her I suppose I can't take part of a Xanax to relax as it might mask whatever problem I am having. She said right, don't take any at this time. I also told her I was afraid to get out of bed, she said don't. The nurse earlier in the evening brought me a heart pill to keep my heart rhythyem steady. When I couldn't breathe, I was on the heart monitor, and of course my heartbeat spiked. So right after swallowing that pill, with cold water, I had a Laryngospasm again. I told them I did not want anything else my mouth until I could get scoped in the morning by the Gastroenterologist. At 8:30 PM, my doctor that I had not even seen, had ordered a shot for me that was similar to Xanax for IV, at first I did not know what to think. They finally told me it would only last six hours, so should not mess up my test for in the morning. So, I let them give it to me. I did rest some after that until about 4:00 AM, they came in to take my weight of all things, and took my oxygen off. Then I got all restless again. We finally had it put back on a few hours later. Then, when I went down for my test, they said they wanted me really oxygenated. The Gastroenterologist said to me, he didn't think this was my problem, see the ENT Doctor, which is throat doctor and have him check my Larynx, Vocal Chords. I guess his notes read that he had seen swelling in my throat when he scoped me. Not sure if it was just specifically my Larynx or where. He did prescribe an acid reflux medication this time called Protonix @ 40mg, once daily a half hour prior to my breakfast meal. They released me Tuesday Evening and as soon as I got in the car, I started having a Laryngospasm again. When I got home, I was unpacking my bag, and sneezed, another Laryngospasm. This time I did go sit in the living room and just breathed slowly in through my nose with my mouth closed for several minutes and got it under control, same as in the car. I was afraid to clear my throat, try to cough, swallow, etc., for several days. I tried to read online, what may help. First, if you pass out, they tell me your vocal chords will open right away, as long as it is not from some other problem, like choking on food, or an allergic reaction, which is a real emergency. I have also read to ONLY BREATHE IN SLOWLY THROUGH YOUR NOSE, WHEN YOU BREATHE IN SLOWLY THROUGH YOUR NOSE, YOUR VOCAL CHORDS WILL OPEN! Also, there is a Laryngospasm notch, that you can PRESS YOURSELF or have someone else do. It says after two breaths time, you will be able to squeak out a small amount of air, after two more breaths time, you will be able to breathe normally! Where is the doctor information on this? It was found out like in1960. It is called the Larson Maneuver. All you do, is FIND THE LARYNGOSPASM NOTCH BEHIND YOUR EARLOBE ON EACH EAR, BETWEEN YOUR SKULL BONE AND JAW BONE, PRESS REALLY HARD WITH YOUR INDEX FINGER OR MIDDLE FINGER UNTIL IT HURTS AND PUSH UP TOWARDS YOUR NOSE! This person says he has done it on babies, children, and adults and it has NEVER FAILED! When I went to the ENT throat doctor, they only gave me reflux information, not Laryngospasm information; and the physician’s assistant is the one who told me what it was. I keep praying it never ever happens to me again, BUT if it does, I will be more informed and try really hard NOT TO PANIC. I am still researching if COUGHING will unlock the spasm or not? Hope this helps! Good Luck.
My words exactly! My anxiety sky rockets at bedtime not knowing if I am going to have an episode of it. I too started experiencing these spasms while having bronchitis. Very scary. I can't relax at all which probably makes it worse.
I have the SAME EXACT feeling....when it's time for bed I can't even lay down because I'm afraid it's going to happen....
This sounds an awful lot like what my husband has been going through, since October. We have been in ER twice, and are currently making the rounds with doctors, trying to get a diagnosis. He did see an ENT, who did a scope and his throat and larynx were swollen. He wants to do a CT scan, before he comes up with a treatment plan, but that was a month ago, and we haven't heard anything else. He gave him a Rx for antacid, but I don't think that's the culprit. His throat will suddenly slam shut and he can't breathe. His O2 at the first ER visit got as low as 88. Very scary! The last ER visit, they treated him with epinephrine, and it was a miracle drug. We both now carry an epipen and have had to use it once...and again it cleared it up immediately; but, we would like to find out what causes this to happen so that he can avoid it. I forwarded this article to him, and plan on mentioning it at our next appointment. I feel completely helpless watching him struggle to breathe, and neither one of us are getting a lot of sleep. In fact, I found this article while searching for what could possibly be wrong, as all of his labs, xrays, and tests come back completely normal...but clearly something is wrong!
Where did you get an EpiPen and training for it? I had my third episode of this throat closing thing exactly as most of those on here have described. And I intend on it never happening again. I am wondering if benadryl also taken after administration of an EpiPen would maintain the results over time? Guess I will have to ask my doctor but I am afraid my MD is not in tune with this and will look at me as though I were crazy. When of course I'm not.
I had the same problems and went with all tests. I started studying the changes in my life style and I found that had started using a different mouth wash . Upon stop using that brand of mouth wash, I never had this issue . I tested using the same mouth wash and for sure I had the same attack.
Hi, I am wondering if anyone can help me. For the last three weeks I have had flu like symptoms ( chest infection, green phlegm and what I can only describe as the worst cough I have ever had ). However for the last Three nights I have woke up unable to breath in, out or speak. I'm not normally a person who scares easily but this has now got me to the point where I fear going to sleep. I tried breathing through my nose but nothing gets through. I have tried lying propped up, on my side and this again has no effect. My GP has prescribed me lanzoprazol which I have just started taking today but I fear this may also be another route to a dead end. If anyone has any advice on how to open up my airway whilst going through an attack then I would be very grateful Regards Gary.
Just an update guys. My spasms have now started to come during the day and are always pre emped by an unbearable tickle in my throat then a cough. I am also having around 6 spasms a night which you can imagine is ruining my life. I have since my last post been to A&E and had Laryngospasms confirmed by the consultant ( I actuall had an attack as he examined me ). Once again, if any of u guys have any tips, medications, herbal remedies or know of any operations that can get my life back on track I would be hugely grateful. All I want is to be able to put my head on my pillow and sleep rite through :-/
I have had exactly the same issue for 3 years now and after many tests had severe gurd diagnosed, I've since had surgery for my gurd which had been a success but unfortunately it hasn't stopped the night time choking . I wake up between 4-8 times a night every night without fail and the exhaustion I feel is hard to explain, my partner is understanding but these episodes are frightening and disturb both our sleep, I'm being referred to an ent surgeon but I really am desperate and truly fed up with this. I feel for you as I know exactly how you feel. My doctor hasn't really got a clue , I'm just hoping this specialist may help me. Good luck