Understanding and managing laryngospasms

2014-01-01 01:47
Laryngospasm

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.

Larynx
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”.

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.

Causes
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.

Flu
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.

Diagnosing
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.

Management
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!

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.

Medication

Botox
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.
Amitriptylline
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.

Homeopathics:
Bromiuin
For use in those with spasmodic constriction, tickling and burning. Inspiration provokes coughing and it is more difficult than expiration.
Chlorum
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.

Sources:
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

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Comments

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?
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.
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.