Understanding and managing laryngospasms

Jan 1 2014 - 1:47am
Laryngospasm

Symptoms of Laryngospasm vary from person to person however most people describe it with any of the following descriptions. This is how managing laryngospasms works.

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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.

Also See: This breathing technique could control asthma

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”.

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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.

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.

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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.

Also See: Take This Simple Test for a Deviated Septum and Control Your Snoring Problem

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?
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
I have recently started having these episodes, hence my being on the website. I didn't know what was going on, but as the article describes so well, my throat closes up and i cannot swallow, and i have difficulty breathing. The first time this happened i was absolutely terrified. So I'm not sure where the information in the article comes from, i just wanted to assure you, this description is very accurate for me at least.
The condition described by almost all the comments on this article is classical laryngospasm, caused by a hyper irritable Larynx usually triggered by acid reflex of stomach contents up through the (food tube)and onto the vocal cords. As a physician who has been experiencing this condition sporadically over the last 25 years, I'm aware that most of my colleagues have never heard of it nor realize how terrifying it can be. Anastasio allergist a very thin that you with laryngospasm, ia well known complication of removing the breathing tube at the end of surgery.Recently I read that mint can be a triggering factor for this condition. Subsequently I noticed that whenever I chewed spearmint gum I would develop the typical paroxysmal coughing that often precedes an episode of laryngospasm . Mint is clearly an inciting factor in my case. The straw breathing technique on the Internet described by the physician is extremely helpful. A cold or flu especially with prominent coughing is a major trigger for an event.
It's nice to hear from a physician who is aware of this. I can remember exactly when I first experienced it - driving on a country road in March 1999, not eating or drinking. Several doctors since have been unable to diagnose or treat. As a child, apple caused throat restrictions but not to the extent it happens now. It only happens a few times a year and, after having my gall bladder removed, I was free of it for 9 months. When it happens, I can't swallow and spit anything out that is in my mouth, even water. I close my mouth and concentrate on breathing through my nose until the 'trapdoor' opens.
That's exactly what it feels like a trap door. Today I had just gotten into the shower when I couldn't breathe. I had to turn off the water and get out before passing out. My husband jumped out of bed and new what was going on. I felt dizzy and had to focus on my breathing. These episodes started back in June of this year. I had an endoscopy with good results. No problems according to the doctor. He put me on Meds for acid reflux. Only took it for a month then stopped, because it leaches calcium from my bones. I think spicy and fatty foods (acid reflux) trigger these spasms. This has been very consistent with my episodes. Not sure if I need to follow up with a ENT or a different kind of specialist. Any suggestions are greatly appreciated.
The first time I had this attack, was in the middle of the night, sound asleep, I awoke quickly and began drying to take a big breath, then another one, and then it opened. The other two times, I tasted Vinegar, and it happened again. It is nothing less than terrifying for sure. I don't get any notice, its immediate. It is like sucking through a very small straw. Mine have gone away within 5 very long seconds. The though of getting another one, is causing me allot of anxiety. Anyone else feeling like that? Sure would like to hear from someone who feels like this. Thanks
I just had one this evening after dinner. I was in the kitchen alone, and decided to take a tablespoon full of apple vinegar. Immediately my throat closed off. I quickly drank a swallow of water, then the awful gasping groaning sound of trying to get a good breath. My daughter heard and ran into the kitchen followed by my wife. She was yelling I don't know what to do and crying. Once again that horrible feeling of dieing right in front of them came on. This time it began to ease up after just about 20 seconds. This has happened at least 4 other times to me. Twice from a dead sleep and twice for no apparent reason at all. I was able to remain somewhat calmer the last couple of times, but as you said it is really scary. I am a Christian and I believe that if I were to die, I would immediately be with Jesus in Heaven. The idea of dieing in some other way is not really that frightening to me, but suffocating seems to cause me major anxiety. I believe that most of my problem is acid reflux related, so I am trying to do all the recommended things for that, in addition my doctor has prescribed a mild anti anxiety drug for my anxiety. I only take it when I begin feeling extra anxious, which could lead to feelings of panic. I guess I am just writing you because I read your post and I can relate. The best I can offer is to say your not alone, and that I will pray for you. God bless AJ
Carole I feel like That! I'm laying down try to recuperate from an attack less than an hour ago. I wish mine only lasted a few seconds. Mine last minutes and I usually feel as though I'm beginning to lose consciousness (And actually have on one occasion) before I begin to get any better. I'm always extremely tired and weak afterwards and oftentimes (like now) get a bad headache after the episode. I believe the headache might be from the prolonged lack of oxygen. Just my theory there though. I had always thought it was my asthma until I started researching it online because other asthma attacks (for me anyway) weren't so severe or sudden. I've always used my inhaler during an attack and that's always been the start of me getting to breathe again so now I don't know for sure whether asthma is involved or not but I do know the one time I passed out was when I couldn't get to my inhaler in time. I did get to it but was already to the point of passing out and only remember pumping it once. Whatever it all adds up to, these are the most terrifying situations to live through that I have ever encountered personally in my life! I live in fear of the next one. I'm afraid one day it will kill me. I do understand your fear and anxiety. No one can even begin the fathom the sheer terror we undergo when waking to one of these or even when they overtake you while you are fully awake unless they have experienced it for themselves. Well, maybe a drowning victim. Anyway, I truly get you. I pray we can overcome this! My prayers for you and have a blessed day. :)
Beth, if you can use an inhaler during an attack, you are still able to inhale and have not stopped breathing. As an asthmatic, I have had to use albuterol during an asthma attack to open my airways, however, I believe the problem being discussed here is being unable to breathe at all for a short period of time. When this happened to me in the middle of the night, I was unable to use my inhaler because I couldn't breath in or out. This was far more frightening than any asthma attack I have ever experienced. I literally thought I was going to die. I have no idea what caused it. Unlike other comments, mine wasn't caused by acid reflux. A sleep disorder physician I spoke with the University of Tennessee suggested that it was related to a form of sleep apnea.
no inhaler works for this unable to breath, i tried them all and used albutural also, none work. the best thing is to not to try and breath when it happens, just stand and wait, when you cought dont open your mouth try and cough wit hit closed it helps a lot, i went to mayo clinic ENt and had a cat scan no one can tell me what it is this is crazy, it may be allergys but i wouldnt think this would cause this to be this bad. over time it is getting better but still is there, so many people have this and no one can figure it out, they say spasms and anxiety for some, but i think it is more in depth. thank you mark
I have experienced this terrifying problem on several occasions - starting in my late twenties. As it has only happened a few times in 20 years, and was over very quickly (about 10-15 seconds each time), I have never really been concerned. However, last year I was sitting in my mother's kitchen chatting and having a cup of tea when my throat closed once again and I could not take a breath. As it had happened before and cleared quickly, I stood and waited for it to clear. This time it didn't clear and my throat remained closed. I started to panic a little and really thought that I was going to die. There was NO airflow at all. The noise that I made was truly awful. Then I passed out and woke up on the kitchen floor with my mum calling for an ambulance. I still struggled to draw in air - but within about five minutes, was more or less recovered (if a little shaky). The ambulance had arrived by this time and the paramedics checked me over - they looked at me very strangely when I said that it felt I had 'choked' on some tea. They had never heard of anyone having this problem before. I must mention that on all the chatrooms/websites I have visited in relation to this issue, many people make mention of this happening to them either after taking a sip of tea or water, or when taking a shower (my first couple of times occurred in the shower). Others state that it can be due to sleep apnoea or acid reflux. As this has not occurred (touching wood that this never does) at night, I can rule out apnoea. I can also rule out acid problems. I would be interested to know how many people with this issue have had general anaesthetic in the past - perhaps this is caused by damage to the vocal chords during the administration of anaesthetic tubing? I am just trying to get to the bottom of the issue - as, I'm sure, you are too! I have seen many people ask whether these spasms could cause death - I haven't heard a definitive response to this as it appears as though most doctors are not aware of the issue, or are dismissive of the problem altogether. I would assume that worst case would be unconsciousness and then recovery as the throat is then able to relax and allow air to flow? Would be interested in other's thoughts on this
Mentioning general anaesthetic, 2 weeks prior to me getting this breating problem i have a endoscopy it felt like they knocked me out during the procedure but not sure, i also had a flu shot 3 weeks prior, i kept thinking maybe the endoscopy may have damaged something but the ENT' s didint see anything when they scopped my throat, i really dodnt think any doctors can get to the bottom of this, i have been to the mayo clinic in Rochester Mn with no help yet,, they all try and say Reflux maybe causing it but i have been on An-tacids for 3-4 months with no help. and no heart burn, there has to be someone out there that has figured this out, but who. thank you mark
Hi Ann, this usually happens to me on two separate occasions. One is when I have a cold and the other occasion is when I have a bad case of reflux. So I dont think its any one single cause. I know others have these spasms for other reasons or no reason at all. I have never been under general anesthetic. Regardless of the reasons, I see everyone experiences the same terror during these attacks. Since its a spasm, I dont see how a doctor could fix this. I have never passed out during one of these attacks but I see that others have and apparently the larynx relaxes and the person can breathe again. I cant even imagine how terrifying that would be and I pray that never happens to me. A few days ago I was driving my car and I had an attack out of the blue and for no reason. I was not eating or drinking anything. I did what Tracy suggested, to tilt my head back and breathe slowly through my nose and although I tried to breathe out of my mouth, my ferocious coughing was taking over. It lasted several minutes and then finally ended. The good news is that I did not have the terror or fear of dying that I previously had because I now understand what is happening and know that if I stay calm and breathe in slowly, I will recover.
i was told it may be sleep apnia for all of us that have this, they put you on a forced oxygen mask at night when you sleep. then it supposed to help get rid of the no breathing problems episodes in the day,, so get a sleep apnia test it is overnight, i was against it and didn't want to, but i was told by 2 of the best doctors to get it done,mayo clinic and Iowa city clinic, it may be the main problem cause. they also said to see a speech pathologist, they supposidly learn you how to relax the larynix spasm problems. mark
Hi Carole, yes I frequently experience this. I also have reflux and a persistent post-nasal drip, both which can apparently cause it. I was just reading an article from a GP that says it can also be related to magnesium deficiency and that taking magnesium regularly is supposed to help relax the muscles and enhance sleep. I am going to try it because my condition has been persistent, especially at night. And yes, I find it also causes me a lot of anxiety. Also tipping the head back to open the vocal chords is supposed to help open the airways. A friend of mine was prescribed amitriptyline to take at night which she finds helpful. All the best - I hope it at least helps to know you are far from alone with this experience. Kind regards, Linda
I have had this condition for many years, it happens a few times a year, and scares the hell out of me each time. I knwo that there is no one that dies of this because you will pass out first then your muscle will relax and you will breath, knowing that still doen't do much, I try to make myself calm down and slowly take a breath bad part is as soon as you get some air you have to cough and it all goes out again,, then its breathing through a tiny straw, after what seems to be minutes you start to get a bit of air through then more,, after that you feel congested for a while. I am writing this as about 10 minutes ago while sitting in my hot tub I had one attack ,,my first action is always to stand up and head for another area?? then I start to get my breath,, its something that is very unnerving. if you are ablt swallow I think that that might end the attack, but usually you are just able to breath in.
I totally get your experience. I have been fearfully suffering from this condition. I had my thyroid checked through blood work and ultra sound. Results were normal. I lead an overall healthy life style with a very healthy diet as far as what I consume, however, the time of day i choose to eat definitely plays a factor. I was told it was from acid reflux. Though relieved from getting this non fatal diagnosis, I remain in a position to have these symptoms continue. I started with a raw apple cider vinegar dose, however the ingestion of the vinegar was causing my throat to close and I could not breath. Pharmaceutical solution is not in my cards, so I am taking a holistic approach. I dilute the apple cider vinegar with a lot of water and sip on it after I work out. It needs to be at room temperature for me to be able to swallow it without choking. Once I get it down, I feel amazing as far as indigestion is concerned. i have always had a very sensitive system, and I was raised on a very healthy organic diet which I continue to this day. Certain foods should be avoided, no matter if its organic or not. Some foods irritate the acids in my body. I completely avoid anything processed with bleached flour, corn syrup, artificial flavors, hydrogenated oil, MSG and just about anything that has processed gluten. Those are common sense things that every one should avoid. In many countries these additives are illegal. The american diet has it everywhere, even in places you don't suspect. Aside from these obvious avoided items, I find that tomatoes, peppers, eggplant, pineapple, lowfat milk, bread, and black pepper, and even too much garlic causes these attacks. As much as I love these things, I avoid them. I do know that avoiding coffee and alcohol is supposed to help, but I wouldn't know, as that's where I draw the line of things to avoid. Hopefully it will never come down to that! If I give that up, then it will cause the anxiety that probably put me here in the first place.
I have had this problem fir years but never saw a dr about. Although I am going to. Juice and vinegar is what gets me. I always panick when it happens.
vinegar is an acid and any acid can irritate the larynx and cause laryngospasm, So if you suffer from this entity, do not gargle with any acid or anything caustic or containing mint or pepper.
This happens to me but only when I am crying and talking at the same time. it feels achey and then feels like it closes up and after a few minutes I can't hardly breathe. My doc put me on prilosec once a day and ranatadine two times a day. It has helped considerably as before this, I had it happen under numerous circumstances. Not ever while sleeping though. Just talking a lot, crying and talking,etc and I had a severe attack once while mowing the lawn. I have no allergies so that was weird. That one was scary as i really couldn't breathe for some time. Should have called an ambulance but didn't. Took about an hour to get comfortable again. So anyway, what I am wondering is my symptoms are so different.....no one mentions the excessive talking or crying. Any thoughts?
Dear Lela, This has happened to me quite a few times but only when I'm trying NOT to cry and holding it in. Like you, I could find no mention of larygospasm related to crying on the medical sites.
I have had 2 episodes that sound very much like the symptoms explained in the previous comments. My last episode was immediately after I had drank a small glass of vinegar,water,and honey mixed together. It was a combination that I had read was helpful in losing weight. Immediately after drinking the vinegar mixture my windpipe closed. I could only get a tiny squeak of air in and out of my lungs, I thought I was checking out for sure. I went over to one of my dining room chairs and bent my stomach over the back of the chair and pressed hard. But I knew I had not any food to lodge in my throat but after I pressed my stomach over the chair I began to gradually get more air little by little until I could breathe normally again. Now I am scared to death of vinegar.
The same thing happened to me! I had to google that throat closing an unable to breath thing that has been bothering me for a few years now. I decided to try apple cider vinegar to aid my stomach, but it caused the exact same episode as you described! My reactions were very similar. I found that diluting the vinegar in a large amount of room temperature water and carefully sipping it avoids the choking completely. Once the cider vinegar reaches it's destination, I have had a major improvement with the acid reflux, which is supposedly causing these episodes to occur. I do not get heartburn, and I do not eat unhealthy processed foods, that would cause acid reflux. I should not have this condition. Apparently, I have acid reflux anyway! All I know is that a diet that lowers your acidic level and raises the alkaline to a certain point will prevent cancer from your stomach, which seems to be taking out so many of my peers lately. Apple cider vinegar is good for the joints and arthritis. I'm not sure why? But it works for me...
Yes! Mint! When this first happened to me 20-some years ago, I was eating peppermint bark. It then happened to me while chewing gum.... DRIVING!!! It's happened many other times, tho, and not necessarily with mint. I've finally decided I need to so something, so a scope is scheduled. Scary, scary, scary.
I had my first episode last night waking up at 3am unable to swallow, then trying to catch my breath, and a chocking feeling. It eventually subsided after a minute when starting to burp.
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.

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