Skip to main content Accessibility help
×
Home

An approach to the management of paroxysmal laryngospasm

  • R J Obholzer (a1), S A R Nouraei (a1), J Ahmed (a1), M R Kadhim (a1) and G S Sandhu (a1)...

Abstract

Objective:

To review the presentation, risk factors and management of paroxysmal laryngospasm.

Study design:

Retrospective review of cases.

Setting:

A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.

Patients:

All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.

Results:

Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56±6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.

Conclusions:

The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.

Copyright

Corresponding author

Address for correspondence: Mr Rupert Obholzer, 5 Little Saint Leonards, London SW14 7LT, UK. Fax: +44 870 4580775 E-mail: robholzer@waitrose.com

References

Hide All
1Visvanathan, T, Kluger, MT, Webb, RK, Westhorpe, RN. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care PMID: 15933300 2005;14:e3
2Maceri, DR, Zim, S. Laryngospasm: an atypical manifestation of severe gastroesophageal reflux disease (GERD). Laryngoscope 2001;111:1976–9
3Thurnheer, R, Henz, S, Knoblauch, A. Sleep-related laryngospasm. Eur Respir J 1997;10:2084–6
4Chodosh, PL. Gastro-esophago-pharyngeal reflux. Laryngoscope 1977;87:1418–27
5Koufman, JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101:178
6Poelmans, J, Tack, J, Feensta, L. Paroxysmal laryngospasm: a typical but underrecognized supraesophageal manifestation of gastroesophageal reflux? Dig Dis Sci 2004;49:1868–74
7Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–51
8Overstein, SR, Overstein, DM, Whitington, PF. Gastroesophageal reflux causing stridor. Chest 1983;84:301–2
9Poelmans, J, Tack, J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut 2005;54:1492–9
10Cohen, HA, Ashkenazi, A, Barzilai, A, Lahat, E. Nocturnal acute laryngospasm in children: a possible epileptic phenomenon. J Clin Neurol 2000;15:202–4
11Schaefer, SD. Neuropathology of spasmodic dysphonia. Laryngoscope 1983;93:1183–204
12Woo, P, Mangaro, M. Aberrant recurrent laryngeal nerve reinnervation as a cause of stridor and laryngospasm. Ann Otol Rhinol Laryngol 2004;113:805–8
13Cantarella, G, Berlusconi, A, Maraschi, B, Ghio, A, Barbieri, S. Botulinum toxin injection and airflow stability in spasmodic dysphonia. Otolaryngol Head Neck Surg 2006;134:419–23

Keywords

An approach to the management of paroxysmal laryngospasm

  • R J Obholzer (a1), S A R Nouraei (a1), J Ahmed (a1), M R Kadhim (a1) and G S Sandhu (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed