Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T18:36:47.713Z Has data issue: false hasContentIssue false
  • English
  • Français

An approach to the management of paroxysmal laryngospasm

Published online by Cambridge University Press:  26 February 2007

R J Obholzer ,
S A R Nouraei ,
J Ahmed ,
M R Kadhim  and
G S Sandhu
R J Obholzer*
Affiliation:
Department of Otorhinolaryngology, Charing Cross Hospital, London, UK
S A R Nouraei
Affiliation:
Department of Otorhinolaryngology, Charing Cross Hospital, London, UK
J Ahmed
Affiliation:
Department of Otorhinolaryngology, Charing Cross Hospital, London, UK
M R Kadhim
Affiliation:
Department of Otorhinolaryngology, Charing Cross Hospital, London, UK
G S Sandhu
Affiliation:
Department of Otorhinolaryngology, Charing Cross Hospital, London, UK
*
Address for correspondence: Mr Rupert Obholzer, 5 Little Saint Leonards, London SW14 7LT, UK. Fax: +44 870 4580775 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

LaryngospasmGastro-Oesophageal RefluxBotulinum Toxin
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 1 , January 2008 , pp. 57 - 60
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Visvanathan, T, Kluger, MT, Webb, RK, Westhorpe, RN. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care PMID: 15933300 2005;14:e3CrossRefGoogle ScholarPubMed
2Maceri, DR, Zim, S. Laryngospasm: an atypical manifestation of severe gastroesophageal reflux disease (GERD). Laryngoscope 2001;111:1976–9CrossRefGoogle ScholarPubMed
3Thurnheer, R, Henz, S, Knoblauch, A. Sleep-related laryngospasm. Eur Respir J 1997;10:2084–6CrossRefGoogle ScholarPubMed
4Chodosh, PL. Gastro-esophago-pharyngeal reflux. Laryngoscope 1977;87:1418–27CrossRefGoogle ScholarPubMed
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;101:1–78CrossRefGoogle Scholar
6Poelmans, J, Tack, J, Feensta, L. Paroxysmal laryngospasm: a typical but underrecognized supraesophageal manifestation of gastroesophageal reflux? Dig Dis Sci 2004;49:1868–74CrossRefGoogle ScholarPubMed
7Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–51CrossRefGoogle ScholarPubMed
8Overstein, SR, Overstein, DM, Whitington, PF. Gastroesophageal reflux causing stridor. Chest 1983;84:301–2Google Scholar
9Poelmans, J, Tack, J. Extraoesophageal manifestations of gastro-oesophageal reflux. Gut 2005;54:1492–9CrossRefGoogle ScholarPubMed
10Cohen, HA, Ashkenazi, A, Barzilai, A, Lahat, E. Nocturnal acute laryngospasm in children: a possible epileptic phenomenon. J Clin Neurol 2000;15:202–4Google ScholarPubMed
11Schaefer, SD. Neuropathology of spasmodic dysphonia. Laryngoscope 1983;93:1183–204CrossRefGoogle ScholarPubMed
12Woo, P, Mangaro, M. Aberrant recurrent laryngeal nerve reinnervation as a cause of stridor and laryngospasm. Ann Otol Rhinol Laryngol 2004;113:805–8CrossRefGoogle ScholarPubMed
13Cantarella, G, Berlusconi, A, Maraschi, B, Ghio, A, Barbieri, S. Botulinum toxin injection and airflow stability in spasmodic dysphonia. Otolaryngol Head Neck Surg 2006;134:419–23CrossRefGoogle ScholarPubMed