Managing Laryngospasms

(Note to SLPs- The free PDF patient education handout version of this information is contained here in the speech store. Download and save the handout to share with your patients.)
What is a laryngospasm?
To understand a laryngospasm, we must first understand how the vocal folds work normally. The vocal folds, or vocal cords, are found in the airway (trachea) and vibrate in an opening and closing pattern when we speak. When we swallow, they come together briefly to close off the airway as a form of protection so food and liquids enter the esophagus (leading to the stomach) instead of the trachea (leading to the lungs). When we breathe at rest, the vocal folds are open so we can breathe freely.
A laryngospasm occurs when the vocal folds or vocal cords slam together suddenly, forcefully, and involuntarily and block off the upper airway. This disrupts breathing and can cause audible gasping sounds. Laryngospasms result in a very unsettling feeling, and many people even go to the hospital the first time one occurs and feel they’re in a life-threatening situation when they become suddenly unable to breathe. The good news is that laryngospasms are not usually dangerous and rarely last over one minute in most cases.

What causes laryngospasms?
Sometimes the cause is known, and sometimes it isn’t. Nerve damage can cause laryngospasms but is difficult to assess for directly. Other more common known contributing factors to laryngospasms include the following:
Gastroesophageal reflux disease (GERD): If reflux is rising back up from the stomach and reaches the level of the throat, the vocal folds can contract and laryngospasms can occur as a form of protection to keep the reflux out of the airway. Often when laryngospasms are related to GERD, medical management and behavioral modifications to control the reflux will often manage or even end the vocal fold spasms.
Dysphagia: Sometimes in the presence of a swallowing disorder (referred to as dysphagia), food or liquid can travel down the wrong way and enter the airway instead of the esophagus (referred to as aspiration). Dysphagia can also cause laryngospasms if the vocal folds become hyper-responsive to aspiration, again as a protective mechanism to keep as much of the food or liquid out of the airway as possible. If swallowing difficulty is a factor, treating the underlying swallowing impairment can improve or eliminate the laryngospasms as well.
Who should you see if you believe you are experiencing laryngospasms?
ENT: If you are experiencing what you believe to be laryngospasms, you should always consult with an ear, nose, and throat specialist who is familiar with and treats laryngopharyngeal reflux (LPR), the term ENTs use to describe reflux that goes up to the level of the throat. An ENT physician can prescribe appropriate medications and/or make a referral to a gastroenterologist if appropriate.
SLP: All of the tiny muscles in the throat are related and affect one another; therefore, it is important to consult a speech-language pathologist with experience treating voice and swallowing disorders any time new symptoms affecting the throat occur. Frequent laryngospasms can also affect voice quality, which an SLP can also evaluate along with swallowing.
What can be done during an attack to help?
Straw Breathing Technique: Many find the straw breathing technique to be very helpful during laryngospasm attacks.
Instructions: Purse the lips together around a straw and breathe in through the straw, inhaling slowly. Then, exhale regularly. Once you have practiced this technique enough, you can use this technique without a physical straw by pursing your lips into that position and pretending to breathe in through a straw. Some people, however, find it comforting to use an actual straw and choose to carry one around specifically for use as a rescue strategy during an attack. Make sure to breathe deeply from the diaphragm. Complete straw breathing until the attack is over. Make sure to practice the technique during times of non-distress so that you’re comfortable executing it smoothly during the stressful event of an attack.
How does straw breathing help?
Breathing through such a small space and only getting a little air at a time sounds counter-intuitive during an attack, but it is actually very helpful. Normally when we breathe, we inhale, exhale, and then pause for a few seconds before repeating. Inhale. Exhale. Pause. Repeat. But during laryngospasms with the straw breathing technique, the pause time is eliminated. Instead, you will inhale slowly through pursed lips, exhale, and repeat. There are no pauses in between. Just breathe in slowly, breathe out quickly, breathe in slowly, breathe out quickly, etc. The typical pause time between breaths is instead being used to extend the inhalation for longer. This technique of extending inhalation time and breathing in through a smaller opening slows the airflow which helps to keep the airway more open during an attack. Conversely, rapid airflow during an attack often further narrows the airway, making symptoms worse.
For more individualized compensatory strategies and treatment techinques, seek a consultation from an ear, nose, and throat specialist and a speech-language pathologist in your area. Feel free to call or email me at the clinic contact information below, and I’m also happy to help answer any questions that you may have or direct you to someone in your area.
Tiffany Turner
Swallowing and Neurological Rehabilitation
2121 S. Columbia Ave., Ste 470
Tulsa, OK 74114
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