Laryngospasm is a sudden “clamping shut” of the vocal cords, cutting off breathing for between a few seconds for a minor laryngospasm, to a minute or so, for a classic laryngospasm. Think of it as a kind of “charley horse” of the tiny muscles of the larynx. A laryngospasm may occur at any time of day, and/or it may awaken you from deep sleep.
The result is panic! Your brain may scream “I can’t breathe!!”
Obviously, laryngospasm will feel and sound life-threatening to you and those around you, especially the first few times you experience it. Thankfully, laryngospasm is not dangerous other than potentially in the context of general anesthesia. (Anesthesiologists know how to manage it safely…)
Cause of Laryngospasm
Nobody knows the exact reason any individual has laryngospasm, but we think this may relate to the temporary irritation from an upper respiratory infection, or when chronic, to viral injury to sensory nerve endings in the throat, or as a part of vocal cord paralysis or paresis.
Description of Laryngospasm
The individual may cough or clear the throat with or without a sensation of tickling. and then suddenly find him- or herself unable to breathe in, while making an involuntary, strained, inspiratory noise. Panic accompanies the onset of laryngospasm. The person will start to struggle to breathe. The harder they try to pull air in, the louder the noise. If able to speak, the voice sounds “choked” at the same time.
Across the next 30-60 seconds, the breathing noise may get a little quieter, and breathing a little easier. Usually, the episode is mostly over within a minute. Once in a while, a person may experience laryngospasms in a “series.” The scenario when this happens? Just as the person is coming out of one laryngospasm, another one may begin.
Option I: Dealing with laryngospasm by “managing the physics of airflow.”
This is the option most often chosen by people whose laryngospasm episodes are infrequent. The idea here is to slow the velocity of the airflow because the harder and faster you pull “in” on the air, the more the vocal cords tend to “suck together” and “lock” in a closed position. (Look up the Bernoulli Effect if you want to know why.)
So, trying harder to breathe is counterproductive. Instead, do the following:
- To prepare for future laryngospasms, practice at least a dozen times, the technique of “straw-breathing” found on the “straw-breathing” video found below. That is, for at least 2 minutes by the clock, do all your breathing through a coffee stirrer straw. (A standard straw is too big.) Once the straw has “taught” you how small the opening of your lips must be to enforce a slow filling of your lungs, breathe in with lips positioned as if the straw were there.
- Accustom yourself to the way this technique increases the time it takes to fill your lungs. Instead of the normal “one second” it takes to breathe in, it will take 7 or 8 seconds.
- Practice “dumping the air” at the end of each breath quickly, and then…
- Begin immediately to re-fill your lungs (through the straw or tightly pursed lips), without any pause between breaths.
- Note that it is possible to breathe sufficiently in this way, though it will be more “work” to pull the air through the tiny straw or tightly pursed lips. A simple calculation: because you are breathing in for 7 seconds, out for one second; in for 7, out for one; etc., in a span of 64 seconds (about a minute), you will use about 56 seconds breathing in and 8 seconds “dumping out” the air, for a total of 8 breaths in those 64 seconds. This is in contrast to normal breathing, during which we “pause” several seconds between breaths.
- NOW, if a laryngospasm occurs, you can go instantly into this well-rehearsed pattern of “straw-breathing”—with or without the straw since lips are trained—until the laryngospasm ends.
Option II: Dealing with laryngospasm (also) by use of medication.
This solution is often utilized in addition to Option I, for those who are experiencing frequent episodes that are disruptive to work, sleep. and so forth. Most people are not interested in taking medication every day of their lives if laryngospasms occur fewer than 3 or 4 times per week.
If you experience very frequent laryngospasm and want to add Option II, start with one of the medicines that can be used for this purpose (typically amitriptyline, desipramine, gabapentin, or pregabalin). Utilize the “road map” that we use for (the related problem) of sensory neuropathic cough. This will review the dose escalation process (gradual increase of dose).
Remember that patience and persistence, change of medication, and tweaking of how they are used, may be required to find the best approach for you.
Laryngospasm, Part I: Introduction
Dr. Bastian explains laryngospasm with video of the larynx and a simulated attack. You will hear the types of noises often made by the person experiencing it and see what the vocal folds are doing at the same time.
Laryngospasm, Part II: Straw Breathing
Laryngospasm is a sudden, often severe attack of difficulty breathing, typically lasting between 30 and 90 seconds. In this video, Dr. Bastian explains a simple procedure—straw breathing—that can be used by individuals suffering an attack.
What are the key points of laryngospasm?
- Laryngospasms are “always” over in about 60 to 90 seconds, though it is possible to have a series with short breaks between so that the entire episode is longer.
- Laryngospasm is NOT life-threatening other than from a fall if the rare most severe case with syncope. It can be serious upon emerging from anesthesia, but can be managed by the anesthesiologist.
- The best technique for occasional laryngospasm is to learn straw breathing.
- Persons who have very frequent laryngospasms, may want to take medication such as amitriptyline, gabapentin, etc. The same medications used for sensory neuropathic cough.
Can I die from laryngospasm?
Having seen hundreds with this scary problem, NONE has died. I have also never heard of anyone who has died. It is only potentially dangerous upon emerging from general anesthesia; make sure your anesthesiologist knows you are prone to this. He or she will have all the equipment at hand rather than being surprised and rummaging around for it.
Laryngospasm is brutal when you don’t know what it is, but is easily managed if anticipated. You can feel like “this is the end of me” and those observing can be terrified, too. Learn to manage the physics of the airway with the video above, Straw Breathing.
Does Larson's Maneuver stop laryngospasms?
Laryngospasm in the operating room is the same kind of laryngeal event, seen typically upon emergence from general anesthesia, while the patient is still fairly sleepy and “under the influence.” It is different in that it can be serious and even life-threatening (in contrast to garden-variety laryngospasm that occurs in a person who is either awake, or suddenly awakened from normal sleep).
Larson’s maneuver in my experience is not always enough to break laryngospasm in the operating room. Depending on severity and duration of the operating room version of laryngospasm, we may also use positive pressure mask ventilation, a mild intravenous dose of a muscle relaxant, and so forth.
Larson’s maneuver would be a fairly intense maneuver in an awake person who might be frightened and struggling and not know what you are trying to do. And it is hard to imagine how one might do this on one’s self.
Straw breathing is the best way to manage an attack in progress.
What if I have frequent laryngospasms?
Remember that straw breathing helps get through each episode, but will not reduce the number or frequency. If a person is having several a week, they may wish to consider very low dose amitriptyline, or gabapentin, etc. The same neuralgia medications listed in my video on sensory neuropathic cough, which is related to laryngospasm.
Some have one siege of this surrounding a bad upper respiratory infection (URI). Others get a few spasms for a few weeks surrounding each URI. Others have it on an ongoing basis but only a few times a year. And it is only the rare person who has it reasonably frequently on an ongoing basis.
Can you have multiple spasms in the same day?
A single laryngospasm doesn’t last longer than 90 seconds. More typical length is between 15 seconds and a minute.
Occasionally, people describe true laryngospasm that lasts only 10 or 15 seconds. Some severely afflicted people insist that their laryngospasms last longer than 10 minutes.
What is actually happening is that a laryngospasm begins, then begins to resolve with easier and quieter breathing, and then suddenly a second laryngospasm happens, blocking breathing and making much louder noise, etc. If a person viewed this episode of several laryngospasms as a single laryngospasm, they could understandably say it lasted 10 minutes. I’d call such an event “an episode of serial laryngospasms that lasts 10 minutes.”
How can I talk to my doctor about laryngospasm?
Doctors and patients alike define things differently, and especially if the word “choke” is ever used. You may want to look at a recent article 4 ways one can choke. I am sure you have used precise language with your doctor, but after you read this article, and by using the term “laryngospasm” you can be sure you and your doctor have the very same phenomenon in mind as you discuss this.
What is the difference between laryngospasms and cricopharyngeal spasms?
They are two different types of spasms. Laryngospasm is a short breathing attack that is caused by a sudden closure of the larynx. Cricopharyngeal spasm is a contraction of the cricopharyngeus muscle, which may feel like a lump in the throat, but which does not actually inhibit swallowing.
Can laryngospasm also be the basis of stuttering?
Strictly defined, laryngospasm is a brief but intense–even dramatic–and inappropriate triggering of the laryngeal closure reflex. For the first 30 seconds of a severe attack, both the victim and those observing may think the person is going to die! In the most severe case I’ve ever seen, laryngospasm lasting about 60 seconds happened two or three times per day and maybe another time or two during sleep. More often, it happens once a week or even a few times a year.
Stuttering is rather non-dramatic but continual interruption of speech/voice and—I would say—is much more easily compared with dystonia & spasmodic dysphonia. The concept of vocal fold locking interfering with speech initiation isn’t new. We’ve even used Botox in some stuttering patients when the “lock” seemed to be clearly laryngeal, and in some Tourette’s patients.