Causes of laryngospasm in adults and children

Thanks to numerous studies, the main causes of spontaneous laryngeal spasm have been established:

• Changes in the body's reactivity.
• Excessive excitability of the reflex neuromuscular apparatus of the larynx.
• Metabolic disorders of the body.
• Deficiency of vitamin D and calcium salts.
• Congenital anomalies of the respiratory system and birth injuries.
• Pathological changes in the elements of the respiratory system: trachea, lungs, pharynx.
• Severe stress or fear.
• Coughing fits.
• Allergic reactions.

The disorder can develop against the background of other diseases:

• Bronchopneumonia.
• Spasmophilia.
• Chorea.
• Dropsy of the brain.
• Rickets.
• Lesions of the gallbladder, pharynx, pleura, larynx, trachea.
• Tetanus.
• Eclampsia.
• Tabes dorsalis (tertiary syphilis).

In adults, laryngospasm is most often associated with the following factors:

• Exposure to air containing irritants or allergens.
• Effects of drugs on the larynx.
• Infringement of tumor formations.
• Edema and inflammation in the larynx.
• Irritation of the recurrent laryngeal or vagus nerve.
• Stressful experiences with increased anxiety.

Very often, laryngospasm occurs in people living in industrial areas, where the air contains many irritating elements.

Spasmophilia and laryngospasm

The tendency to develop convulsions, muscle twitching and spasms associated with a deficiency of calcium and vitamin D in the body is spasmophilia. Most often, this disease develops at the age of 1-3 years, but in some cases it occurs in adults.

Spasmophilia has several types:

1. The explicit form can occur in several variants, which occur separately or simultaneously.
   • Laryngospasm is an acute spasm of the glottis. The larynx narrows completely or partially. It causes breathing problems and changes in the voice. The attack lasts about 2-3 minutes. It requires emergency care, as it can cause life-threatening complications.
   • Carpopedal spasm is a spasm and hypertonicity of the hands and feet. The disorder lasts from a couple of minutes to several hours.
   • Eclampsia is the most severe form of the disease. It manifests itself as rare breathing and numbness of the whole body. As it progresses, convulsions, involuntary urination and tongue biting occur. The attack lasts for several hours.
2. Latent form – has an asymptomatic course, the problem can only be identified with the help of complex diagnostics. The impact of severe stress on the body, infectious pathologies and other factors leads to the transition of the disease into an obvious form.

Spasmophilia and laryngospasm are less common in adults than in children. The main causes of the disorder include:

• Extraction of parathyroid glands.
• Pregnancy and lactation.
• Tumor neoplasms.
• Infectious diseases.
• Nervous tension.
• Hemorrhages.

Diagnostics consists of a set of different methods: anamnesis, visual examination, laboratory (blood test for calcium level) and instrumental studies (ECG, MRI). Treatment depends on the severity of the disease. First of all, emergency care is provided. The patient is laid on a flat surface and clothing that restricts the chest is removed, and fresh air is provided. The face and skin are sprinkled with cold water, ammonia is given.

In case of an acute attack, medical assistance is required. Doctors administer calcium gluconate or 10% calcium chloride solution intravenously. Constant monitoring of heart rate is also indicated. Without timely treatment, there is a risk of complications: convulsions, respiratory failure, cardiac arrest.

Allergic laryngospasm

A non-infectious inflammatory process in the larynx with spasm of its walls is allergic laryngospasm. It occurs due to various allergens and irritants. Very often, this type of disorder is called a special form of inflammation, since it is not associated with viruses or bacteria. The inflammatory reaction leads to a sharp weakening of local immunity, which entails an exacerbation of laryngitis.

Each person's body is individual, so it reacts differently to certain irritants. The main provoking factors include:

• Household allergens – animal hair, detergents and cleaning products, hygiene products, cosmetics.
• Natural allergens – plant smells, pollen, fluff.
• Food products – red fruits, honey, chocolate, nuts, dairy products, eggs, artificial additives and sweeteners.
• Medicines – antibiotics, anesthetics, vaccines, serums, vitamins, sedatives.
• Industrial pollutants.

The development of the disease is facilitated by hypothermia, drinking hot or very cold drinks. Often, allergic attacks in adults occur due to work in hazardous production or in dusty rooms.

Symptoms of laryngeal spasms of allergic origin:

• Difficulty breathing due to narrowing of the glottis.
• Shortness of breath and painful swallowing.
• Hoarseness and huskiness of the voice.
• Burning, itching and dryness in the throat.
• Coughing fits and sore throat.

The painful condition may also be accompanied by rhinitis or nasopharyngitis. If local immunity is impaired and the allergen has a long-term effect on the body, chronic infectious foci are formed in the oropharynx and nasal cavity. This leads to the development of laryngitis, which is characterized by fever, cough with phlegm, sore throat and general intoxication.

Each time contact with an allergen causes spasms of the larynx. To establish the cause of the disorder, a number of diagnostic manipulations are indicated: general clinical studies, allergy test analysis, laryngoscopy. Differentiation with viral inflammation of the larynx, tracheitis, diphtheria is mandatory.

Treatment depends on the severity of the attacks. The patient may be sent to a hospital. On average, the course of treatment takes about 10 days. The patient is prescribed antihistamines and desensitizing drugs, glucocorticosteroids, and antispasmodics. If breathing cannot be restored, tracheal intubation is performed. After recovery, repeated allergy tests are performed, this is necessary to prevent relapses of the disease.

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Laryngospasm during anesthesia

Complications during anesthesia arise due to various factors:

• Underestimation of operational risk.
• Incorrect choice of anesthesia.
• Reaction to medications.
• Errors during surgical or diagnostic procedures.

One of such complications is laryngospasm. During anesthesia, the closure of the vocal cords leads to the patient being unable to inhale air, and exhalation is significantly hampered. If the spasm is incomplete, a characteristic sound appears during inhalation.

The pathological condition is the result of local irritation or manifests itself reflexively. It can occur at the beginning of anesthesia, i.e. when inhaling cold ether vapors. In this case, the spasm is associated with a high concentration of ether, irritation of the larynx by mucus, an intubation tube, or food masses. Most often, spasm occurs with barbiturate anesthesia.

Reflex laryngospasm is formed during surgical manipulations on reflexogenic zones: solar plexus, pulling on the mesentery or stomach.

To prevent spasms from anesthesia, the following measures are recommended:

• After the anesthesia has taken effect, the patient is given Atropine and Promedol.
• The concentration of ether is increased gradually to avoid irritation of the mucous membrane of the larynx.
• During the introduction of barbiturate anesthesia, the patient must breathe oxygen. Intubation is performed in deep sleep. The airway is not inserted if the pharynx and root of the tongue are not previously lubricated with Dicaine.
• If reflex spasms are likely, at the most traumatic moments, the anesthesia is deepened or Novocaine is injected into the surgical wound.

If laryngeal spasm occurs during anesthesia, the narcotic is stopped and pure oxygen is administered until the spasms are completely eliminated. If intubation and artificial ventilation with pure oxygen are required, short-acting muscle relaxants are administered. If intubation is impossible and laryngospasm persists, the doctor punctures the cricothyroid ligament with a thick needle and injects oxygen/air through it. In particularly severe cases, emergency tracheotomy is performed. It is necessary to reduce oxygen starvation.

Laryngospasm during extubation

Extubation is the removal of the intubation tube after anesthesia. The procedure is performed when the patient is breathing normally on his own, that is, after consciousness and reflexes have been restored. One of the complications that can occur during extubation is laryngospasm.

Laryngeal spasm is a reflex due to irritation of the airways. The disorder manifests itself as "croaking" sounds when inhaling, paradoxical movement of the chest and abdomen, and pronounced retraction of the suprasternal space. If complete obstruction occurs, the patient is unable to inhale. Without emergency medical care, this can lead to post-obstructive pulmonary edema, hypoxic cardiac arrest, and death.

In order to minimize the risk of laryngospasm, extubation is performed under superficial anesthesia. Local application of Lidocaine as an aerosol to the vocal cords during the administration of anesthesia reduces the risk of spasms.

Laryngitis and laryngospasm

An acute disease with obstruction of the airways in the larynx and the development of respiratory failure is stenosing laryngitis. Laryngospasms are one of the symptoms of the disease.

Inflammation of the larynx very often develops against the background of acute respiratory infections or flu, prolonged exposure to dust, or hypothermia. Also, stenosing laryngitis is associated with viral and viral-bacterial infections.

Lumps of phlegm and mucus form on the mucous membranes of the throat, causing shortness of breath and interfering with breathing. A number of other symptoms also occur:

• Difficulty breathing (stenotic breathing).
• Change in voice, hoarseness.
• Rough cough.

Spasms occur suddenly, causing coughing fits, noisy breathing, and pale skin. Treatment is aimed at eliminating the factors causing the disorder. Patients are prescribed bronchodilators and inhalations. It is necessary to give up smoking and drinking alcohol, which irritate the mucous membrane of the larynx. If the disease is acute with frequent attacks that are difficult to treat, you should immediately seek medical help.

Reflex laryngospasm

Most often, reflex spasm of the larynx occurs in children due to artificial feeding, rickets, and hydrocephalus. In adults, reflex irritation is associated with foreign bodies entering the larynx, diagnostic or surgical manipulations, tumors, and other factors.

One of the most common causes is increased excitability of the neuromuscular apparatus of the larynx. Laryngeal spasms can be provoked by psychogenic disorders and occur during severe stress and anxiety.

During an attack, the aryepiglottic cords are brought to the midline and the vocal cords are tightly closed. This causes the following symptoms:

• Noisy inhalation and shallow breathing.
• The man cannot cough.
• The skin takes on a bluish tint.
• The nasolabial triangle is clearly visible.
• Tense muscles of the face, neck and abdomen.
• Mouth slightly open, head thrown back.
• Weakening of the pupils' reaction to light.

Attacks are characterized by sudden onset. Without timely medical care, the above symptoms can cause loss of consciousness, seizures, involuntary urination, and cardiac depression. As a rule, the spasm quickly stops on its own, resembling an epileptic seizure. A prolonged attack without emergency care can lead to death from asphyxia.

Laryngospasm in epilepsy

A serious disease of the nervous system with sudden epileptic seizures due to an abnormal, super-strong electrical discharge in one of the parts of the brain is epilepsy. Every year, this pathology is detected in 5-7 people out of 10 thousand. The peak incidence falls on the period of puberty and the age of 60-75 years.

There are many reasons and factors that can provoke the development of pathology. The disorder has several types, each of which is characterized by certain manifestations. The appearance of laryngospasms most often indicates temporal epilepsy. Its appearance is associated with birth injuries, brain damage as a result of injuries or inflammatory processes.

• During an attack, all muscles contract and the person loses consciousness.
• Breathing stops for a couple of seconds due to spasm of the muscles of the larynx and diaphragm.
• An acute attack lasts no more than a minute.
• After the tonic phase, muscle contractions begin to alternate with relaxation. At this point, foaming may appear at the mouth.
• The convulsions last about 3-5 minutes, after which a post-seizure period begins, when the patient falls asleep.
• Excessive muscle relaxation may result in involuntary urination or defecation.

The main feature of epileptic seizures with laryngospasms is that the patient feels their approach. The disease is characterized by a chronic course with gradual progression. If the attacks follow one another without stopping, then the spasms of the respiratory muscles lead to persistent respiratory arrest, oxygen starvation of the brain and death.