Laryngospasm in adults

A sharp contraction of the larynx muscles with respiratory failure is laryngospasm. In adults, it arises from the effects on the body of external and internal stimuli.

According to the International Classification of Diseases of the 10th revision of ICD-10, the pathological process is most often associated with the category X Diseases of the respiratory system (J00-J99).

Features of laryngospasm:

• It is characterized by instantaneous contractile spasms of the laryngeal musculature.
• It leads to a narrowing or complete closure of the vocal opening.
• It can occur simultaneously with tracheospazmom or bronhospazmom, that is, the contraction of smooth muscles of the trachea, bronchi.
• It wears an unconscious character and causes panic among people.

The most acute period of the disorder falls on the winter and spring period, when the body suffers from a deficiency of calcium, vitamin D and other nutrients. It can be manifested absolutely in anyone, both an adult and a child. At the same time, children from 3 months to 2 years face this problem most often.

[1], [2], [3]

Epidemiology

According to medical statistics, annually more than 2 million people face a diagnosis - laryngospasm, half of them are children. The pathological condition most often occurs in infancy and in children under 16 years old. In adult patients, involuntary spasms are associated with the constant inhalation of substances hazardous to the body, bad habits, infectious diseases and other factors that lead to irritation of the laryngeal mucosa.

[4], [5], [6], [7],

Risk factors

There are many prerequisites for the development of laryngospasm, but all of them are caused by a disorder in the well-coordinated work of the nervous system, muscles and metabolism. Interaction of these causes leads to increased nervous excitability and pathological symptoms.

The main risk factors for the development of laryngospasm in adults include:

• Inflammatory diseases of the throat: laryngitis, tonsillitis, pharyngitis.
• Irritation of the recurrent or vagus nerve: stress, aortic aneurysm, goiter, esophageal tumors.
• Inhalation of air with a large number of irritating elements and allergens.
• The use of allergens inside.
• Mental disorders.
• Foreign objects in the throat.

In some cases, spasms appear when swallowing while eating. Most often, this condition is directly related to stuck food in the throat. If the clamping of the vocal cords occurs during the swallowing of saliva and is accompanied by pains in the throat, sensation of a coma, shortness of breath, then this can be infectious factors or tumor lesions.

For other reasons for laryngospasm in children and adults, read this article.

[8], [9], [10], [11], [12]

Pathogenesis

The mechanism of origin and development of spasms of the larynx is associated with the impact on the body of various factors. Laryngospasm manifests itself as a short-term attack of suffocation and acts as one of the most dangerous diseases of the respiratory system. It affects both adults and children.

A sharp "interception" of the larynx is an unconscious contraction of her muscles and has such a development mechanism:

• The voice gap sharply narrows or completely closes.
• Inspiratory dyspnea, a person can inhale, but exhalation is difficult.
• Spasm of the trachea, that is involuntary contraction of smooth muscles.

All this leads to a sharp and involuntary contraction of the muscles of the larynx. Attacks are easy when the laryngeal lumen is slightly narrowed and very heavy when it is completely closed. In the latter case, urgent medical attention is required.

[13], [14], [15], [16], [17], [18], [19]

Symptoms of the laryngospasm in adults

The form of laryngospasm depends on its symptoms. The painful condition has the same manifestations both in children and adults. The main symptoms of spasm of the larynx are:

• Difficult, noisy breathing with whistling.
• Unsuccessful attempts to clear your throat.
• Blurred skin.
• The pronounced nasolabial triangle.
• Increased sweating.
• A head thrown back and a wide open mouth.
• Tense muscles of the body: face, neck, stomach.
• Weak pulse.
• The pupils do not respond to light.
• Convulsive seizures, foam from the mouth, involuntary urination.
• Loss of consciousness.
• Heart failure.

The last points are characteristic for the severe form of laryngospasm, which is fatal. The duration of seizure takes a couple of minutes, but if there are complications, then longer. Very often, the seizure of the glottis in adults is confused with epilepsy.

The attack ends with a deep breath. Gradually, the respiratory system recovers and pathological symptoms go away. In this case, spasms can occur at any time of the day, several times a day.

[20], [21]

First signs

In its symptoms, the spasm of the glottis proceeds in the same way in children and adults. The first signs of laryngospasm are manifested by a noisy and difficult breathing. The voice becomes hoarse, it is impossible to clear your throat. Against this background, cyanosis of the nasolabial triangle appears, the neck muscles are maximally strained. The patient opens his mouth wide and tilts his head back in an attempt to draw a normal breath.

At this moment, sweating increases, on the forehead there are large drops of sweat. The pulse becomes threadlike. Rapid increase in the level of carbon dioxide in the body leads to irritation of the respiratory center. The patient makes a deep, choking breath. The respiratory function stabilizes, the skin acquires a normal color, the attack passes.

If the spasm proceeds in severe form, then a deep breath does not come. There are cramps all over the body because of attempts by the patient to restore breathing. Perhaps involuntary urination, foam from the mouth, loss of consciousness.

[22], [23], [24], [25]

Attack of laryngospasm

A sudden involuntary contraction of the larynx musculature with partial or complete blockage of the airways is an attack of laryngospasm. It can occur both in young children and adults. Most often, a painful condition is associated with metabolic disorders, hormonal failures, viral infections, diseases of the ENT organs, allergic factors.

The attack proceeds with a noisy, labored breathing, blueness of the skin and a strain of the respiratory musculature. If the cramp takes place in a mild form, then within a couple of seconds the breath is restored. In severe cases, there is a risk of loss of consciousness, hypoxia and other life-threatening complications.

[26], [27], [28], [29], [30]

Laryngospasm at night in adults

A sudden involuntary contraction of the larynx musculature with narrowing of the glottis arises regardless of the time of day. Night attacks occur with a strong cough, redness of the face, a noticeable strain on the muscles of the neck and a violation of breathing.

In most cases, laryngospasm at night is due to such factors:

• Strong emotional experiences.
• Mental traumas.
• Inhalation of contaminated air.
• After consuming allergenic foods or irritating larynx drinks.

Also, an attack can be associated with chronic or acute diseases of the ENT organs, arise during laughter, crying, fright.

The main rule that should be followed when spasming the throat is not to panic. The panic condition will further aggravate the seizure. The patient must ensure an influx of fresh air, if possible, give a drink of water or moisten the face. Effective are considered irritating actions: pats on the back, lungs tingling and other. You can also give breathe a couple of ammonia or cause a vomiting reflex. If the attack proceeds in mild form, then it lasts no more than a minute, after which the patient again falls asleep.

Complications and consequences

If laryngospasm occurs in severe form and is manifested by several attacks a day, which are difficult to treat, then this threatens with serious consequences and complications for the body.

Severe convulsions during breathing disorders can cause trauma to the patient. Inability to inhale leads to oxygen starvation of the whole organism and hypoxia of the brain. Without timely assistance, an attack can result in a fatal outcome.

[31], [32], [33], [34], [35]

Diagnostics of the laryngospasm in adults

To diagnose - laryngospasm, carry out a set of various diagnostic procedures. The doctor studies the clinical picture, collects an anamnesis and analyzes the patient's complaints. There is a mandatory physical examination, which is aimed at assessing respiratory failure, neck feeling for the presence of tumors.

All diagnostic procedures are performed at the hospital. The patient is examined by a therapist, pulmonologist and a number of other specialists (neuropathologist, surgeon, infectious disease specialist). After an initial assessment of the disorder, the doctor prescribes laboratory and instrumental studies. They are necessary for determining the general condition of the patient and help to identify the root cause of painful attacks. Based on the results of the diagnosis, treatment, corrective and preventive methods are prescribed.

[36], [37], [38], [39], [40]

Analyzes

Laboratory diagnosis of laryngospasm consists of such studies:

• A blood test reveals changes in the composition of the biological fluid that can be triggered by bouts of respiratory failure and indicate their underlying cause. Special attention is paid to the level of leukocytes, erythrocytes, ESR, hemoglobin, eosinophilins, an increase in hematocrit. If the spasm is associated with an acute inflammatory process, then the C-reactive protein, haptoglobin, the growth of seromucoid and fibrinogen are detected. Antibodies to infectious agents can also be detected.
• Urinalysis - if the seizures are caused by a shock state, then the amount of urine released is greatly reduced or there is no renal filtration at all. The level of protein, erythrocytes and the presence of cylindrical epithelium are assessed.
• The gas composition of the blood - the spectrophotometric sensor - reads the data on the level of oxygen saturation of the blood. This analysis allows you to assess the consequences of frequent seizures with respiratory failure.
• Bacteriological analysis of sputum is another mandatory study that is carried out by all patients. The presence of sputum indicates active multiplication of pathogens in the respiratory tract.

The results of the analyzes performed are evaluated in conjunction with other diagnostic procedures.

[41], [42], [43], [44], [45], [46]

Instrumental diagnostics

Another mandatory component of the examination with involuntary closure of the glottis is instrumental diagnostics. It consists of several methods:

• Radiography - reveals various pathological processes in the lungs (darkening of the lobe, foci or the entire organ), lesions of the respiratory center and its musculature.
• Electrocardiography - allows you to evaluate the performance of the heart muscle. In the course of the study, cardiovascular disorders, signs of arrhythmia or myocardial infarction that provoke spasmodic contractions of the larynx can be detected.
• Bronchoscopy - an endoscope is inserted into the lumen of the bronchi, with the help of which the doctor examines the condition of the mucous membrane of the trachea and large bronchi.
• Laryngoscopy - in the throat introduce a flexible fibrolaringoscope with which the doctor examines the larynx. During an attack, partial overlapping of ligaments or their complete closure occurs. In some cases, the vocal appendages of the anteroidal laryngeal cartilage of the right for the left are seen.

In addition to the above methods can be appointed computed tomography of the larynx, ultrasound of the thyroid gland, roentgenography of the esophagus, MRI of the brain and other methods.

Differential diagnosis

Symptomocomplex laryngospasm can easily be confused with other diseases with acute respiratory failure. For the final diagnosis, differential diagnosis is performed. Spasms of the glottis are compared with such pathologies:

• Edema of the Quincke.
• Acute stenosing laryngotracheitis ( false croup ).
• Stenosis of larynx.
• Spasm of the larynx under hysteria.
• Laryngotracheonronhit.
• Bronchial asthma.
• Tumor lesions of the larynx.

The results of differentiation are compared with other diagnostic measures. The doctor makes the final diagnosis and makes a scheme of therapy.

What is the difference between laryngospasm and bronchospasm?

Both pathologies belong to the category - stenosis of the larynx. A painful condition can be caused by allergic reactions to food or medications, various infectious diseases, tumors, diagnostic procedures. And also act as a complication of surgical interventions or because of improper injection into anesthesia.

• Laryngospasm is a contractile spasm of the laryngeal musculature of an unconscious character. It manifests inspiratory dyspnea with noisy breathing. It is accompanied by a violation of the cardiac activity, seizures of the whole body, involuntary urination or defecation, temporary stop of breathing. Without timely medical assistance can lead to death from asphyxia.
• Bronchospasm is the narrowing of the bronchi caused by the contraction of muscles due to the action of various factors. It can accompany laryngospasm or appear independently. It is characterized by shortness of breath with prolonged exhalation, increased tone of respiratory muscles, wheezing in the lungs, cyanosis, bradycardia.

The main difference between spasm of the larynx and spasms of the bronchi is that in the first case there are problems with inhalation, and exhalation is relatively free, while in bronchospasm the breathing out with normal inspiration is disturbed. Both conditions require urgent treatment, as they can cause life-threatening complications.

Laryngospasm or bronchial asthma?

One of the diseases with which obligatory differentiation of laryngospasm is performed is bronchial asthma. It is a chronic noninfectious infection of the inflammatory airways. Accompanied by instant bronchial obstruction, which is why the air flow rate is limited and choking occurs.

Attacks occur very often, proceed with a short sharp inhalation and a severe prolonged exhalation. There may be a cough with phlegm and loud wheezing. One of the differences from seizures of the larynx is that patients feel the approaching bronchospasm.

Chronic bronchial asthma is dangerous with the development of the pulmonary heart, emphysema and asthmatic status. While the main danger of laryngospasm is asphyxia, that is, a lethal outcome from suffocation.

Treatment of the laryngospasm in adults

The main goal of treating spasms of the larynx with the closing of the vocal cords is to eliminate the root cause of the disorder.

• With an allergic attack, antihistamines and antiallergic drugs are used.
• If asthma is caused by bronchial asthma, then use bronchodilators and medicines in the form of inhalations.
• With endocrine disorders - hormonal drugs.
• Infectious pathologies - antibacterial, antiviral and other medicines.
• Mental disorders and emotional experiences - antidepressants, sedatives, muscle relaxants.
• In case of tumor lesions, surgical intervention with further chemotherapy is performed.

During treatment, patients are prescribed multivitamin complexes to strengthen the immune system. Physiotherapeutic procedures and diet therapy may also be prescribed. Timely begun and correctly formulated treatment is a pledge of a speedy recovery.

Prevention

Methods of preventing spasms of the larynx are based on the elimination of situations that provoke seizures. Prevention is reduced to such simple rules:

• Timely treatment of any disease, especially airway damage and other pathologies that can trigger spasms in the throat.
• A balanced diet with a rejection of allergenic foods, food with artificial additives, sweeteners, dyes.
• Taking medication only for medical purposes with observance of dosages.
• Regular walks in the fresh air.
• Full sleep and rest.
• Moderate physical activity.
• Refusal from bad habits: smoking, alcoholism, drug addiction.

Also, prevention of laryngospasm should include the intake of vitamins and multivitamin complexes to enhance the protective properties of the immune system and the overall strengthening of the body.

[47], [48], [49], [50], [51], [52]

Forecast

As a rule, laryngospasm in adults has a favorable prognosis. If it is mild, the risk of complications is minimal. In severe seizures with severe respiratory failure and seizures of the entire body, the prognosis depends entirely on the correct first aid and secondary prevention. In rare cases, laryngospasm results in asphyxia and cardiac arrest.

[53]