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Paroxysmal Laryngospasm: a Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea

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Paroxysmal Laryngospasm: a Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea Hindawi Canadian Respiratory Journal Volume 2020, Article ID 2451703, 7 pages https://doi.org/10.1155/2020/2451703 Clinical Study Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea Yu Bai,1 Xi-Rui Jing,2 Yun Xia,3 and Xiao-Nan Tao 1 1Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China 2Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China 3Department of Nephrology, (e First People’s Hospital of Jiangxia District, Wuhan, Hubei 430022, China Correspondence should be addressed to Xiao-Nan Tao; [email protected] Received 15 April 2020; Revised 19 May 2020; Accepted 10 June 2020; Published 6 July 2020 Academic Editor: Massimo Pistolesi Copyright © 2020 Yu Bai et al. /is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In recent years, we have observed respiratory difficulty manifested as paroxysmal laryngospasm in a few outpatients, most of whom were first encountered in a respiratory clinic. We therefore explored how to identify and address paroxysmal laryngospasm from the perspective of respiratory physicians. Methods. /e symptoms, characteristics, auxiliary examination results, treatment, and prognosis of 12 patients with paroxysmal laryngospasm treated in our hospital from June 2017 to October 2019 were analyzed. Results. Five males (42%) and 7 females (58%) were among the 12 Han patients sampled. /e average age of the patients was 49.25 ± 13.02 years. /e disease course ranged from 14 days to 8 years and was characterized by sudden dyspnea, an inability to inhale and exhale, a sense of asphyxia, and voice loss during an attack. Eight patients with gastroesophageal reflux were cured after antacid treatment. One case of upper respiratory tract infection (URI) was completely relieved after symptomatic treatment. One patient with left vocal cord paralysis experienced complete relief after specialist treatment by an otorhinolar- yngologist. Episodes in 1 patient were significantly reduced after lifestyle improvement. One patient experienced spontaneous relief after rejecting treatment. Conclusions. Paroxysmal laryngospasm is a rare laryngeal disease that generally occurs secondary to gastroesophageal reflux disease (GERD), and antireflux therapy is frequently effective for its treatment. A respiratory physician should master and identify the symptoms and differentiate this condition from hysterical stridor, reflux-related laryngospasm, and asthma. Timely referral to otolaryngologists, gastroenterologists, and other specialists for standardized examination and regular treatment should be provided when necessary. 1. Introduction severe dyspnea during an attack. Several patients cannot obtain a definite diagnosis and treatment. In contrast to Dyspnea is a common clinical symptom with several well- respiratory physicians, otolaryngologists and anesthesiolo- defined causes: pulmonary dyspnea, cardiogenic dyspnea, gists are experts in managing paroxysmal laryngospasm. dyspnea caused by hematologic abnormalities, central Articles related to this condition are also published in nervous system dyspnea, dyspnea caused by endocrine otolaryngology, anesthesiology, and other specialized jour- abnormalities, and dyspnea associated with hysteria [1, 2]. nals. We therefore urge pulmonologists to understand and Dyspnea caused by various conditions has its own distinct become familiar with paroxysmal laryngospasm in order to characteristics [3]. However, in recent years, we have ob- improve the management of this condition. served respiratory difficulty manifested by paroxysmal lar- Laryngospasm, a clinical symptom characterized by yngospasm in a few outpatients. Most of these patients have involuntary laryngeal muscle spasm, is a manifestation of 2 Canadian Respiratory Journal glottic obstruction when vocal cords are closed. Vocal cords stated that their symptoms occurred during the day, and and soft tissue of the supraglottic folds are blocked at the only 1 had nocturnal symptoms. upper airway, resulting in obstruction of inspiration and expiration, which sometimes occurs during or after the administration of anesthesia and is associated with severe 2.2. Clinical Manifestations and Related Findings. Table 1 perioperative complications. Failure to manage this condi- lists the concomitant conditions of all the patients. /ese patients came to see a doctor because they were experiencing tion leads to hypoxia, hypercapnia, bronchospasm, pul- sudden dyspnea, an inability to inhale and exhale, a sense of monary edema, arrhythmia, and heart failure, among other asphyxia, and loss of their voice during attacks. Two patients sequelae, which can eventually cause death from severe mostly complained of wheezing. /e duration of each attack laryngeal spasm [4, 5]. One type of reactive airway ob- varied among the patients from a minimum duration of 10 struction is paroxysmal laryngospasm, which is a rare la- seconds to a maximum of 2 minutes. All patients were able ryngeal disease in adults. In this condition, the throat is to recover from the attacks on their own. Eight of the 12 completely closed due to some form of hypersensitivity or a patients had a history of GERD. Seven of these had conscious protective laryngeal reflex causing a transient, complete sensation of regurgitation into the pharynx as part of their inability to breathe. Paroxysmal laryngospasm onset in patients is often characterized by a sudden and complete GI problems. All 12 patients had signs of chronic pharyngitis inability to breathe, along with voice loss or hoarseness and such as mucosal hyperemia and hypertrophic lymphoid follicles. Apart from these findings and history, these pa- stridor. Paroxysmal laryngospasm usually lasts from several tients had no other relevant complaints or conditions. /eir seconds to several minutes [6] and may be accompanied by workup included pulmonary CT, pulmonary function obvious causes such as upper respiratory tract infection testing, routine blood examination, and electrocardiograms, (URI), emotional agitation or tension, and/or severe all of which were negative. All other fiberoptic laryngoscopy coughing. studies were within normal limits except for one case of left Several studies have established that paroxysmal lar- vocal cord paralysis identified. yngospasm is often secondary to laryngopharyngeal reflux, a variant of gastroesophageal reflux disease (GERD). Parox- ysmal laryngospasm is often misdiagnosed as asthma, 3. Results hysterical stridor, obstructive sleep apnea, paroxysmal 3.1. Diagnosis. Laryngeal function, particularly with respect nocturnal dyspnea, and other conditions [7]. Patients with to vocal fold movement, would be expected to be normal in paroxysmal laryngospasm have a short attack period and patients with reflux-related paroxysmal laryngospasm as often show no symptoms and signs after these episodes. /e observed in this study with the exception of one patient with diagnosis usually relies on clinical manifestations [8]. unilateral paralysis. Even the patients without GERD his- /erefore, clinicians who do not understand the clinical tories had normal fiberoptic exams. No patients underwent a manifestations of this condition regularly misdiagnose the fiberoptic exam during one of their laryngospasm events. disease [9]. Paroxysmal laryngospasm yields obvious /e diagnosis of paroxysmal laryngospasm mainly depends dyspnea; consequently, this symptom should be recognized on a patient’s medical history and a lack of alternative ex- not only by otolaryngologists, anesthesiologists, and gas- planations for symptoms. An alternative explanation was troenterology physicians but also by respiratory physicians. identified in only 1 of the 12 patients, and we diagnosed /erefore, we call on pulmonologists to be conversant with paroxysmal laryngospasm in the remaining 11 patients the management and treatment of paroxysmal laryngospasm based on the following medical histories and clinical and to refer patients to relevant specialists when necessary. manifestations: (1) with or without obvious triggers, URI, Based on experience in our clinic, 12 cases of paroxysmal emotional agitation or tension, and a history of GERD; (2) laryngospasm were reviewed and described in this work. typical laryngospasm attacks: sudden dyspnea, asphyxiation, stridor, and hoarseness usually lasting for several seconds to 2. Methods several minutes; and (3) exclusion of asthma, hysterical stridor, obstructive sleep apnea-hypopnea syndrome, heart 2.1. Participants. We collected data from 12 patients seen at attack, epilepsy, rabies, tumor, nervous system disorders, the Department of Respiratory and Critical Care Medicine, and other diseases. Hysterical stridor was excluded because Union Hospital Affiliated with Tongji Medical College, it has a strong demographic pattern of occurring in young Huazhong University of Science and Technology, China, adult females, lasting for minutes to hours, frequently re- from June 2017 to October 2019. Patients were all from the quiring sedation or anxiolytics for treatment, and persisting Han tribe. Five of the patients were male, representing 42%, for years. /e patient with vocal fold paralysis in this
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