The Journal of Laryngology & Otology

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An approach to the management of paroxysmal laryngospasm

R J Obholzera1 c1, S A R Nouraeia1, J Ahmeda1, M R Kadhima1 and G S Sandhua1

a1 Department of Otorhinolaryngology, Charing Cross Hospital, London, UK

Abstract

Objective: To review the presentation, risk factors and management of paroxysmal laryngospasm.

Study design: Retrospective review of cases.

Setting: A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.

Patients: All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.

Results: Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56±6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.

Conclusions: The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.

(Accepted October 27 2006)

(Online publication February 26 2007)

Correspondence:

c1 Address for correspondence: Mr Rupert Obholzer, 5 Little Saint Leonards, London SW14 7LT, UK. Fax: +44 870 4580775 E-mail: robholzer@waitrose.com

Footnotes

Mr R Obholzer takes responsibility for the integrity of the content of the paper.

Competing interests: None declared

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