Laryngospazmus a dysfunkcia hlasiviek (indukovateľná laryngeálna obštrukcia): Inspiračný stridor, Larsonov manéver ťahu čeľuste a resetovanie dýchania¶

Náhla, desivá neschopnosť vtiahnuť vzduch do hrdla môže byť výsledkom dvoch úzko súvisiacich funkčných kríz hlasiviek: akútny reflexný laryngospazmus (násilné, mimovoľné, úplné alebo takmer úplné uzavretie pravých a falošných hlasiviek sprostredkované horným hrtanovým nervom) a hlasivka, oficiálne klasifikovaná ako medzinárodná respiračná dysfunkcia (VCD)** laryngeálna obštrukcia (ILO)** (paradoxná addukcia hlasiviek smerom k strednej čiare počas inhalácie namiesto toho, aby sa doširoka otvorili, ako by normálne mali). Zatiaľ čo úplný laryngospazmus je život ohrozujúce anestetikum, stav po extubácii, utopení alebo naliehavej chorobe dýchacích ciest, ktorý môže spôsobiť závažnú hypoxiu, bradykardiu alebo podtlakový pľúcny edém v priebehu 60 až 120 sekúnd, ak nie je fyzicky zlomený, obštrukcia vyvolaná samovoľným prebudením, benígny laryngeálny stav, OB-obmedzenie laryngu kŕče vyvolané vysoko intenzívnym cvičením, kyslým refluxom, studeným vzduchom, silným chemickým zápachom, kvapkaním z nosa alebo akútnym stresom, ktorý je často nesprávne diagnostikovaný ako život ohrozujúci astmatický stav alebo anafylaxia. Pretože oba stavy zužujú hlasivkovú štrbinu na úrovni hrtana na krku, vydávajú hlasný, vysoký, hudobný alebo krikľavý zvuk pri dýchaní IN (inspiračný stridor), pričom pacient smeruje priamo do hrdla, na rozdiel od bronchiálnej astmy, ktorá zužuje dolné dýchacie cesty vo vnútri hrudníka a spôsobuje predovšetkým pískanie** piskot ** sipot** Ak sa u niekoho objaví náhly stridor, nemôže hovoriť ani dýchať, má modrasté pery (cyanóza), má opuchnutý krk alebo jazyk alebo stratí vedomie, zavolajte tiesňové čísla okamžite (911 v Spojených štátoch a Kanade, 112 v celej Európskej únii, 999 v Spojenom kráľovstve). Prečítajte si tiež našich sprievodcov na astmatické záchvaty, epiglotitída, krupica a stridor, a alergické reakcie a anafylaxia.

Vašou bezprostrednou prioritou je skontrolovať príznaky skutočnej mechanickej alebo anafylaktickej obštrukcie dýchacích ciest (dusenie cudzieho telesa, angioedém pier alebo jazyka, slintanie alebo zhoršenie vedomia), použiť Larsonov manéver (pevný obojstranný tlak smerom dovnútra a smerom nahor v záreze laryngospazmu, ak je kompletný s ušným lalokom akútny záchvat v kombinácii s ušným lalokom) nereagujúcim pacientom alebo pacientom po sedácii a trénujte bdelého pacienta pomocou Dvojitého nosa a vydychovania so stiahnutými perami (alebo resetovania dychu), aby ste v priebehu niekoľkých sekúnd reflexívne uniesli (otvorili) hlasivky.

Urobte to teraz¶

1. Okamžite skontrolujte život ohrozujúce červené vlajky a zavolajte na miestne tiesňové číslo, ak je prítomné. Vytočte číslo 911 v Spojených štátoch a Kanade, 112 v celej Európskej únii, 999 v Spojenom kráľovstve, 000 v Austrálii alebo si pozrite náš globálny adresár tiesňové čísla ak ide o prvú epizódu stridoru, ak jedol tesne pred nástupom (dusenie), ak majú žihľavku alebo opuchnuté pery alebo jazyk (alergické reakcie), ak majú horúčku a slintajú (epiglotitída), alebo ak ich pery zmodrajú alebo sa stanú zmätenými alebo nereagujú.
2. Ak má osoba v bdelom stave náhly kŕč hlasiviek (VCD / ILO) alebo paroxyzmálny laryngospazmus po kašli: Posaďte ho vzpriamene s ramenami spustenými dopredu a zabráňte mu lapať po dychu cez otvorené ústa. Silné lapanie po dychu cez doširoka otvorené ústa vytvára vysokorýchlostné turbulentné prúdenie vzduchu cez hrtan a hlasivkový povraz**, ktorý silno nasáva podtlak k sebe**B vysušuje sliznicu hrtana.
3. Trénujte „Dvojitý nosový nádych + dlhý výdych so stiahnutou perou“ (EILOBI / Resetovanie na precvičenie dýchania):
4. Krok A (Najskôr vydýchnite): Povedzte osobe, aby jemne vyfúkla zostávajúci vzduch cez pevne našpúlené pery (ako keby fúkala cez úzke miešadlo na kávu alebo blikala plameň sviečky bez toho, aby ho sfúkla) na 3 až 4 sekundy. Dýchanie proti zovretým perám vytvára 5 až 10 cmH2O protitlaku (vlastný PEEP), ktorý pneumaticky odtláča hlasivky od seba.
5. Krok B (Nosový ňucháč): Nechajte ich zavrieť ústa, uvoľnite čeľusť a hrdlo a urobte dva rýchle, jemné šnupanie nosom (akoby ovoňali kvet). Čuchanie cez nos aktivuje silný reflex mozgového kmeňa prostredníctvom zadného krikoarytenoidného svalu (jediného únosového svalu hrtana), ktorý núti hlasivky doširoka otvoriť.
6. Krok C (alternatíva dychčanie/slamený dych): Ak majú upchatý nos, nechajte ich rýchlo dýchať ako pes s jazykom uvoľneným na dne úst, alebo sa pomaly nadýchnite úzkym otvorom medzi zovretými perami a zároveň roztiahnite brucho (bránicové dýchanie).
7. Ak dôjde k úplnému tichému laryngospazmu (nulový prietok vzduchu napriek dvíhaniu hrudníka alebo po anestézii / po refluxe / utopení kŕčov): Okamžite vykonajte LARSONOV MANÉVER.
8. Nájdite Larsonov bod („laryngospazmový zárez“) na oboch stranách hlavy: malá kostná priehlbina ohraničená vpredu vzostupným ramenom (zadným okrajom) dolnej čeľuste, vzadu mastoidným výbežkom za uchom a nad spodinou lebky, hneď za ušným lalôčikom.
9. Umiestnite končeky prostredníka alebo ukazováka hlboko do oboch zárezov a zatlačte silne dovnútra smerom k stredu lebky a dopredu/nahor smerom k nosu a súčasne zdvihnite spodnú čeľusť do silného predsunutia čeľuste.
10. Larsonov manéver mechanicky natiahne geniohyoidné a tyreohyoidné väzy, aby sa oddelili epiglottis a falošné hlasivky, pričom sa spustí intenzívna stimulácia kraniálnych nervov, ktorá preruší reflexný oblúk vagového laryngospazmu v priebehu 5 až 15 sekúnd.
11. Ak osoba pozná astmu aj dysfunkciu hlasiviek: Ak si nie ste istí, použite svoj záchranný inhalátor na salbutamol (albuterol) s medzikusom, pretože až 30 až 50 percent pacientov s VCD má súbežnú astmu. Uvedomte si však, že inhalátory s beta-2 agonistami a epinefrín nesmú uvoľňovať funkciu vokálneho pruhovaného dýchania pri dysfunkcii hlasiviek** pri dysfunkcii hlasiviek. vykonávať spolu s akýmkoľvek použitím inhalátora.
12. Dajte si malý dúšok vody pri izbovej teplote (len raz sa môže človek zľahka nadýchnuť a nedusí sa jedlom) alebo si pobruknite nízky tón („Mmmmmm“). faryngeálny reflex prehĺtania aj bočné bzučanie (fonácia) resetuje poruchu motorickej signalizácie mozgového kmeňa, hrtana, štítnej žľazy, hypertenzných a stenóznych svalov.

Klinický rozhodovací strom: inspiračný stridor, VCD/ILO a kompletný laryngospazmus¶

flowchart TD
    A["Náhle zvieranie hrdla, ťažkosti s dýchaním IN alebo vysoký inspiračný stridor"] --> B{"Skontrolujte vedomie, prúdenie vzduchu a anafylaxiu / príznaky cudzieho telesa"}
    B -->|Unconscious, cyanotic, silent chest with tracheal tug, or post-sedation/drowning| C["ÚPLNÝ LARYNGOSPASM ALEBO UDUSENIE: Zavolajte EMS (911/112/999); overiť prítomnosť cudzieho telesa; okamžite vykonajte LARSONOV MANÉVER + ťah čeľuste + pretlak 100 % O2 (CPAP 10 až 20 cmH2O)"]
    B -->|Swollen lips/tongue, generalized hives, hypotension, or exposure to allergen| D["ANAFYLAXIA ALEBO ANGIOEDÉM: Ihneď vstreknite intramuskulárny epinefrín (0,3 až 0,5 mg) do vonkajšej polovice stehna a zavolajte EMS"]
    B -->|Fever, drooling, tripod posture, muffled hot-potato voice, or barking cough| E["EPIGLOTITÍDA ALEBO KRIEŽKA: Udržujte pacienta pokojného a vzpriameného; NEkontrolujte hrdlo lyžičkou; okamžite zavolajte EMS"]
    B -->|Awake, alert, no hives/swelling, pointing to throat; loud inspiratory stridor triggered by exercise, cough, reflux, scent, or stress| F["Indukovateľná laryngeálna obštrukcia (VCD / ILO) alebo prebudený paroxyzmálny laryngospazmus"]
    F --> G["Krok 1: Posaďte sa vzpriamene a nakloňte sa mierne dopredu; pokles ramien; uvoľniť svaly čeľuste a krku"]
    G --> H["Krok 2: Pomaly vydýchnite na 4 sekundy cez pevne ZAPNUTÉ PERY (vytvorí pozitívny protitlak na otvorenie šnúrok)"]
    H --> I["Krok 3: Vezmite 2 jemné šnuchy NASA cez nos (alebo dýchajte ako pes / dýchajte imaginárnou slamkou) pomocou brušného dýchania"]
    I --> J{"Upravili stridor a zvieranie hrdla v priebehu 1 až 3 minút?"}
    J -->|Yes (Typical VCD / Awake Laryngospasm resolution)| K["Pomaly popíjajte vodu; vyhnúť sa spúšťačom (reflux, studený vzduch, dráždivé látky); zabezpečiť ambulantnú laryngoskopiu a terapiu rečovo-jazykovej patológie (EILOBI)"]
    J -->|No: Stridor persists > 3 to 5 minutes, SpO2 drops below 92%, or severe distress| L["Call EMS (911/112/999) for Emergency Department evaluation, flexible nasolaryngoscopy, CPAP, or Heliox (80:20 helium-oxygen)"]
    C --> M["Hospital / Anesthesia Escalation if Larson Maneuver + CPAP fail: IV Propofol (0.25 to 0.8 mg/kg) or IV Succinylcholine (0.1 to 1.0 mg/kg) + tracheal intubation"]

Pathophysiology: How the Larynx Works and Why the Vocal Cords Slam Shut¶

The human larynx (voice box) serves three critical biological functions: maintaining an open airway for breathing, producing voice (phonation), and acting as a protective sphincter valve to prevent food, liquid, and stomach acid from entering the lungs during swallowing.

Normal Vocal Cord Movement vs Paradoxical Adduction (ILO) vs Complete Laryngospasm¶

1. Normal Respiration:
2. During Inhalation (Breathing In): The respiratory center in the medulla oblongata fires signals down the recurrent laryngeal nerve to contract the posterior cricoarytenoid (PCA) muscle, the only muscle in the entire human body that opens (abducts) the vocal cords. The vocal cords swing wide apart into a broad V-shape, allowing silent, laminar airflow into the trachea.
3. During Exhalation (Breathing Out): The vocal cords relax slightly toward the midline (narrowing by 10 to 30 percent) to maintain mild physiological positive end-expiratory pressure.
4. Inducible Laryngeal Obstruction (Vocal Cord Dysfunction / VCD):
5. In patients with VCD / ILO (including Exercise-Induced Laryngeal Obstruction [EILO] in competitive athletes), chronic irritation of the laryngeal mucosa (from silent laryngopharyngeal acid reflux, post-nasal drip, or inhaled irritants) or autonomic hyper-reactivity causes the adductor muscles (lateral cricoarytenoid, thyroarytenoid, and interarytenoid muscles) to contract paradoxically during inhalation (or causes the aryepiglottic folds above the cords to prolapse inward during peak exercise).
6. Instead of opening into a wide V when the person breathes in, the anterior two-thirds of the vocal cords slam together toward the midline, leaving only a tiny posterior diamond-shaped chink at the back of the glottis through which air whistles with a high-pitched inspiratory stridor.
7. Acute Complete Reflex Laryngospasm:
8. Mediated via the internal branch of the superior laryngeal nerve (a branch of the Vagus Nerve, CN X), complete laryngospasm is an exaggerated, primitive brain-stem protective reflex designed to keep water or vomit out of the lungs.
9. When a droplet of microscopic stomach acid (laryngopharyngeal reflux / LPR), thick post-nasal mucus, blood, water (during swimming or drowning), or a violent coughing fit (such as Bordetella pertussis whooping cough or post-viral vagal neuropathy) hits the hypersensitive laryngeal vestibule, the true vocal cords, false vocal cords (vestibular folds), and aryepiglottic folds all contract into a sustained tetanic spasm simultaneously.
10. Unlike normal swallowing closure (which lasts 0.5 seconds), reflex laryngospasm locks the glottis shut for 15 to 90 seconds even after the irritant is gone.

Side-by-side comparison: Vocal Cord Dysfunction (ILO) vs Asthma Attack vs Anaphylaxis vs Foreign Body Choking¶

Because up to 40 percent of patients with Vocal Cord Dysfunction are misdiagnosed for years as having "refractory brittle asthma", sometimes receiving unnecessary high-dose oral corticosteroids, intramuscular epinephrine injections, or even emergency endotracheal intubation, every emergency responder and patient should know these classic distinguishing features:

Detailed step-by-step guide to Larson's Maneuver (The Laryngospasm Notch Technique)¶

Described by anesthesiologist Dr. C. Philip Larson Jr. and honed over four decades of clinical practice, Larson's maneuver is the single most effective non-pharmacological physical maneuver to break acute complete or severe partial laryngospasm (whether occurring after general anesthesia extubation, during procedural sedation with ketamine, during a drowning rescue, or during a severe awake paroxysmal laryngospasm attack where the patient cannot inhale at all).

Anatomical Landmarks of the Laryngospasm Notch (Larson's Point)¶

On both sides of the head, immediately behind the earlobes, sits a deep pyramidal depression called the laryngospasm notch: - Anterior Boundary (Front Wall): The posterior border of the ascending ramus and condyle of the mandible (lower jawbone). - Posterior Boundary (Back Wall): The anterior border of the bony mastoid process of the temporal bone behind the ear. - Superior Boundary (Roof): The base of the skull right below the external auditory canal (ear canal) and styloid process. - What Lies Deep Inside the Notch: The stylohyoid ligament, the trunk of the facial nerve (CN VII), branches of the glossopharyngeal (CN IX) and vagus (CN X) nerves, and the parotid fascia.

How to Execute Larson's Maneuver in 4 Steps¶

1. Position Yourself Behind or Facing the Patient: Stand at the head of the bed (if the patient is lying down) or directly behind/beside the seated patient.
2. Place Your Middle or Index Fingers Deep into Both Laryngospasm Notches: Slide the pads of both middle fingers (or index fingers) directly behind the earlobes into the soft triangular hollow between the back edge of the jawbone and the mastoid bone, right at the very top of the jaw near the ear canal.
3. Press Forcefully Inward (Medially) Toward the Center of the Skull: Apply firm, deep inward pressure toward the opposite ear. This generates a strong, sharp periosteal stimulus over the styloid process and cranial nerve branches.
4. Simultaneously Pull Forward and Upward (Anterior-Cephalad Jaw Thrust) Toward the Nose: While pressing inward into the notch, hook your fingers behind the angle/ramus of the mandible and lift the entire lower jaw forcefully forward (lifting the lower teeth in front of the upper teeth).

Why Larson's Maneuver Works (Dual Mechanical and Neurological Mechanism)¶

• Mechanical Supraglottic Unfolding: Pulling the mandible forcefully forward stretches the geniohyoid, mylohyoid, and thyrohyoid muscles and the hyoepiglottic ligament, pulling the hyoid bone and tongue base anteriorly. This physically unfolds the buckled aryepiglottic folds and pulls the false vocal cords away from the true vocal cords.
• Central Autonomic / Vagal Reflex Interruption: The intense deep pressure inside the laryngospasm notch stimulates somatic afferent fibers of the trigeminal (CN V), facial (CN VII), and glossopharyngeal (CN IX) nerves, sending an overriding central impulse to the nucleus tractus solitarius and nucleus ambiguus in the brainstem that inhibits the hyperactive superior laryngeal nerve motor arc, causing the vocal cords to relax and swing open within 5 to 15 seconds (often accompanied by an audible sigh or swallow).

Detailed step-by-step guide to Awake Vocal Cord Reset Breathing (Sniffing, Panting, and EILOBI)¶

When a teenager, athlete, or adult is wide awake and experiencing an acute episode of Vocal Cord Dysfunction (ILO) or post-cough / post-reflux paroxysmal laryngospasm (manifesting as terrifying throat tightness and loud high-pitched inspiratory stridor), do not inflict painful pressure unless complete silent obstruction occurs. Instead, guide them through these evidence-based Speech-Language Pathology (SLP) laryngeal rescue techniques:

Technique 1: The Nasal Sniff + Pursed-Lip Exhale ("Sniff-Sniff-Blow")¶

1. Posture Reset: Sit the person upright on the edge of a chair, have them rest their forearms on their thighs (tripod or relaxed forward lean), drop their shoulders away from their ears, and unclench their teeth.
2. Exhale First Through Pursed Lips: Instruct them: "Don't try to suck air in right now. Pucker your lips like you are whistling and blow the air you have out slowly for 4 seconds: Sssssss or Fffffff." This positive expiratory pressure pushes the adducted vocal cords apart from below.
3. Double Nasal Sniff In: Instruct them: "Keep your mouth closed and take two quick, light sniffs in through your nose, like sniffing a rose: Sniff, sniff." Nasal sniffing maximally recruits the posterior cricoarytenoid muscle, forcing the vocal cords into wide abduction.
4. Repeat for 5 to 10 Cycles: Within 3 to 5 breaths, the high-pitched stridor softens and disappears.

Technika 2: Resetovanie dychu (keď je nos zablokovaný)¶

Ak má osoba upchatý nos alebo nemôže čuchať cez nos: 1. Have them open their mouth slightly and rest their tongue flat and wide on the floor of the mouth behind the lower front teeth. 2. Have them pant rapidly and shallowly like a hot dog (2 to 3 shallow pants per second) for 5 to 10 seconds, followed by a slow pursed-lip exhale. 3. Panting continuously stimulates the brainstem respiratory rhythm generator to keep the posterior cricoarytenoid muscle contracted, preventing the vocal cords from slamming shut mid-breath.

Technique 3: EILOBI Breathing (Exercise-Induced Laryngeal Obstruction Biphasic Inspiration) for Athletes¶

Developed specifically by Scandinavian and international sports medicine laryngologists for competitive runners, swimmers, cyclists, and rowers who develop supraglottic or glottic closure at maximum exertion (EILO): 1. While continuing or slowing their stride, the athlete inhales initially through lightly adducted teeth or pursed lips (creating slight oral resistance) for the first half of inhalation, then smoothly opens the mouth while expanding the lower ribcage and abdomen (diaphragmatic excursion) without lifting the clavicles or tensing the anterior neck strap muscles. 2. Why it works: Creating slight oral resistance at the lips shifts the pressure drop forward to the mouth instead of at the larynx, eliminating the negative Bernoulli suction across the aryepiglottic folds and vocal cords.

Sleep-Related and Reflux-Induced Paroxysmal Laryngospasm (Waking Up Gasping at Night)¶

One of the most frightening human experiences is sleep-related laryngospasm: a person wakes up bolted upright from deep sleep in the middle of the night completely unable to inhale a single drop of air, making a desperate high-pitched crowing sound (or total silence) for 15 to 45 seconds and feeling certain they are about to die, before the throat finally pops open with a loud gasp.

• Primary Cause (Silent Laryngopharyngeal Reflux / LPR): When lying flat at night, a tiny micro-droplet of gastric acid and pepsin travels up the esophagus past the upper esophageal sphincter and drips onto the posterior larynx (the interarytenoid notch). Unlike the esophagus (which can tolerate brief acid exposure), the laryngeal mucosa has almost zero carbonic anhydrase defense; a single drop of acid triggers an immediate, violent chemoreflex laryngospasm to protect the lungs.
• How to Break a Nighttime Reflux Laryngospasm Attack:
• Stand up or sit bolt upright immediately (stops further acid reflux).
• Suppress the urge to gasp violently through an open mouth; immediately blow out through pursed lips and take tiny nasal sniffs.
• As soon as a tiny trickle of air passes, take one small sip of water kept on the nightstand and swallow. The mechanical act of swallowing triggers a brainstem reset that immediately unlocks the laryngeal sphincter.
• How to Prevent Nighttime Attacks: Stop all food and liquids at least 3 hours before bedtime, elevate the head of the bed by 15 to 20 centimeters (6 to 8 inches) or sleep on an inclined wedge pillow (sleeping on the left side keeps the gastroesophageal junction above the pool of stomach acid), and consult an ENT or gastroenterologist for proton pump inhibitor (PPI) and alginate raft therapy.

Hospital and Anesthesia Management of Refractory Laryngospasm¶

In the hospital emergency department, intensive care unit, or operating room (such as after pediatric tonsillectomy, upper endoscopy, or ketamine procedural sedation), if complete laryngospasm does not break within 15 to 30 seconds of Larson's maneuver + chin lift, clinicians execute a rapid escalation protocol before hypoxia or negative-pressure pulmonary edema (NPPE) develops:

1. Remove the Irritant Stimulus: Gently suction blood, saliva, or secretions from the hypopharynx above the vocal cords and remove any supraglottic airway device or oral airway that is tickling the glottis.
2. 100% Oxygen Continuous Positive Airway Pressure (CPAP 10 to 20 cmH2O) with Tight Two-Handed Mask Seal: Combine Larson's maneuver with a two-handed C-E mask grip delivering 100% oxygen with 10 to 20 cmH2O of continuous positive airway pressure (CPAP) via a Mapleson circuit or anesthesia bag. Avoid violent high-pressure squeezing of the bag if the cords are completely locked, as pressures above 25 cmH2O force air down the esophagus into the stomach (gastric insufflation), pushing up on the diaphragm.
3. Sub-Hypnotic Intravenous Propofol (First-Line Pharmacological Breaker): Administer a small intravenous bolus of Propofol (0.25 to 0.8 mg/kg IV). Deepening sedation with low-dose propofol breaks 75 to 85 percent of refractory post-extubation or sedation laryngospasms within 15 seconds without requiring paralysis or re-intubation.
4. Intravenous or Intramuscular Succinylcholine (Gold-Standard Neuromuscular Blockade): If hypoxia worsens (SpO2 dropping below 85%) or bradycardia develops despite propofol and Larson's maneuver:
5. Low-Dose IV Succinylcholine: 0.1 to 0.25 mg/kg IV immediately relaxes the striated vocal cord muscles within 20 to 30 seconds while often preserving spontaneous diaphragm breathing.
6. Full-Dose IV Succinylcholine (1.0 to 2.0 mg/kg IV) or IM Succinylcholine (4.0 mg/kg IM into the deltoid or quadriceps if no IV line is present): Completely paralyzes the vocal cords for emergency ventilation and endotracheal intubation, paired with IV Atropine (0.02 mg/kg) in young children to prevent severe hypoxic/succinylcholine-induced bradycardia.
7. Heliox (80% Helium / 20% Oxygen) for Severe Awake Refractory Stridor: In the Emergency Department, patients with severe persistent awake upper airway stridor respond rapidly to Heliox (80:20 or 70:30 helium-oxygen mixture) because helium has one-seventh the density of nitrogen, lower Reynolds numbers, and converts turbulent glottic airflow back into smooth laminar flow while breaking the Bernoulli suction cycle.

Regional emergency numbers and clinical guidelines¶

• United States and Canada: Call 911 for any first-time stridor, cyanosis, anaphylaxis, or unresponsive laryngospasm. Follow American Thoracic Society (ATS), American College of Chest Physicians (CHEST), and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for flexible laryngoscopy confirmation of Inducible Laryngeal Obstruction (ILO) and respiratory retraining therapy.
• United Kingdom: Call 999 for acute stridor with respiratory distress or cyanosis. The ** European Respiratory Society (ERS) / European Laryngological Society (ELS) / Royal Brompton Hospital** consensus guidelines define Inducible Laryngeal Obstruction (ILO) and Exercise-Induced Laryngeal Obstruction (EILO) and recommend continuous laryngoscopy during exercise (CLE) testing and specialist speech and language therapy.
• European Union: Call 112 across all EU member states. Follow the joint ERS / ELS / ACCP Task Force Consensus Statement on Nomenclature and Diagnosis of Inducible Laryngeal Obstructions.
• Australia and New Zealand: Call 000 in Australia or 111 in New Zealand. Follow Thoracic Society of Australia and New Zealand (TSANZ) and Australian and New Zealand College of Anaesthetists (ANZCA) laryngospasm crisis management algorithms.

Často kladené otázky¶

How can I tell the difference between Vocal Cord Dysfunction (VCD / ILO) and an asthma attack?¶

The clearest difference is whether it is harder to breathe IN or OUT, and where the sound comes from: in Vocal Cord Dysfunction (inducible laryngeal obstruction), the vocal cords in your neck close paradoxically when you inhale, making it feel like air hits a wall at your throat with a high-pitched crowing sound (stridor) on inhalation, and episodes start and stop within minutes while oxygen levels stay normal. In an asthma attack, the small bronchial tubes deep inside your chest narrow, making it hardest to breathe air OUT with whistling expiratory wheezing in the chest that requires a bronchodilator inhaler (salbutamol/albuterol) and takes hours to resolve.

What is Larson's maneuver and where is the laryngospasm notch located?¶

Larson's maneuver is an emergency physical technique used to break severe or complete laryngospasm. The laryngospasm notch (Larson's point) is the small triangle-shaped indentation directly behind both earlobes, located between the back edge of the lower jawbone (mandibular ramus) in front, the mastoid bone behind the ear in back, and the base of the skull on top. Pressing firmly inward toward the center of the head with your middle fingers deep in both notches while simultaneously pulling the lower jawbone forcefully forward and upward (a jaw thrust) stretches the laryngeal tissues open and triggers a cranial nerve reflex that relaxes vocal cord spasm within seconds.

Why does sniffing through your nose and breathing out through pursed lips stop a vocal cord spasm?¶

When your vocal cords spasm partway shut, gasping hard through an open mouth creates a high-speed vacuum (the Bernoulli effect) that sucks the vocal cords even tighter together. Blowing air out slowly through tightly pursed lips creates gentle positive back-pressure from below that pushes the vocal cords apart, while taking two gentle sniffs in through the nose activates a built-in brainstem reflex that fires the posterior cricoarytenoid muscle, the only muscle in the body that pulls the vocal cords wide open.

Why do I sometimes wake up in the middle of the night gasping for air with my throat locked shut?¶

Waking up suddenly from sleep unable to pull air in for 15 to 45 seconds with a high-pitched stridor sound is classic sleep-related reflux laryngospasm. When you lie flat, a microscopic droplet of stomach acid and digestive enzyme (laryngopharyngeal reflux) can travel up your esophagus and touch your vocal cords, triggering an immediate protective reflex that slams the voice box shut to keep acid out of your lungs. Sitting bolt upright, blowing out through pursed lips, sniffing gently through your nose, and taking a small sip of water resets the reflex within seconds.

Zdroje a oficiálne pokyny¶

• European Respiratory Society (ERS), European Laryngological Society (ELS), and American College of Chest Physicians (ACCP): International Consensus Statement on Nomenclature, Diagnosis, and Management of Inducible Laryngeal Obstructions (ILO and EILO).
• Larson CP Jr. (Anesthesiology / Clinical Airway Management): Laryngospasm: The Best Treatment (Foundational Description of the Laryngospasm Notch and Larson's Jaw-Thrust Maneuver).
• American Thoracic Society (ATS) and American Academy of Allergy, Asthma, and Immunology (AAAAI): Clinical Differentiation and Co-Management of Vocal Cord Dysfunction (Paradoxical Vocal Fold Motion) and Asthma.
• Association of Anaesthetists (United Kingdom) and Australian and New Zealand College of Anaesthetists (ANZCA): Perioperative Laryngospasm Crisis Management Algorithm (CPAP, Larson's Maneuver, Propofol, and Succinylcholine).
• Royal College of Speech and Language Therapists (RCSLT) and American Speech-Language-Hearing Association (ASHA): Respiratory Retraining and EILOBI Therapy for Inducible Laryngeal Obstruction.

Súvisiaci sprievodcovia¶

• Asthma attack emergency treatment and inhaler spacer technique
• Epiglottitis, croup, stridor, and acute upper airway obstruction
• Negative-pressure pulmonary edema (NPPE) after relieving choking or laryngospasm
• Allergic reactions and anaphylaxis first aid
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