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Introduction
Laryngospasm is a forceful, sustained apposition of the glottis and supraglottis which impedes ventilation. It has long been a recognised complication of general anaesthesia and typically occurs during the recovery period.1 On the other hand, paroxysmal laryngospasm occurs spontaneously; the patient frequently describes a sudden onset of difficulty in breathing, which becomes stridulous.2 The episodes frequently have a positional component, and they may wake the patient.3 These episodes are brief and resolve within minutes but are extremely distressing to the patient, who often feels a sense of impending doom. Some patients may also lose consciousness during these episodes, which leads to relaxation of the larynx. Patients often present to the clinic seeking both relief from their distressing symptoms and reassurance that their sense of impending doom is unwarranted.
The underlying pathological abnormality is believed to be an increased sensitivity of the laryngeal mucosa, which is secondary to, or exacerbated by, laryngopharyngeal reflux of gastric contents.2,4-6 This condition is often misdiagnosed as asthma, obstructive sleep apnoea or paroxysmal nocturnal dyspnoea. The diagnosis is based primarily on the characteristic history, with physical examination between episodes being usually unremarkable except for the presence of supraglottic inflammation and inter-arytenoid oedema. Some patients may also have symptoms of gastroesophageal reflux disease or other manifestations of laryngopharyngeal reflux, including hoarseness, recurrent pharyngitis and taste disturbance. In this study, we reviewed our experience with the management of paroxysmal laryngospasm.
Materials and methods
We undertook a retrospective analysis of 15 patients diagnosed with laryngospasm over a two-year period starting in 2003. Information was obtained about the patients' presentation, risk factors, management strategy and outcome (regarding symptom resolution).
Results
Table I shows the patient data obtained. The patients comprised nine women (60 per cent) and six men. The average age at presentation plus or minus the standard deviation was 56±7 years (range 29-85 years). The age-adjusted Charlson comorbidity score was used to assess the burden of associated medical comorbidity.7 This score represents a validated index which correlates with the risk of death over five years from the time of intervention, with a maximum theoretical score of 37. Ten patients had a score of zero, three had a score of two,...