Laryngospasm: Why the Vocal Cords Suddenly Close and How to Manage It

01Basics

What happens during laryngospasm

The larynx (voice box) protects the airway. When something irritates it, such as a drop of liquid, acid or mucus, the vocal cords close tightly to stop it entering the lungs, and a cough follows. In laryngospasm this reflex is exaggerated: the cords stay closed for several seconds even after the threat has passed, so the person cannot breathe in.

As the muscles start to relax, air passes through a narrow gap, producing a loud, high-pitched sound called stridor. The episode then settles, often leaving a tired voice, a sore throat or coughing for a while.

02Symptoms

Symptoms of laryngospasm

• Sudden inability to breathe in, or a feeling of choking or suffocation.
• Being unable to speak during the episode.
• A high-pitched squeaking or whistling sound when breathing in (stridor).
• Panic, a racing heart and sweating.
• Waking abruptly from sleep gasping for air.
• Hoarseness, sore throat or cough afterwards.

03Causes

Common causes and triggers

• Reflux: acid or non-acid reflux reaching the larynx is the most common cause in adults, often at night; see laryngopharyngeal reflux.
• Postnasal drip and mucus falling onto the vocal cords.
• Swallowing the wrong way: food, saliva or liquid touching the larynx.
• Irritants: smoke, strong perfumes, chemical fumes or cold, dry air.
• Viral laryngitis or a recent chest infection making the larynx more sensitive.
• Anaesthesia and airway procedures: laryngospasm is a known complication when breathing tubes are placed or removed, particularly in children.
• Sensitive larynx after infection (laryngeal hypersensitivity), sometimes with chronic cough.

04Similar

Conditions that can look similar

• Paradoxical vocal fold motion (inducible laryngeal obstruction): the vocal cords close when breathing in, usually during exercise, stress or exposure to irritants, with episodes lasting longer; see paradoxical vocal fold motion.
• Asthma: wheeze on breathing out and chest tightness, often improving with inhalers.
• Obstructive sleep apnoea: waking gasping or choking, with snoring and daytime sleepiness; see central sleep apnoea and related guides.
• Panic attacks: breathlessness without true airway closure.
• Allergic reactions: throat swelling with hives or lip swelling, which is an emergency.

05During

What to do during an episode

• Try to stay calm: the episode almost always ends on its own within a minute.
• Sit or stand upright and lean slightly forward.
• Breathe slowly and gently in through the nose, then out through pursed lips, as if blowing through a straw. Avoid trying to gasp in hard, which tightens the cords further.
• Some people find that a gentle «sniff» in through the nose, or holding the breath for a moment and then breathing out slowly, helps the cords relax.
• Once breathing eases, take small sips of water and swallow.
• Afterwards, rest the voice and avoid clearing the throat forcefully.

06Diagnosis

How it is assessed

Because episodes are short, the diagnosis is usually based on the description. An ENT specialist examines the larynx with a thin camera (laryngoscopy) to look for signs of reflux, inflammation, nodules or other problems, and may observe the vocal cords during breathing. Recording an episode on a phone can be helpful. Depending on the history, tests for reflux, a sleep study or breathing tests to exclude asthma may be suggested.

07Treatment

Treatment and prevention

• Treat reflux: avoid large late meals and eat at least three hours before bed, raise the head of the bed, limit alcohol, coffee and fatty foods, and use medication when prescribed; see foods to avoid with acid reflux.
• Manage postnasal drip and allergies with saline rinses and nasal sprays.
• Avoid irritants such as smoke and strong fumes.
• Eat and drink slowly, sitting upright, and avoid talking while swallowing.
• Speech and voice therapy: a speech and language therapist can teach rescue breathing techniques and reduce laryngeal sensitivity, especially when episodes are frequent or linked to chronic cough.
• Medication for laryngeal hypersensitivity may be considered by a specialist in persistent cases.

09Summary

Key points to remember

• Laryngospasm is a brief reflex closure of the vocal cords.
• Reflux, mucus and irritants are the most common triggers in adults.
• Slow nose breathing and staying upright help an episode pass.
• Treating the trigger and voice therapy reduce future episodes.