Airway

Laryngospasm is a sudden, involuntary spasm (tightening) of the vocal cords that temporarily blocks airflow into the lungs, making it difficult to breathe or speak. It can feel frightening, but the episode is usually brief and not life-threatening.

During a laryngospasm, you may experience:

• Sudden difficulty breathing in
• A feeling that your throat is closing
• Noisy breathing (high-pitched sound or stridor)
• Inability to speak or cry out
• Coughing or choking
• Feeling panicked or anxious during the episode

Most episodes last less than a minute, though they may feel much longer.

Laryngospasm is usually triggered by irritation or stimulation of the vocal cords. Common causes include:

• Gastro-oesophageal reflux (acid reflux)
• Post-nasal drip or mucus in the throat
• Exposure to irritants (e.g. smoke, strong smells, cold air)
• Vocal strain or excessive throat clearing
• Anxiety or panic
• Infections such as laryngitis
• After a procedure involving the throat or airway (e.g. intubation, surgery)

Laryngospasm can affect both children and adults, but it is more common in people with:

• Reflux disease (GORD)
• Asthma
• Voice disorders
• A history of airway procedures

Although it can feel alarming, laryngospasm is not usually dangerous and does not stop oxygen flow completely. The vocal cords relax again on their own, and normal breathing returns shortly.

In very rare cases (e.g. during anaesthesia), medical treatment may be needed to reopen the airway.

If you experience a laryngospasm:

• Try to stay calm – panic can worsen the spas
• Take gentle breaths through your nose (if possible)
• Try to sip cold water or swallow saliva if able
• Breathe slowly and sit upright
• Wait – the spasm usually settles within 30–60 seconds

If episodes are severe or frequent, seek medical advice.

Diagnosis is based on your symptoms and history. Your doctor may also:

• Perform a flexible camera examination of your throat (nasendoscopy)
• Investigate possible triggers like acid reflux, allergies, or airway irritation

Treatment focuses on managing the underlying cause and reducing triggers:

• Reflux management – lifestyle changes, antacids or medications
• Voice therapy – with a speech and language therapist to reduce tension or throat clearing
• Avoiding triggers – such as smoke, strong odours, or cold air
• Breathing techniques – to manage anxiety and regain control during episodes

In rare cases, further investigations or procedures may be needed.

Contact your doctor if:

• You have frequent or severe episodes
• You’re unsure if what you're experiencing is laryngospasm
• Your voice is persistently hoarse or you have ongoing throat discomfort

You develop wheezing, chest tightness, or difficulty breathing between 

• You experience prolonged difficulty breathing that does not resolve
• You feel faint, turn blue, or cannot get any air in

Laryngospasm is a sudden, brief spasm of the vocal cords that temporarily affects breathing. It can feel frightening but is rarely dangerous and usually resolves on its own. Managing triggers like reflux, irritation, or anxiety can reduce episodes.

Help is available — speak to your doctor if episodes are frequent, severe, or affecting your quality of life.

Inducible Laryngeal Obstruction (ILO) is a condition where the airway in the throat (larynx) narrows or closes in response to certain triggers, causing difficulty breathing. Unlike other types of airway obstruction, ILO occurs when the larynx closes up in response to specific stimuli, such as exercise, stress, or exposure to irritants.

It is sometimes referred to as exercise-induced laryngeal obstruction or vocal cord dysfunction. It can mimic symptoms of asthma, but the causes and treatments are different.

The symptoms of ILO can vary from person to person, but they commonly include:

• Shortness of breath: Feeling as though you can’t breathe or that your throat is tight.
• Wheezing or stridor: A high-pitched whistling sound when breathing in or out.
• Coughing: A dry, non-productive cough may occur.
• Throat tightness: A feeling of tightness or obstruction in the throat or chest.
• Difficulty during exercise: Symptoms often worsen with physical activity.
• Episodes of breathing difficulty: These can come on suddenly, especially during physical exertion, emotional stress, or exposure to strong smells.

Many people with ILO may have normal lung function tests and no problems when at rest. Symptoms typically worsen with activity or stress.

The exact cause of ILO is not always clear, but it can be triggered by various factors:

• Physical exertion: Exercise or heavy physical activity can sometimes trigger symptoms.
• Stress and anxiety: Emotional stress or panic attacks can cause the throat to constrict.
• Environmental triggers: Exposure to strong odors, smoke, or allergens may provoke symptoms.
• Respiratory illnesses: A cold or respiratory infection may sometimes lead to ILO episodes.
• Hyperventilation: Breathing too quickly or too deeply can also trigger the condition.

Diagnosing ILO can be tricky because its symptoms overlap with other conditions, such as asthma. Your doctor will:

1. Take your medical history: Ask about your symptoms, triggers, and family history.
2. Conduct a physical exam: This will help rule out other conditions.
3. Perform breathing tests: To check your lung function (like spirometry).
4. Laryngoscopy: In some cases, your doctor may use a small camera to look at the inside of your larynx while you are breathing, especially during an episode of symptoms.
5. Challenge tests: These may involve breathing exercises, exercise, or exposure to known triggers to provoke symptoms under controlled conditions.

Treatment for ILO is aimed at managing symptoms and preventing episodes. There are a variety of strategies that may help:

1. Breathing Techniques

• Pursed-lip breathing: This helps slow down your breathing and keep your airways open.
• Diaphragmatic breathing: Encourages you to breathe from your diaphragm, helping to relax your throat muscles and reduce tightness.

2. Speech Therapy

• A speech and language therapist (SLT) may teach you techniques to control your vocal cords and breathing patterns. These techniques can help prevent or reduce episodes.

3. Cognitive Behavioral Therapy (CBT)

• If anxiety or stress is a trigger, CBT may help you manage emotional responses and reduce the likelihood of episodes.

4. Avoiding Triggers

• Identify and avoid environmental triggers such as strong smells, allergens, or cold air.
• Managing stress through relaxation techniques or regular exercise may also help reduce symptoms.

5. Medications

• While ILO is not treated with the same medications as asthma, sometimes medications used to treat anxiety or respiratory issues, such as inhalers or relaxants, may be prescribed as part of the treatment plan.

6. Exercise Modification

• Gradually increasing physical activity levels and warming up properly before exercise can help reduce the chances of triggering ILO during physical exertion.

Living with ILO can be challenging, but many people find that with proper treatment and management strategies, they can lead a normal, active life. Here are some tips to help manage the condition:

• Stay active: Regular physical activity is important but be mindful of your limits and pace yourself to avoid triggering symptoms.
• Manage stress: Practice relaxation techniques like yoga, meditation, or mindfulness to reduce stress and anxiety.
• Stay informed: Learning about ILO and understanding your triggers can help you anticipate and manage episodes before they occur.
• Support system: Consider joining a support group or speaking with a counsellor if the condition causes anxiety or frustration.

If you experience any of the following, it is important to seek medical attention:

• Severe breathing difficulty that doesn’t improve with breathing techniques.
• Frequent or worsening episodes that interfere with your daily life or exercise.
• Chest pain or discomfort during an episode.
• New or unusual symptoms that you haven’t experienced before.

Inducible Laryngeal Obstruction (ILO) can be distressing, but it is treatable. Working with your healthcare team, you can find the best ways to manage symptoms and improve your quality of life. If you suspect you have ILO or have been diagnosed with it, follow your treatment plan and practice the recommended breathing techniques to gain better control over your condition.

Remember, you are not alone, and with the right support and strategies, you can live an active and fulfilling life.

Laryngeal hypersensitivity is a condition where the larynx (voice box) becomes overly sensitive to stimuli, leading to symptoms such as chronic cough, throat irritation, and voice disturbances. It can result from various triggers, including acid reflux, allergies, infections, or excessive voice use.

• Persistent throat clearing or chronic cough
• Sensation of a lump or tightness in the throat
• Hoarseness or changes in voice quality
• Increased throat sensitivity to irritants (e.g., smoke, strong odours, cold air)
• Throat pain or discomfort
• Difficulty swallowing or a sensation of food sticking in the throat

Laryngeal hypersensitivity can be triggered by:

• Gastroesophageal reflux disease (GORD) – Stomach acid irritating the vocal folds
• Post-nasal drip and allergies – Causing chronic throat irritation
• Viral or bacterial infections – Leading to lingering throat sensitivity
• Excessive voice use or strain – Common in singers, teachers, and public speakers
• Exposure to environmental irritants – Such as smoke, pollution, or strong chemicals
• Nerve dysfunction – Increased sensitivity of the laryngeal nerves after an illness or injury

A specialist, such as an ear, nose, and throat (ENT) doctor, may perform:

• Laryngoscopy or videostroboscopy – A camera examination to assess the larynx
• Voice and cough assessment – To analyze symptoms and triggers
• Acid reflux tests – If GERD is suspected as a contributing factor
• Allergy testing – If allergic triggers are suspected

Treatment focuses on reducing sensitivity and managing underlying causes.

1. Voice Therapy and Behavioural Techniques

A speech-language therapist may help by:

• Teaching techniques to reduce throat clearing and coughing
• Providing breathing exercises to reduce laryngeal tension
• Encouraging proper voice use and avoiding strain

2. Medical Management

• Acid reflux treatment – Proton pump inhibitors (PPIs) or dietary changes
• Anti-inflammatory or antihistamine medications – If allergies or inflammation are contributing
• Neural desensitisation treatments – In cases where nerve sensitivity is a factor

3. Lifestyle and Symptom Management Tips

• Avoid excessive throat clearing and coughing – Sip water instead
• Stay hydrated – Drink plenty of fluids to keep the throat moist
• Manage acid reflux – Avoid spicy, acidic foods and eat smaller meals
• Use a humidifier – Helps soothe throat irritation
• Limit exposure to irritants – Avoid smoke, dust, and strong odours

With appropriate treatment, symptoms of laryngeal hypersensitivity can improve over time. Addressing underlying causes and avoiding triggers are key to long-term relief.

Consult a doctor if you experience:

• Persistent throat discomfort or chronic cough lasting more than four weeks
• Hoarseness that does not improve
• Difficulty swallowing or breathing
• Severe throat pain

Laryngeal hypersensitivity is a manageable condition with voice therapy, medical treatment, and lifestyle changes. If symptoms persist, seek medical evaluation to determine the best course of action.

Subglottic stenosis is a narrowing of the airway just below the vocal cords, in a region called the subglottis. This narrowing can make it harder to breathe and may also affect the sound of your voice.

It can occur at any age and may range from mild to severe. In some cases, it is discovered during investigation for breathing difficulties, noisy breathing (stridor), or persistent hoarseness

There are several possible causes, including:

• Prolonged intubation (breathing tube in the windpipe)
• Trauma or surgery to the airway
• Inflammatory conditions, such as:
  • Idiopathic subglottic stenosis (cause unknown, most common in middle-aged women)
  • Granulomatosis with polyangiitis (a rare autoimmune condition)
• Infections
• Congenital stenosis (present from birth)

In many cases, especially in idiopathic subglottic stenosis, the exact cause is not known.

Diagnosis usually involves:

• Clinical assessment and history
• Flexible nasendoscopy – a small camera passed through the nose to look at the airway
• CT scan or MRI of the neck
• Microlaryngoscopy and bronchoscopy under general anaesthetic – to view the airway in detail and assess the degree and length of narrowing

Treatment depends on the severity and cause of the stenosis. Common treatments include:

1. Endoscopic (Minimally Invasive) Procedures:

• Balloon dilatation – the narrowing is stretched open using a special balloon
• Laser or cold steel surgery – used to carefully remove scar tissue
• Often combined with steroid injection or mitomycin C (to reduce recurrence)
• Usually a day case procedure under general anaesthetic

2. Open Surgery (for severe or recurrent cases):

• Laryngotracheal reconstruction (LTR) – cartilage grafts are used to widen the airway
• Tracheal resection – removal of the narrowed segment with reconnection of the airway

3. Tracheostomy (in some cases):

• A breathing tube is placed through the neck into the windpipe to bypass the narrowing, often as a temporary measure

Your specialist will discuss the best approach for your individual case.

• Many patients experience good improvement in breathing and voice after treatment.
• Multiple treatments may be needed over time, especially for idiopathic subglottic stenosis.
• Regular follow-up is important to monitor for recurrence.
• Voice therapy may be helpful if the voice is affected.

• You may need to avoid irritants like smoke, pollution, or reflux.
• It’s helpful to recognise early signs of recurrence (e.g. breathlessness, noisy breathing).
• Ongoing care may involve an ENT surgeon, respiratory specialist, and speech and language therapist.

Contact your doctor or attend A&E if you experience:

• Sudden or severe difficulty breathing
• Noisy breathing that is getting worse
• New or worsening voice changes or stridor

Subglottic stenosis is a narrowing just below the vocal cords that can affect breathing and voice. It can often be managed effectively with minimally invasive procedures. Ongoing monitoring and follow-up are important, as recurrence is possible. Treatment is tailored to the cause and severity of the condition.