Advertisement

Phenotypic Characterization of Laryngospasm: The Utility of Laryngeal Neurophysiological Studies

      Summary

      Objective

      To determine the existence of laryngeal neuropathy and the influence of gastroesophageal reflux in patients with episodic laryngospasm.

      Study Design

      Single -center, observational study with prospective clinical collection.

      Study Setting

      Prospective analysis of 18 Spanish patients with episodic laryngospasm in a Spanish Public Center collected by otolaryngologist. The recruitment dates were from January 2019 to December 2019.

      Methods

      Data collection of 18 patients with episodic laryngospasm. Clinical characteristics, laryngeal neurophysiological studies and reflux esophageal testing were analyzed.

      Results

      All patients have a trigger for the laryngospasms, being the most prevalent adopting the supine position (27.7%). EMG and ENG were pathological in 83.3 and 63.6 % respectively. Chronic bilateral denervation (increased amplitude and duration of potentials) with signs of reinnervation in the non-active chronic phase (large polyphasia), was the most prevalent finding. Evidence of gastroesophageal reflux either by pH meter, Gastroscopy or both was found in 38.8 % of patients.

      Conclusions

      Neurophysiological studies have confirmed the existence of laryngeal neuropathy in the majority of patients with laryngospasm. A substantial percentage of patients (38.8%) with laryngospasm had objective GERD and improved with PPIs. Laryngeal EMG and ENG can establish a more accurate diagnostic for episodic laryngospams and may supports treatment with neuromodulators.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Holley D
        • Mendez A
        • Donald C.
        Paroxysmal laryngospasm: episodic closure of the upper airway.
        JAAPA. 2019 Feb; 32: 31-34
        • Goizueta San Martin G
        • Górriz Gil C
        • Pinilla Urraca M
        • et al.
        Protocol for neurophysiological.studies of the superior and recurrent laryngeal nerves and of the cricothyroid and thyroarytenoid muscles. clinical utility.
        J Otolaryngol ENT Res. 2017; 6: 00149
        • Volk GF
        • Hagen R
        • Pototschnig C
        • et al.
        Laryngeal electromyography: a proposal for guidelines of the European laryngological society.
        Eur Arch Otorhinolaryngol. 2012; 269: 2227-2245
        • Gyawali CP
        • Kahrilas PJ
        • Savarino E
        • et al.
        Modern diagnosis of GERD: the Lyon consensus.
        Gut. 2018; 67: 1351-1362
      1. Alcedo González J. Documento de actualización de la guía práctica clínica sobre la enfermedad por reflujo gastroesofágico en el adulto. 2019.

        • Morrison M
        • Rammage L
        • Emami AJ.
        The irritable larynx syndrome.
        J Voice. 1999; 13: 447-455
        • Zalvan CH
        • Yuen E
        • Thomas AM
        • et al.
        Laryngeal electromyographic findings in a cohort of recalcitrant chronic neurogenic cough patients.
        J Voice. 2020; 35 (S0892-1997(19)30633-2): 901-905
        • Joniau S
        • Bradshaw A
        • Esterman A
        • et al.
        Reflux and laryngitis: a systematic review.
        Otolaryngol Head Neck Surg. 2007; 136: 686-692
        • Ulualp SO
        • Toohill RJ
        • Shaker R.
        Outcomes of acid suppressive therapy in patients with posterior laryngitis.
        Otolaryngol Head Neck Surg. 2001; 124: 16-22
        • Patel DA
        • Blanco M
        • Vaezi MF.
        Laryngopharyngeal reflux and functional laryngeal disorder: perspective and common practice of the general gastroenterologist.
        Gastroenterol Hepatol (N Y). 2018; 14: 512-520
        • Tatar EÇ
        • Öcal B
        • Korkmaz H
        • et al.
        Postviral vagal neuropathy: what is the role of laryngeal electromyography in improving diagnostic accuracy?.
        J Voice. 2015; 29: 595-599
        • Lee B
        • Woo P.
        Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment.
        Ann Otol Rhinol Laryngol. 2005; 114: 253-257
        • Chhabra A
        • Ahlawat S
        • Belzberg A
        • et al.
        Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications.
        Indian J Radiol Imaging. 2014; 24:: 217-224