Can nothing be done about vocal cord spasms?

? On rare occasions toward the end of a 10-mile run or longer, I will experience a vocal cord spasm. Inhaling becomes quite difficult, and though walking alleviates it, the spasm returns very quickly. I'm a 55 year-old male, 170 lbs, with well-controlled reflux and asthma. Only during the last two of my 25 years of running have I had this problem. I have also been swimming my whole life as well, but have never experienced this problem during those workouts. I was told by an otolarynologist that there is no treatment for these spasms. Is this true?

Michael Hechtkopf,

Virginia Beach, VA

Laryngeal spasm is a sudden constriction of the muscles that bring the vocal cords together. It is usually easier to exhale than inhale, and the spasms resolve on their own, typically after 30 to 60 seconds. This is actually the body's normal response to prevent drowning. When nerves in the larynx detect the presence of fluid near the vocal cords, the vocal folds spasm to prevent it from entering the lungs.

Management of laryngeal spasm can be quite difficult, but not impossible. A speech therapist can teach you breathing techniques that will help stop the spasm. When we breathe, we usually exhale slowly, then take a quick breath in. You can learn to breathe in slowly during one of these episodes, let it out quickly, then follow that with another slow breath in. You can repeat this until the spasm ceases.

Make sure you do indeed have good control of your gastroesophageal reflux disease, since this can trigger the spasm. Typically, a proton pump inhibitor is required to reduce acid secretions from the stomach. Antidepressants such as Amitriptyline or Doxepin may help to reduce the trigger response in the larynx. For severe cases, Botulinum toxin can be injected into the muscles of the voice box, and there are surgical procedures as well--though these last two are almost always reserved for those with significant nerve injuries to the neck.

Douglas J. Johnson, MD, FAAFP,

Morganfield, KY

Some patients do develop a vocal cord spasm related to stress or tension. This has been reported among Olympic athletes.

In addition to carefully controlling your asthma and reflux, I suggest a five to ten minute slow warm up before running, and a cool down phase during which you stop very gradually instead of right away.

Talal M. Nsouli, MD, FACAAI,

Burke, VA

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