15 W. Dry Creek Circle 6169 S. Balsam Way; Suite 290
Littleton, CO 80120-4427 Littleton, Colorado 80123
Phone: (303) 798-1309 Fax: (303) 798-2319
Ear, Nose & Throat Center
Specialists of the Ear, Nose and Throat / Head and Neck Surgery / Facial Plastic Surgery
Evaluation of Dizziness & Vestibular Disorders
For more information see us at our web site ! http://www.ENT Center.Net
LARYNGOSPASM, AND MASS SENSATIONS
WITHIN THE THROAT (GLOBUS SENSATION)
The throat is a unique structure that is uniquely qualified to separate air and food into appropriate passageways. Air is directed through the voice box (the larynx) into the lungs. Food is directed into the esophagus. The way that the voice box prevents food from getting into the larynx and into the trachea is twofold. The epiglottis, which is above the vocal cords, during swallowing folds over the vocal cords to provide a shield, shunting the food into the esophagus. The true vocal cords will close during swallowing, sealing off the trachea. Hoarseness occurs when the true vocal cords become inflamed and injured. Edema occurs, the vocal cords swell and they can no longer vibrate at the very high rate necessary to make sound. Most people produce sounds at 1,000 to 2,000 Hz. This means that the vocal cord vibrates at 1,000 to 2,000 times per second.
Causes that irritate the larynx and cause laryngitis include viral infections. Viral infections are most probably the most common cause for laryngitis. The virus can destroy up to half of the mucosal lining of the true vocal cords. The voice will not return to normal until the vocal cord mucosa has healed and the swelling in the vocal cord has resolved.
Another cause for laryngitis is chronic purulent drainage from a sinusitis or pharyngitis. This pus material is very caustic and can cause direct irritation to the vocal cords, again causing swelling.
Yet another cause for laryngitis involves inhaled allergens. When people have severe difficulties in the spring and fall of the year the inhaled allergens can get past the nose and stick to the vocal cords, causing an allergic reaction to be mediated there. The best way to avoid this is to try to stay inside during times of high allergens, and to use the appropriate antihistamines and topical nasal steroids.
Another common cause for laryngitis is gastroesophageal reflux. Hydrochloric acid that a person's stomach produces is extremely caustic. Left on the back of the hand for five minutes, it would cause a chemical burn to the external skin. Over half the adults over the age of 40 have problems where the valve that separates the esophagus and the stomach becomes leaky. If the person goes to sleep and lays flat, the acid can roll up from the stomach into the esophagus and get into the throat and voice box. If this occurs for only five minutes a night, the true vocal cords will swell and laryngitis will resolve. At times patients do not have heartburn, but rather only have a mild cough or difficulty swallowing as the only symptom of acid reflux. Therefore, the lack of heartburn does not mean that acid reflux is not present.
Excessive use of voice, such as screaming at a football game or other types of activities, can cause excessive strain on the vocal cords and cause laryngitis. Similarly, chronic cough causes increased pressure below the vocal cords, with the vocal cords opening and having a tremendous shear pressure across the cords. This can cause the laryngitis to persist.
The throat has relatively primitive nerve innervation. The throat perceives any type of damage as having a mass within the throat. Therefore, a small abrasion, infection or acid reflux can cause this mass sensation to be felt within the throat. This is called a “globus” sensation, which represents a phantom sensation that a mass is stuck within the throat. At times the lingual tonsils, which are behind the tongue, can become so swollen that they too can cause a mass sensation in the throat. It is important that when a person experiences a mass sensation for more than ten days, that the patient is evaluated by an otolaryngologist so that the throat can be visualized and cancer or abscess formation can be ruled out.
Sometimes, to evaluate the esophagus in more detail, a barium swallow will be obtained, which is an x-ray test where barium in a milkshake-like liquid is swallowed by the patient and x-rays are taken as it goes down. Defects in the walls or acid reflux frequently can be detected by that. In more severe cases the patient will be referred to a gastroenterologist for an esophagogastroduodenoscopy (EGD) to visualize the esophagus and stomach.
In cases where the patient has had a severe infection or other excessive irritation to the vocal cords, the vocal cords will sometimes become abnormally sensitive and the vocal cords will go into an involuntary spasm, bringing the vocal cords to the midline. With inspiration, normally the vocal cords will open widely to allow the air to go down into the trachea. When laryngospasm occurs, the vocal cords are in this involuntary spasm and will not open to allow air in. Therefore, the patient gets a very high, stridorous sound and feels very short of breath. As the patient gets more anxious, feeling he cannot breathe well, the spasm gets worse. Generally the spasm will remit spontaneously after one to two minutes. It is imperative that the patient stay calm and try to drink a neutral fluid, like water, to wash off any type of irritant to the vocal cords. In severe cases patients have been known to faint. As soon as the patient is unconscious, the vocal cords naturally relax. Therefore, laryngospasm can be an extremely uncomfortable and scary process, but generally is benign once the acute episodes are over. It is important that, whatever the irritative focus, the cause of laryngospasm is addressed. That means any infection is treated with appropriate antibiotics, that steroids are given to decrease inflammation, that acid blockers, such as ranitidine, Prevacid or Prilosec, are employed to neutralize stomach acid, that adequate throat moisturization is maintained by increased oral fluid intake and the use of a bedside humidifier or use of guaifenesin to cause the throat to make more fluids. In certain cases, smooth muscle relaxants are also used to decrease the chance of laryngospasm.
Generally, the best way of dealing with laryngospasm is understanding it and remaining calm. When laryngospasms occur, it is important to be seen by an otolaryngologist so that a full visualization of the vocal cords can be undertaken, and to rule out any possible neoplasm or more severe infection, such as epiglottitis.
WHAT IS OTOLARYNGOLOGY-HEAD AND NECK SURGERY ?
Otolaryngology-Head and neck surgery is a specialty concerned with the medical and surgical treatment of the ears, nose, throat and related structures of the head and neck. The specialty encompasses cosmetic facial reconstruction, surgery of benign and malignant tumors of the head and neck, management of patients with loss of hearing and balance, endoscopic examination of air and food passages, and treatment of allergic, sinus, laryngeal, thyroid and esophageal disorders. To qualify for the American Board of Otolaryngology certification examination, a physician must complete five or more years of post-M.D. specialty training.
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Laryngospasm & Mass Sensations |
