Laryngeal obstruction is a serious and often fatal emergency condition that needs urgent medical attention. Obstruction of the larynx is a very dangerous condition which can result in death in a matter of minutes due to oxygen deprivation and
hypoxia. The larynx, commonly known as the voice box, is a stiff box that is inelastic which is predisposed in many foreign object obstruction.
Laryngeal obstruction occurs when the narrow space between the vocal cords or the glottis in which air passes becomes obstructed by a foreign object through accidental swallowing of large chunks of food material. In other cases, swelling of the laryngeal mucus membranes which in turn causes narrowing of the airway leading to impaired gas exchange through suffocation. Edema of the glottis seldom if not rarely happens to people with existing infection of the larynx (laryngitis). However, it does happen intermittently in individuals with recurring and severe inflammation of the throat. Moreover, it is infrequently but a preventable cause of mortality in individuals in severe anaphylactic reactions.
Aggravating factors of laryngeal obstruction
Cases of laryngeal obstruction report that foreign materials entering the larynx is the most common reported cause of obstruction of the larynx. Foreign material is frequently aspirated into the pharynx as well as the larynx and even the trachea which causes a twofold problem; first such foreign object obstructs the airway which causes problems and difficulty in breathing that later can result in asphyxiation and hypoxia. Secondly, foreign object obstruction can lead to the object being pushed further down the airway which can severely aggravate the situation when it reaches the bronchial branch which can cause persistent cough, expectoration of blood and mucus and labored breathing.
Clinical manifestations of laryngeal obstruction
Clinical manifestations of laryngeal obstruction can be better appreciated through the individual x-ray findings which is also used as a confirmatory diagnosis of laryngeal obstruction. The patient usually would manifest a lowered oxygen saturation, although this is not a reliable interpretation that the obstruction is not significant that warrants attention. The patient would also show labored breathing with the use of accessory muscles in order to better maximize gas exchange through inspiration and expiration. Moreover, labored breathing may also be manifested through contractions of the neck or abdomen during cycles of breathing. Individuals who demonstrate these symptoms are at an imminent risk of collapse and hypoxia.
Medical management of laryngeal obstruction
Medical management of laryngeal obstruction is primarily based on a quick assessment of the individual’s status if there is an urgent need for an invasive measure to secure a patent airway. If the airway is obstructed by a foreign body and there are imminent signs of asphyxiation, a visual sweep must be done over the throat and make use of a finger in an attempt to dislodge the material. It is imperative never to do a blind sweep of the airway if the foreign material cannot be visualized as this may further push the material down the airway. If the obstruction is in the trachea or in the larynx, rescuers can perform the abdominal thrust maneuver to forcefully clear the foreign object. However, if all else fail an immediate tracheostomy procedure is initiated to surgically remove the foreign object that causes laryngeal obstruction.