Laryngeal Muscle Tension/breathing distress

[NelsonAAA]

I appear to have developed adult onset asthma, possibly due to aspiration of gastric asthma (?) I'm still having tests.

The asthma-like problem is exacerbated by an ache in my neck/larynx.

I was convinced this might be due to inflammation from laryngeal reflux, but a recent laryngoscopy and endoscopy showed my voice box to be absolutely fine (although I did have a mild hiatal hernia !). I presently take a PPI daily.

Q. Could you please suggest why I might have this ache (laryngitis)- it feels like muscle tension and makes me feel tired and run down? Is this anxiety/tension idea plausible?  If so, what can I do to relieve it?

THANKS!!!

[National Jewish]

A possible cause of throat tightness is vocal cord dysfunction (VCD).  This is a condition that can mimic asthma.  However, VCD is not helped by asthma medicines.  While inhaling the vocal cords should open to let air into the lungs.  With VCD the vocal cords close together during inhalation.  This makes it difficult for air to get into the lungs.  A lot of the same things that trigger asthma can trigger VCD including upper respiratory infections, fumes, odors, reflux, cigarette smoke, singing, emotional upset, postnasal drip and exercise.  Sometimes the trigger is not known.  These attacks are often seen with panic attacks or anxiety.

Testing needs to be done while you are having symptoms.  Breathing tests may be normal, but the “breathing in” or inspiratory part, also called an inspiratory flow volume loop, will show little airflow while you are inhaling.  A laryngoscopy is a procedure done by a specialized doctor using a camera at the end of a flexible tube to see how your vocal cords open and close.  Your vocal cords will look absolutely fine if you are not having symptoms.

VCD is treated by a speech therapist that will instruct you in open throat breathing techniques.  Counseling can help you identify and deal positively with chronic stress, which may be an underlying factor in VCD.  Please read our Vocal Cord Dysfunction MedFact at http://www.nationaljewish.org/medfacts/vocal.html for more information.  It is important for you to be thoroughly evaluated so that the diagnosis is determined.  Only then can you be treated appropriately.

It is possible to have VCD with or without asthma.  If you have both, it is important that you learn to tell whether it is the VCD or the asthma causing your symptoms.  Only then will you be able to use the treatment that will help stop your symptoms.  Asthma medicines do not help VCD.  The open throat breathing technique does not help asthma.

Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube.  This is most commonly called acid reflux or heartburn.  This reflux can come all the way up into the mouth and nose.  When this happens the material can be aspirated, dribbling into the windpipe and lungs.  Since your larynx looks absolutely fine, you are probably not aspirating gastric contents.  However even without aspiration, reflux can trigger asthma and vocal cord dysfunction (VCD).  It’s important that your reflux is controlled by the PPI you take daily.

Diaphragmatic breathing can help you move more air in and out of your lungs.  This is the most efficient way to breathe and may relieve your symptoms.  Learning this technique will help you to breathe slowly, regularly, gently, and smoothly all of the time.  Here are the instructions:
· Breathe in slowly and deeply through your nose.
· While you breathe in, count 1, 2 and push your stomach out.
· Place your hand on your stomach so you can feel your stomach going out.  This promotes the use of your diaphragm and your lower respiratory muscles.
· Breathe out slowly and deeply through your mouth.  Imagine that you are breathing out through a straw by “pursing” your lips.
· While you slowly breathe out all the way, count 1, 2, 3, 4 and let your stomach relax.  You can feel your stomach going in with your hand.
You often can get help with this type of breathing by taking an introductory yoga class or checking out a videotape on yoga that focuses on breathing and relaxation.

You have raised the issue that this could be related to stress and anxiety.  While it is always important to first rule our specific organic causes, it is possible that stress can play a role to produce the symptoms you have described.  People feel" tired", "weak" have aches and pains related to this cause all the time.  However, as discussed above, there are other possible causes that have to be eliminated as possibilities before making this decision.

[mokita]

A related discussion, laryngeal spasm was started.