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Wednesday, January 21, 2015

Laryngospasm: It's often confused for a wheeze

Comics and writers like Stephen King can call it a wheeze.
But clinicians should know that if it's audible, it's laryngospasm.
For lack of a better description, you can call it rhonchi.
Oh, for crying out loud, call it a wheeze if you must,
but don't be fooled into thinking it's bronchospasm.
Clinicians don't learn about laryngospasm in nursing school, medical school, nor respiratory therapy school.  The reason is because most clinicians confuse it as bronchospasm, and call it a wheeze.  However, it is not bronchospasm, and it is not a wheeze: it's laryngospasm.  You should call it rhonchi.

So what is laryngospasm.  It's a harsh (coarse) audible sound during expiration. It's the sound of air moving through secretions sitting around the vocal cords, so when the patient exhales it is made audible.

Frequently it's caused by pulmonary edema and heart failure. Sometimes it is caused due to dehydration, such as when a patient suffers from detox or ETOH.

Many times it gives the appearance of airway obstruction, because the patient has a prolonged, forced, expiratory phase.  But when you ask these patients if they are short of breath they deny it.  This is because they are not experiencing bronchospasm, and the sound is perhaps "annoying" but it is not a wheeze.

If you don't want to call it "laryngospasm" you can call it rhonchi.  Rhonchi is the sound of air moving through secretions, and, more than likely, this is what you are hearing.  But you are certainly not hearing a "bronchospasmic wheeze," because a bronchospasmic wheeze is never audible. Bronchioles are teeny tiny airways, and you cannot possibly hear a wheeze produced by bronchospasm without the aid of a stethoscope.


Stephen J said...

I was looking for some information about breath sounds and believe what I was hearing was rhonchi from some other posts on this blog. Searching for that led me to this post though and I'm confused...

In my field, speech and language pathology, laryngospasm is a very different beast! It's the sudden onset of your vocal folds clamping tightly shut. A very frightening experience that typically lasts several seconds, up to a minute, and during which the person either can't breath at all or has extreme difficulty breathing. With reassurance it normally settles and breathing returns to normal.

Not sure if it's just the same word for different things within disciplines that vaguely cross boundaries at some points. Interesting nontheless!

John Bottrell said...

You have to take what I wrote here with a grain of salt. I was sort of making fun of doctors who confuse audible upper airway rhonchi with a wheeze caused by bronchospasm, thereby ordering albuterol. I think that secretions sit over the vocal cords making the rhonchi audible, and too many healthcare experts confuse this for bronchospasm. So we just call it laryngospasm, which is might be of course. It's a sound we too often hear in patients who produce a lot of secretions, such as with pneumonia or heart failure (pulmonary edema). It's also heard a lot when a patient is dehydrated, such as occurs with ETOH or detoxification.