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Paroxysmal laryngospasm after laryngeal nerve injury

Objective: Describe a clinical syndrome of laryngeal hypersensitivity following laryngeal nerve injury. Study Design: Retrospective review of six patients with laryngeal paralysis sustained during neck surgery who presented with paroxysms of coughing and stridor, progressing to brief episodes of complete airway occlusion. Methods: Chart review. Results: Superior laryngeal nerve blockade temporarily improved symptoms in four of five patients. Botulinum toxin relieved spasm in two of three patients and reduced symptoms in the third. Symptoms gradually diminished or resolved in four patients from 1 to 2.5 years later. One patient underwent arytenoidectomy and one patient has a tracheostomy. Conclusions: Patients with laryngeal injury may present with stridor and acute airway obstruction secondary to paroxysmal laryngospasm. The authors have found that superior laryngeal nerve blockade or botulinum toxin may be effective in temporary relief of symptoms.