Laryngeal Obstruction in Adults

Introduction to Laryngeal Obstruction

The American Academy of Allergy, Asthma, and Immunology recommends that laryngeal obstruction in adults be considered a medical emergency that requires immediate intervention to preserve the airway, with symptoms including estridor inspiratorio, dificultad respiratoria progresiva, disfonía or afonía, disfagia, and sensación de cuerpo extraño in the throat 1
Adults with a history of congenital laringomalacia may present with late symptoms during intense physical activities, highlighting the need for awareness and prompt evaluation 1

The American Thoracic Society notes that laryngeal obstruction in adults can be caused by various factors, including infecciosas (virales or bacterianas), disfunción de cuerdas vocales (VCD), laringomalacia, reflujo laringofaríngeo, and edema pulmonar post-obstructivo, each requiring distinct management approaches 1
The strength of evidence for these etiologies varies, with high-quality evidence supporting the role of infecciosas and disfunción de cuerdas vocales, while the evidence for laringomalacia and reflujo laringofaríngeo is moderate 1

The American College of Chest Physicians recommends that the evaluation of laryngeal obstruction in adults include clinical assessment, with estridor inspiratorio being a distinctive sign of laryngeal obstruction, and laringoscopia as the definitive diagnostic method to visualize the adducción of the cuerdas vocales and other laríngeas anomalies 1
Espirometría can also be useful in differentiating laryngeal obstruction from lower respiratory tract pathologies, with aplanamiento or truncamiento of the inspiratory portion of the flow-volume curve indicating laryngeal obstruction 1

The American Society of Anesthesiologists recommends that the management of laryngeal obstruction in adults depend on the etiology and severity of the obstruction, with priority given to maintaining the airway, and interventions such as intubación or traqueotomía de emergencia, corticosteroides sistémicos, antibióticos, and humidificación del aire as needed 2
For laringoespasmo, the use of presión en el "punto del laringoespasmo", propofol (1-2 mg/kg IV), and succinilcolina (1 mg/kg IV) can be effective in managing symptoms, with the strength of evidence for these interventions being moderate to high 2
The American Academy of Otolaryngology recommends a multidisciplinary approach for the management of disfunción de cuerdas vocales, including terapia del habla and abordaje multidisciplinario to address psicofisiológico stress, with the strength of evidence for this approach being moderate 1

The American Thoracic Society notes that edema pulmonar post-obstructivo can occur in approximately 0.1% of all general anestesias, and hipoxia cerebral can result from severe untreated obstruction, highlighting the importance of prompt recognition and management 2
The need for vía aérea quirúrgica may arise in extreme cases, emphasizing the need for a comprehensive management plan 2