(Spasm of the Glottis)
=Definition.=—A spasm of the muscles of the larynx that are supplied
by the inferior or recurrent laryngeal nerves. This is commonly not
excited by an inflammatory condition, but it is usually a purely
nervous condition.
=Osteopathic Etiology= and =Pathology=.—Spasm of the glottis is usually
found in children with =enlarged tonsils and adenoids=. It has been
observed that rickets and syphilis are probably frequent underlying
causes. The spasm is occasionally associated with tetany. The nervous
factor is the immediate and important consideration. Cervical lesions,
both vertebral and muscular, are invariably found. Then nasopharyngeal
and tracheal disorders and reflex digestive disturbance are exciting
causes. An elongated uvula or a deranged hyoid bone will occasionally
be exciting factors. Subluxation of the upper two or three ribs and of
the clavicle may also be exciting factors.
The affection is usually found in children under five years of age. All
cases are not of a distinct nervous type, for slight acute catarrhal
laryngitis may be present.
=Symptoms.=—There is a sudden onset and the spasm may occur on waking
from sleep, but it may come on either in the night or day. The disease
starts with a sudden arrest of breathing, the child struggles for
breath; there are tonic muscular spasms and the face becomes congested
in a few seconds. This is followed by sudden relaxation of the spasm
and the air is drawn through the glottis with a shrill, crowing sound.
Several spasms may occur in a day or they may be weeks apart. Death
rarely occurs.
=Diagnosis.=—The absence of fever, cough and hoarseness and its
distinctly intermittent nature will differentiate it from croup. Should
there be any question of diagnosis a bacteriological examination is
advisable.
=Prognosis.=—The prognosis is almost always favorable. In very young
children death from suffocation may occur, but rarely.
=Treatment.=—The treatment should be applied either centrally
or peripherally, depending altogether upon the location of the
irritation. If the irritation is of central origin, that is, through
the innervation from the brain and spine, a correction of the superior
and inferior laryngeal nerves is necessary; if the stridor is due to
peripherial irritations, a correction of the end-plates (muscles) over
and about the larynx is required in order that the spasms be relieved.
Thorough treatment should be applied to the upper part of the chest
and diaphragm, chiefly the phrenic nerves at the third, fourth and
fifth cervicals and over the eighth, ninth and tenth ribs anteriorly,
in order that the spasms may be prevented from extending to the
intercostal muscles and the diaphragm.
Placing the patient in a hot bath will be of service in some cases
when the spasms are severe. Alternating hot and cold packs about the
throat are of service. The air of the room should always be kept moist.
Care should be taken that the trouble is not due to gastro-intestinal
disorders or to dentition. Keep the child upon a fluid diet of milk,
meat broths and egg albumin.
In the more severe cases the well known osteopathic method of relaxing
and inhibiting the soft palate and contiguous tissues will stop the
spasm.