Choking
Choking is a term that, as used popularly, can describe at least a few distinct scenarios or disorders:
- Minor aspiration. A person swallows and food or liquid “goes down the wrong tube” (down the airway), which provokes aggressive coughing.
- Life-threatening aspiration. A person swallows food (a piece of meat, for instance) that enters the airway and plugs it, requiring a Heimlich maneuver.
- Sensory neuropathic cough. A person uses the term “choking” to describe a severe episode of coughing, but without any aspiration of liquid or food.
- Laryngospasm. A person uses the term “choking” to describe the sudden inability to breathe and the noisy inspiration of a laryngospasm attack.
When a patient uses the term “choke,” the clinician must ask a series of questions to verify whether the fundamental issue is dysphagia with aspiration, coughing unrelated to dysphagia or aspiration, or laryngospasm. View this article for more information.
MTD at Prephonatory Instant, and During Phonatory Blurring
Prephonatory instant (1 of 2)
Nineteen year-old singer with “small, quiet, breathy voice,” whose throat feels strained, tight, and choked when she tries to sing. This view shows the position of the cords one frame (1/30 th of a second) before vibration begins. Note the remarkably wide “stance” of the cords.
Phonatory blur (2 of 2)
Eleven video frames (1/3 of a second) later, during phonation, the vibratory blur makes the cords appear slightly closer, but the “stance” of the cords is actually the same as in photo 1 above. See short vertical lines for reference between photos.
Tracheal Red Herring; the Real Culprit is Cricopharyngeus Spasm
Tracheal stenosis? (1 of 4)
During a grave illness, this woman eventually underwent tracheotomy. Though she wore the tube for several months, it was removed 3 years ago. Only six months prior to this examination, due to a feeling of choking, she underwent a CT scan that revealed tracheal stenosis. The patient does have mildly noisy breathing but has no sense of exercise intolerance.
Narrowing at trachea (2 of 4)
Viewing from just below the vocal cords, there is narrowing and deformity of the trachea at the site of prior tracheotomy.
Closer view (3 of 4)
A closer view shows normal trachea beyond.
No significant change in breathing (4 of 4)
Now with the scope through the area of greatest narrowing, the patient doesn’t experience any significant change in her breathing. Her symptoms are those of cricopharyngeus spasm, not tracheal stenosis.
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