Laryngeal spasm

[The Horse]

Hello, i have a problem on removing my mask in cold water when asked to do so by an instructor. I find it difficult to inhale or exhale once my mask is off. untill recently i didn't know what it was and my family and instructor put it down to a psychological problem...(they always seem to put things i do down to a psychological problem hehe)anyway upon whtching an episode of CSI tonight they mentioned Laryngeal spasm, the Larinx contracts in order to prevent water from entering the lungs, however air cannot penatrate either. in fact about 10-20% of drowings occur this way and are known as dry-drownings with no water actually entering the lungs. i was just wondering if anyone else has this problem, or know of someone who has had simmilar difficulties and knows how to overcome them, or perhaps i am wrong in my assumption that this is what i am experienceing. if someone can shed some light on this it would be great as i would like to become a profesional diver or an instructor in which case i may need to teech this perticuar skill

regards
Matthew Horsewood

[Tony Dwyer]

Hello, i have a problem on removing my mask in cold water when asked to do so by an instructor. I find it difficult to inhale or exhale once my mask is off. untill recently i didn't know what it was and my family and instructor put it down to a psychological problem...(they always seem to put things i do down to a psychological problem hehe)anyway upon whtching an episode of CSI tonight they mentioned Laryngeal spasm, the Larinx contracts in order to prevent water from entering the lungs, however air cannot penatrate either. in fact about 10-20% of drowings occur this way and are known as dry-drownings with no water actually entering the lungs. i was just wondering if anyone else has this problem, or know of someone who has had simmilar difficulties and knows how to overcome them, or perhaps i am wrong in my assumption that this is what i am experienceing. if someone can shed some light on this it would be great as i would like to become a profesional diver or an instructor in which case i may need to teech this perticuar skill

regards
Matthew Horsewood

An internet search on 'Laryngeal Spasm' produces some interesting results. This is particularly interesting;

<a href="http://www.b.s.b.btinternet.co.uk/aboutdystonia/aboutdystoniaa.html" >http://www.b.s.b.btinternet.co.uk/aboutdystonia/aboutdystoniaa.html</a>

You do not say whether or not you've experienced a spasm at any other time. If you have not, it is perhaps unlikely that the problem you felt is actually a true Laryngeal Spasm. If you have, then you should get yourself ckecked out. Such a condition occuring at random must be a serious issue with regard to diving.

[the horse]

:=Hello, i have a problem on removing my mask in cold water when asked to do so by an instructor. I find it difficult to inhale or exhale once my mask is off. untill recently i didn't know what it was and my family and instructor put it down to a psychological problem...(they always seem to put things i do down to a psychological problem hehe)anyway upon whtching an episode of CSI tonight they mentioned Laryngeal spasm, the Larinx contracts in order to prevent water from entering the lungs, however air cannot penatrate either. in fact about 10-20% of drowings occur this way and are known as dry-drownings with no water actually entering the lungs. i was just wondering if anyone else has this problem, or know of someone who has had simmilar difficulties and knows how to overcome them, or perhaps i am wrong in my assumption that this is what i am experienceing. if someone can shed some light on this it would be great as i would like to become a profesional diver or an instructor in which case i may need to teech this perticuar skill
:=
:=regards
:=Matthew Horsewood

An internet search on 'Laryngeal Spasm' produces some interesting results. This is particularly interesting;

http://www.b.s.b.btinternet.co.uk/aboutdystonia/aboutdystoniaa.html

You do not say whether or not you've experienced a spasm at any other time. If you have not, it is perhaps unlikely that the problem you felt is actually a true Laryngeal Spasm. If you have, then you should get yourself ckecked out. Such a condition occuring at random must be a serious issue with regard to diving.

no, it's not occured at any other time at random...that would be horrid in the middle of a dive. But perhaps that is understandable, the sudden experience of cold water on my face after removing the mask is the only event that triggers it off, and at what other time would my throat need to close up?

In terms of danger i've had to surfice twice due to this, and it's hardly a pleastent experience, maybe i fear such an experenice repeating and so am more nervous than relaxed. hopefully with practice i shall overcome it, other wise i'm tightening my mask straps.

[Ed Howart]

In terms of danger i've had to surfice twice due to this, and it's hardly a pleastent experience, maybe i fear such an experenice repeating and so am more nervous than relaxed. hopefully with practice i shall overcome it, other wise i'm tightening my mask straps.

The trouble with the brain is that it remembers the bad bits much more strongly than the good! To overcome this you need to experience doing it right many times to wipe out that one bad one. Instructors know this and make sure that the trainee progresses in small increments, succeeding in each one before moving on. If there is a difficulty then the trainee should be taken back one step and the success reinforced.

I know your problem is in cold water, but why not go to the pool with mask, fins and snorkel. In this way you don't need scuba gear and instructor to get bored with you, just progress at your own pace. What I did is fin up and down the pool (so I didn't feel conspicuous just kneeling there!) and play at mask removal/clearing. After a bit, you should be able to swim a couple of lengths with no mask at all, leaving it in the shallow end to be picked up and refitted on your next visit. If you have a patient buddy keep each other company, swap masks etc.

The thing to do, is take things slowly and succeed *every* time. Aim to keep your head under water for 20 minutes at a time with 10 complete mask removals.

Once your brain has got so used to all of this that it thinks nothing of it and it has become "normal", go to your cold water site and, with your instructor's permission and a buddy, do the same thing, but start again from the beginning: bit of water around the nose pocket, clear, bit more, leave for 10 secs, clear, bit more, leave for 20 secs, etc etc. With patience you should soon be doing your snorkelling and mask removals like you were in the pool. Remember to go back one stage if you have problems, and reinforce the success.

Ed

[the horse]

:=In terms of danger i've had to surfice twice due to this, and it's hardly a pleastent experience, maybe i fear such an experenice repeating and so am more nervous than relaxed. hopefully with practice i shall overcome it, other wise i'm tightening my mask straps.

The trouble with the brain is that it remembers the bad bits much more strongly than the good! To overcome this you need to experience doing it right many times to wipe out that one bad one. Instructors know this and make sure that the trainee progresses in small increments, succeeding in each one before moving on. If there is a difficulty then the trainee should be taken back one step and the success reinforced.

I know your problem is in cold water, but why not go to the pool with mask, fins and snorkel. In this way you don't need scuba gear and instructor to get bored with you, just progress at your own pace. What I did is fin up and down the pool (so I didn't feel conspicuous just kneeling there!) and play at mask removal/clearing. After a bit, you should be able to swim a couple of lengths with no mask at all, leaving it in the shallow end to be picked up and refitted on your next visit. If you have a patient buddy keep each other company, swap masks etc.

The thing to do, is take things slowly and succeed *every* time. Aim to keep your head under water for 20 minutes at a time with 10 complete mask removals.

Once your brain has got so used to all of this that it thinks nothing of it and it has become "normal", go to your cold water site and, with your instructor's permission and a buddy, do the same thing, but start again from the beginning: bit of water around the nose pocket, clear, bit more, leave for 10 secs, clear, bit more, leave for 20 secs, etc etc. With patience you should soon be doing your snorkelling and mask removals like you were in the pool. Remember to go back one stage if you have problems, and reinforce the success.

Ed


yeah good advice, thanks! i shall give it ago, in regards to cold water i could always fill the bath up with cold water, the same thing seems to happen even in smaller amounts than a swimming pool. hopefully i shall start to remember the success as apose to the failures.

[matt]

Excellent post Ed.

:=..hopefully with practice i shall overcome it, other wise i'm tightening my mask straps.

Tightening your mask strap is not going to help. A tight mask strap often causes a mask to leak, by deforming the seal, and it is harder to clear because of the pressure needed to displace the mask.

Having taught scuba for a few years now, I have heard lots of reasons why trainees can not possibly clear their mask - Laryngeal Dystonia is orginal. I have not yet met anyone that could not clear a mask given patience and encouragement. Showing people how to attain what they are convinced is impossible is one of the things I like most about instructing.

If you seriously think that Laryngeal Dystonia could be the problem you need to get it checked out. You will not easily overcome this problem while you can use a medical condition as an excuse for failure. You need to believe that you can remove and refit your mask in cold water to have any chance of doing it.

Unfortunately mask clearing in cold water is never pleasant, but it is a skill you have to be able to do - as my buddy found out this morning. There was a bit of current twisting his snorkel, causing his mask to leak. After removing his mask, he had a problem refitting it until I removed the snorkel completely (maybe a lesson about snorkels there ;-) But top marks to him for putting up with the discomfort for a couple minutes, and not giving up until the problem was sorted.

As Ed says, practice in a more pleasant environment until you are thoroughly bored of mask clearing and refitting. I try to get 3 to 6 mask clears into every Ocean Diver pool lesson, and at least 6 refits by the end of the pool element. So when we get to open water there is no drama over the skill and the water temperature is the only additional challenge. Most importantly, use the pool to learn how to breathe in through your mouth and out through your nose. This is key to mask clearing, you must be able to exhale through your mouth or nose at will, using your tongue to seal the back of the mouth. Sitting in front the TV in mask and snorkel, breathing out through the nose, has been known to help with this.

There are a few tips which I have picked up teaching in very cold water.

It helps to know that when the water temperature comes as as a shock we all breathe in very forcefully and involuntarily. The regulator can cause a breath or two to feel tight. There is no danger and it only lasts a couple of seconds. Once your body has adjusted to the initial shock your breathing can return to normal.

Do not rush the skill, take it steady and focus on getting it right - not perfect. Follow Ed's advice about gradually filling the mask. This will help your body aclimatise. Throwing a little of the local water over your face when rinsing your mask can also help.

Having removed your mask, fit the mask to your face and clear it before attempting to fit the strap. You should be able to do this within a few seconds, removing some of the stress and discomfort. Take your time to straighten the strap and make sure hair and hood are clear of the seal before fitting the strap over your head. Water pressure can be used to help keep the mask in place so that you can use two hands on the strap.

If you really are having trouble be aware that shiverring is the first sign of a very serious problem. If you start to shiver, you must abort the drill and think about surfacing as soon as possible. You will have to make an ascent maskless so the shallower you are the better. In fact standing depth would be best.

Should cold water mask removal remain a sticking point you may have to wait for the water to warm up before venturing deeper than 3m to 6m. The deeper you are the harder it is to abort safely. You also need to make your buddy aware of the situation, it is their problem too. Once the sea has warmed up take every opportunity to practice. You could aim to complete a mask refit at the end of every dive. Carry on practicing when things cools down again next Winter.

Whatever happens do not ignore your skills. If you can not refit and clear a mask in cold water you should not be diving in cold water - it is that simple. The skills we learn early on in scuba training are the most important skills we learn. Fortunately pretty much every one is capable of learning and mastering those skills.

Good luck with it and I hope you do not have Laryngeal Dystonia. CNS problems and scuba rarely mix.

[Andy Wade]

Excellent post Ed.

:=:=..hopefully with practice i shall overcome it, other wise i'm tightening my mask straps.

Tightening your mask strap is not going to help. A tight mask strap often causes a mask to leak, by deforming the seal, and it is harder to clear because of the pressure needed to displace the mask.

Having taught scuba for a few years now, I have heard lots of reasons why trainees can not possibly clear their mask - Laryngeal Dystonia is orginal. I have not yet met anyone that could not clear a mask given patience and encouragement. Showing people how to attain what they are convinced is impossible is one of the things I like most about instructing.

If you seriously think that Laryngeal Dystonia could be the problem you need to get it checked out. You will not easily overcome this problem while you can use a medical condition as an excuse for failure. You need to believe that you can remove and refit your mask in cold water to have any chance of doing it.

Unfortunately mask clearing in cold water is never pleasant, but it is a skill you have to be able to do - as my buddy found out this morning. There was a bit of current twisting his snorkel, causing his mask to leak. After removing his mask, he had a problem refitting it until I removed the snorkel completely (maybe a lesson about snorkels there ;-) But top marks to him for putting up with the discomfort for a couple minutes, and not giving up until the problem was sorted.

As Ed says, practice in a more pleasant environment until you are thoroughly bored of mask clearing and refitting. I try to get 3 to 6 mask clears into every Ocean Diver pool lesson, and at least 6 refits by the end of the pool element. So when we get to open water there is no drama over the skill and the water temperature is the only additional challenge. Most importantly, use the pool to learn how to breathe in through your mouth and out through your nose. This is key to mask clearing, you must be able to exhale through your mouth or nose at will, using your tongue to seal the back of the mouth. Sitting in front the TV in mask and snorkel, breathing out through the nose, has been known to help with this.

There are a few tips which I have picked up teaching in very cold water.

It helps to know that when the water temperature comes as as a shock we all breathe in very forcefully and involuntarily. The regulator can cause a breath or two to feel tight. There is no danger and it only lasts a couple of seconds. Once your body has adjusted to the initial shock your breathing can return to normal.

Do not rush the skill, take it steady and focus on getting it right - not perfect. Follow Ed's advice about gradually filling the mask. This will help your body aclimatise. Throwing a little of the local water over your face when rinsing your mask can also help.

Having removed your mask, fit the mask to your face and clear it before attempting to fit the strap. You should be able to do this within a few seconds, removing some of the stress and discomfort. Take your time to straighten the strap and make sure hair and hood are clear of the seal before fitting the strap over your head. Water pressure can be used to help keep the mask in place so that you can use two hands on the strap.

If you really are having trouble be aware that shiverring is the first sign of a very serious problem. If you start to shiver, you must abort the drill and think about surfacing as soon as possible. You will have to make an ascent maskless so the shallower you are the better. In fact standing depth would be best.

Should cold water mask removal remain a sticking point you may have to wait for the water to warm up before venturing deeper than 3m to 6m. The deeper you are the harder it is to abort safely. You also need to make your buddy aware of the situation, it is their problem too. Once the sea has warmed up take every opportunity to practice. You could aim to complete a mask refit at the end of every dive. Carry on practicing when things cools down again next Winter.

Whatever happens do not ignore your skills. If you can not refit and clear a mask in cold water you should not be diving in cold water - it is that simple. The skills we learn early on in scuba training are the most important skills we learn. Fortunately pretty much every one is capable of learning and mastering those skills.

Good luck with it and I hope you do not have Laryngeal Dystonia. CNS problems and scuba rarely mix.


As Matt has said, this is a pretty big problem if it's anything other than a psychological issue with mask clearing in cold water.

My first reaction to the question was that it sounded a bit like 'The Mammalian Diving Reflex', sometimes called 'The Human Diving Response', which is triggered by cold water on the face. It is a throwback from when we left the sea to walk on the land. (No I don't mean when you last walked up the beach after a dive).
If it sounds like it could be something along these lines, you need to consult a diving doc/medical referee. I doubt it is this though, as this is more to do with the heart and organ shutdowns in response to cold water shock on the face.

If it's actually just a general confidence problem, then as Matt has said, you need to do it so much that you become throughly bored with doing it.

There are a few exercises on the 'Dive Instruct' page linked below. Maybe if you run through some of them in the pool with your buddy or with an instructor, you'll go a long way to solving the problem, then the cold water will be just one tiny step to overcome as you'll be so accomplished at what is a relatively simple task.

Feel free to print off a copy and take it to the pool.


.

[gareth]

Matthew

As both Matt & Andy have stated. Take your time & build your confidence. Plenty of Pool practice is always a great help, making the skill second nature - take you gloves & hood to the pool as well. Then when you move to open water, if you have any concerns at all, work in no more than standing depth if possible.

It is most inportent that you can clear your mask with confidence. It doesn't matter if you need several attempts to remove all the water, but you do need to be happy & confident.

To illustrate the point - I hit my head on the side of a wreck a couple of years ago - it completely shattered the strap mount, & knocked my mask off. I replaced the mask & cleared it without a second thought. I was at 40 meters with 30 minutes of deco to do!
(In 13 years this is the first 'catastrophic' mask failure I've ever had - so don't get to worried).

I am certain you will find that once you get this skill right the first time your confidence will grow, but keep practicing once you do get it right, even (especially) after completing your Ocean diver.

Safe & enjoyable diving - just keep practicing, & it will come.

Gareth

[Nigel Hewitt]

no, it's not occured at any other time at random...that would be horrid in the middle of a dive. But perhaps that is understandable, the sudden experience of cold water on my face after removing the mask is the only event that triggers it off, and at what other time would my throat need to close up?

I'm not sure about this. One of the problems is that we tend to talk about airway separation and never teach it. People don't believe how easy it is because they've been doing it for years and never knew. If you don't shut off your nose when you take your mask off you will splutter and snort.

All you have to do is go into blowing up a balloon mode. And stay in it as you breath in and out. Once you hold that mode mask off swims are a piece of cake. Practice it by closing your mouth up small so you have to blow and suck a bit. Your nose is switched off.

In terms of danger i've had to surfice twice due to this,

Bad. Really bad. I have coughed and choked into a reg after getting what feels like a lung full of sea water (This is where the laryinx's aversion to water really pays off) but keep your face down and it will pass. Never bolt for the surface. Nothing is worth that. If you have a reg with gas in your mouth you won't die but I can't promise that for a bolt.

other wise i'm tightening my mask straps.

That's the way to flood a mask regularly. A mask wants to be a loose as can be so the seal moulds to your face or it will leak like a sieve. Also a tight mask gets to be evil after an hour in the water.

[the horse]

:=no, it's not occured at any other time at random...that would be horrid in the middle of a dive. But perhaps that is understandable, the sudden experience of cold water on my face after removing the mask is the only event that triggers it off, and at what other time would my throat need to close up?

I'm not sure about this. One of the problems is that we tend to talk about airway separation and never teach it. People don't believe how easy it is because they've been doing it for years and never knew. If you don't shut off your nose when you take your mask off you will splutter and snort.

All you have to do is go into blowing up a balloon mode. And stay in it as you breath in and out. Once you hold that mode mask off swims are a piece of cake. Practice it by closing your mouth up small so you have to blow and suck a bit. Your nose is switched off.

:=In terms of danger i've had to surfice twice due to this,

Bad. Really bad. I have coughed and choked into a reg after getting what feels like a lung full of sea water (This is where the laryinx's aversion to water really pays off) but keep your face down and it will pass. Never bolt for the surface. Nothing is worth that. If you have a reg with gas in your mouth you won't die but I can't promise that for a bolt.

:=other wise i'm tightening my mask straps.

That's the way to flood a mask regularly. A mask wants to be a loose as can be so the seal moulds to your face or it will leak like a sieve. Also a tight mask gets to be evil after an hour in the water.

[the horse]

:=
:=:=no, it's not occured at any other time at random...that would be horrid in the middle of a dive. But perhaps that is understandable, the sudden experience of cold water on my face after removing the mask is the only event that triggers it off, and at what other time would my throat need to close up?
:=
:=I'm not sure about this. One of the problems is that we tend to talk about airway separation and never teach it. People don't believe how easy it is because they've been doing it for years and never knew. If you don't shut off your nose when you take your mask off you will splutter and snort.
:=
:=All you have to do is go into blowing up a balloon mode. And stay in it as you breath in and out. Once you hold that mode mask off swims are a piece of cake. Practice it by closing your mouth up small so you have to blow and suck a bit. Your nose is switched off.
:=
:=:=In terms of danger i've had to surfice twice due to this,
:=
:=Bad. Really bad. I have coughed and choked into a reg after getting what feels like a lung full of sea water (This is where the laryinx's aversion to water really pays off) but keep your face down and it will pass. Never bolt for the surface. Nothing is worth that. If you have a reg with gas in your mouth you won't die but I can't promise that for a bolt.
:=
:=:=other wise i'm tightening my mask straps.
:=
:=That's the way to flood a mask regularly. A mask wants to be a loose as can be so the seal moulds to your face or it will leak like a sieve. Also a tight mask gets to be evil after an hour in the water.

Thanks for all the advice, the thing about tightening the mask straps was just a bit of daft sarcasm so no need to worry about that. as for passing my open water course, i was fortunet enough to have the opertunity to pass this when i was 12, this was not a problem back then but aparently it's more common in adults, i'm realy looking forward to doing my Dive leader course in the summer, but hopefully i should be ok with practicing blocking off my nasal airway. so I'll let you know how it goes.

[Philip Smith]

Hello, i have a problem on removing my mask in cold water when asked to do so by an instructor. I find it difficult to inhale or exhale once my mask is off.

I doubt if this is due to a laryngeal spasm. I have experienced something like this in the past and I put it down either to a fear of breathing water up your nose or the unnaturalness of breathing when your face is in water. As the others have said, progressive practice is the key. A useful exercise that used to be in the pool training scheme was swimming lengths face down without a mask, but breathing through a snorkel held in place with one hand and the other hand held out in front, superman style, to avoid banging your head on things. I used to find the sensation of water moving over my face made it difficult to breathe normally at first. You can progress to breathing from a regulator in standing depth, with your face in the water, then submerge and breathe while kneeling on the bottom, then move to swimming underwater without a mask (led by the hand).

In open water, start off by splashing cold water on your face to get used to the cold, then repeat the pool exercises in very shallow water.

Good luck,
Philip Smith

[Don Russo]

Hello, i have a problem on removing my mask in cold water when asked to do so by an instructor. I find it difficult to inhale or exhale once my mask is off. untill recently i didn't know what it was and my family and instructor put it down to a psychological problem...(they always seem to put things i do down to a psychological problem hehe)anyway upon whtching an episode of CSI tonight they mentioned Laryngeal spasm, the Larinx contracts in order to prevent water from entering the lungs, however air cannot penatrate either. in fact about 10-20% of drowings occur this way and are known as dry-drownings with no water actually entering the lungs. i was just wondering if anyone else has this problem, or know of someone who has had simmilar difficulties and knows how to overcome them, or perhaps i am wrong in my assumption that this is what i am experienceing. if someone can shed some light on this it would be great as i would like to become a profesional diver or an instructor in which case i may need to teech this perticuar skill

regards
Matthew Horsewood

I have developed the same problem, Laryngeal spasm. My throat was pretty dry from being on the tank and when a little bit of water hit the back of my throat I had to surface. I recently experienced it in the pool during scuba class though it has happened on land as well. My instructor recognized what the problem was when I told her that my throat closed up. I talked to my Ear, Nose & Throat (ENT) specialist, who also dives, and he thinks it is (at least in my case) related to reflux. He suggested I so not eat for a couple of hours before I dive. In my case this made sense, as I had eaten about an hour or so before we did the pool session. It also happened to me while I was swimming to get in shape for the class. For me, I found myself much more incomfortable in water then when I was I teenager..., and seem to be more reactive to the now unfamiliar environment, water. I've thought of gargling deeply to try to condition myself, but the LS only happened a couple of days ago and wanted to consult my ENT before I did anything else.

I still have two pool sessions before I have to certify. I did a search online and the Nation Jewish center in Denver has a lot of info on this subject.

If its true in fact that 1 in 5 drownings occur because of this is enough to quench my enthusiasm. If it happens again, I will probably give up the sport...no sport is worth dying over.
Don

[Sarah Gauci Carlton]

Hello, i have a problem on removing my mask in cold water when asked to do so by an instructor. I find it difficult to inhale or exhale once my mask is off. untill recently i didn't know what it was and my family and instructor put it down to a psychological problem...(they always seem to put things i do down to a psychological problem hehe)anyway upon whtching an episode of CSI tonight they mentioned Laryngeal spasm, the Larinx contracts in order to prevent water from entering the lungs, however air cannot penatrate either. in fact about 10-20% of drowings occur this way and are known as dry-drownings with no water actually entering the lungs. i was just wondering if anyone else has this problem, or know of someone who has had simmilar difficulties and knows how to overcome them, or perhaps i am wrong in my assumption that this is what i am experienceing. if someone can shed some light on this it would be great as i would like to become a profesional diver or an instructor in which case i may need to teech this perticuar skill

regards
Matthew Horsewood

Hi Matthew,
This is probably not an insurmountable problem. Try standing in waist deep cold water and splashing water on your face. Then put your reg in your mouth and repeat the exercise. Then keeping your reg in your mouth, but holding your nose closed, bend down and put just your chin in the water. You can very slowly work deeper until your whole face is in the water, but you are still holding your nose closed. If your breathing is still OK when your whole face is in the water, when you are comfortable start to exhale through your nose (release the fingers holding your nose slightly to allow bubbles to come out of the nose). When you are comfortable again, let go of your nose completely. If you have trouble with water entering your nose, it means you are not breathing out through it. Try putting your tongue agaisnt the roof of your mouth as you exhale.
If you are now comfortable about having your face in cold water and are breathing normally, start practicing clearing your mask in very shallow water.
You will find that even when you have become very confident about mask clearing absolutely anywhere, it will still help to put your face in the water with mask off and breathe at the surface before starting the dive (obviously not in rough sea or heavy currents). This just reduces the shock if you need to replace your mask at depth.
Good luck,
Sarah