Joan Rivers’ cause of death has been revealed as the result of laryngospasm, as a result of a biopsy done during the routine surgery that eventually ended her life prematurely. Rivers checked in to a Yorkville, N.Y., clinic for a simple endoscopy procedure—and had signed only for an endoscopy. Her surgeon decided on giving her a biopsy; though she had no given consent, in these situations, if a doctor finds something that he is unsure of or something that could be a danger to his patient, it is within the doctor’s purview to investigate.

It is being speculated now that the biopsy resulted in the laryngospasm which cut off Rivers’ oxygen supply and eventually killed her. Though the New York Medical Examiner’s Office has yet only commented that their own inquest has not been completed and Rivers’ cause of death is not final. They did observe, however, that had this procedure taken place in a hospital and not a clinic such as Yorkville Endoscopy, there was a chance she might have survived.

Though endoscopies are considered routine and “simple” surgeries, it is the rare situation like this that make some question why it’s now an out-patient procedure.

What is Laryngospasm?

Laryngospasm is the involuntary contraction and spasm of the vocal cords. The seizure may happen for up to a minute during which time the airway narrows, making it harder to inhale but easier to exhale. It is not a common condition, and those that suffer often from it are usually diagnosed with silent reflux disease. It can strike whether you are awake or asleep.

What Causes Laryngospasm?

Laryngospasm can happen under several circumstances. When the vocal cords or the lower trachea themselves detects the entry of a liquid or other foreign substance (in the case of Rivers, it may have been the endscope), the cords immediately contract to keep water from seeping into other vital areas of the body.

The condition can also be the result of anesthesia; it happens with no warning, though there’s a greater expectancy after extubation. Given the procedure Rivers was originally in the clinic for, it is unlikely she was extubated in the first place.

Laryngospasm can be treated, though there is little time to do so. If it is detected, the patient’s neck should be hyperextended and given a flow of 100% oxygen through a ventilator to help assist in breathing. The use of muscle relaxants is also shown to be useful.