The Difference Between Choking and Strangulation

Both Impair Air Flow but in Different Ways

man doing heimlich maneuver on woman

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The terms choking and strangulation both refer to restriction of air in the trachea (windpipe)—the tube that connects the larynx (voice box) to the bronchi (the large airways that branch off to enter each lung).

However, each word describes a different mechanism by which air is restricted. When a person is choking, some sort of foreign object inside the body is blocking airflow. When someone is being strangled, an outside force is exerting enough pressure to impede movement of air.

Because both choking and strangulation can lead to serious injury and even death, it’s important to understand the differences between them, including the ways in which each cause harm, how to recognize when someone is choking or has been strangled, and what to do if you or someone else is experiencing either. 

Choking

The medical terminology for choking is foreign body airway obstruction. The most common cause of choking is food that gets stuck in the trachea. Choking also can occur when something becomes lodged in the esophagus, the tube that transports food to the stomach, effectively squeezing the trachea from behind.

Treatment for choking depends on the severity of the situation—for instance, mild choking may be resolved by encouraging the person to cough forcefully. Severe choking—when the person can't speak, cry, cough, or breathe—is best treated by giving five sharp blows between the person's shoulder blades with the heel of your hand or by performing the Heimlich maneuver.

Treatment also depends on the age of the patient. Infant choking is treated differently than choking in adults and children over 1 year old. In kids under 1, severe choking—when the person can't speak, cry, cough, or breathe—is best treated by giving five sharp blows between the person's shoulder blades with the heel of your hand, or by using chest thrusts. The Heimlich maneuver can be used for choking in adults and children over 1.

Strangulation

Strangulation occurs when something compresses the neck tightly enough to restrict airflow to the trachea.

Strangling cuts off the flow of oxygen to the brain in one or more ways. Strangulation compresses the carotid artery or jugular veins, resulting in cerebral ischemia. It can also compress the laryngopharynx, larynx, or trachea, causing asphyxia. It can also stimulate the carotid sinus reflex, causing bradycardia, hypotension, or both.

The treatment for strangulation is the immediate removal of the device or object that's impairing breathing. Then, call 911.

A medical evaluation is crucial if someone's been strangled. An injury to the trachea may not appear to be serious right away, but swelling in the tissues around the trachea can lead to a secondary restriction of airflow a few minutes after the neck is free.

There are three main types of strangulation:

  • Manual strangulation occurs when one person uses their hands, another extremity, or an object of some sort to block airflow in another person. It sometimes is called throttling.
  • Ligature strangulation, also called garroting, is the wrapping of a pliable object such as a rope, wire, or shoelaces partially or fully around the neck and pulling it tightly across the throat.
  • Hanging is strangulation that occurs when a ligature such as a rope or other pliable object is wrapped around the neck and then used to suspend a person high enough above the ground so that the pull of gravity causes the ligature to tighten. 

Temporary strangulation can lead to a brief high when oxygen rushes back to the brain. Some people abuse self-strangulation to get this rush. While it is referred to as a choking game, it is actually strangulation. This is a dangerous practice that can lead to death.

Some couples also engage in choking during sex play, known as erotic asphyxiation. While many people refer to it as choking, it is actually strangulation. Choking games during sex is dangerous and should only be done with caution.

Domestic Abuse

Strangulation is often used in domestic abuse situations. According to the National Domestic Violence Hotline, It is one of the most lethal forms of domestic violence because unconsciousness may occur within seconds and death within minutes.

Many people who have been strangled by a domestic partner may minimize the act and not press charges or report the incident because it is not seen as being as violent as hitting.

Research suggests roughly 10% of domestic violence victims are strangled. In fact, non-fatal strangulation is a significant predictor for future violence, and people who were strangled by their partner are at a 6 to 10 times greater risk of being murdered by their abuser.

If you have been strangled by your partner, the National Domestic Violence Hotline can help connect you to local resources. Call 1-800-799-7233 to speak to someone today.

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Article Sources

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  1. Duckett SA, Roten RA. Choking. Treasure Island, Fl: StatPearls Publishing; 2019.


  2. Dunn RJ, Lopez RA. Strangulation Injuries. Treasure Island, Fl: StatPearls Publishing; 2019.


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