Currently, the larynx is one of the most complex human organs. Even in ancient times, they began to study its structure and are still doing it. There are a huge number of varieties of lesions of the larynx, but one of the most interesting is paresis of the vocal cords. It manifests itself in the form of a decrease in the motor functions of the muscles of this organ, as a result of which there is a violation of breathing and voice formation. At the moment, this disease makes up a third of all chronic diseases of the larynx. It is quite dangerous, and effective treatment depends on the accuracy of identifying the causes.
How does the disease develop?
The anatomy of the larynx suggests the presence of vocal cords that are parallel to each other. Between them is the glottis. When air is exhaled through this hole, vibration is formed, vibration of the ligaments and a voice is created. This is how the mechanism of the larynx works, performing the function of phonation.
The muscles of this organ respond to impulses that come through small branches from the central nervous system. If any damage or pathology occurs, then between the brain, nervous system and musclethe device is in violation of the relationship. As a result of this development of events, paresis of the vocal cords and, accordingly, the larynx appears.
Typology of disease
This disease is divided into three types: myopathic (associated with the muscular apparatus), neuropathic (due to disorders of the laryngeal nerve) and functional (problems with the balance of excitation and inhibition in the cerebral cortex).
The defeat of the vocal apparatus can be unilateral or bilateral. In addition, pathology is congenital and acquired. The first is characterized by the development of the most severe form - paralysis of the larynx. Those who suffer from this disease cannot move the muscles of the organ.
Myopathic appearance
Let's consider each type of vocal cord paresis in more detail. The myopathic type of the disease is formed as a result of inflammatory changes in the laryngeal apparatus due to an increase in the number of microorganisms. Infectious viruses act in much the same way.
This type of disease also appears when dust and dirty substances get into the throat. Cold air and excessive tension can cause paresis of the right or left vocal cord. Sometimes there is a bilateral nature of the disease. Of the symptoms here can be identified:
- hoarse voice;
- changing tone;
- unable to play high pitched sounds;
- slurred speech;
- the ability to speak only in a whisper.
Neuropathic appearance
This kind of voice paresisligaments and larynx is the most common. It, in turn, is divided into two subspecies: peripheral and central. The first is characterized by damage or damage to the laryngeal nerve. And the second is formed as a result of trauma to the brain stem and cortex.
If a unilateral pathology develops, then breathing and voice-forming function work normally, a hoarseness of voice appears a little later. Recovery of the laryngeal nerve takes several months. However, if the patient is a singer, then he will have to be upset, vocal abilities will never be the same. Bilateral pathology is characterized by a very serious condition that can lead to suffocation.
Symptoms:
- noisy breathing;
- to facilitate the process, the patient in a sitting position rests on something with his hands;
- skin turns blue.
Functional view
The peculiarity of this type of paresis of the larynx is that it manifests itself only against the background of instability of the nervous system. The main sign of the functional type of the disease is a whisper, turning into aphonia. If the patient is passionate about something, he may not even notice that the voice disappears, then appears.
Usually, paresis is formed as a result of the appearance of laryngitis or another disease. Imaginary patients, of which there are now quite a few, talk in whispers until the underlying disease is cured. They often reprimand doctors that they are being treated incorrectly. Usually in these patientsthe following symptoms are observed:
- sore throat;
- tickle and tickle;
- dizziness and pain in the head;
- insomnia.
Treatment of the functional type of paresis of the larynx takes quite a long time. It is recommended to connect a psychotherapist or psychoanalyst. Sometimes patients complain that their voice has disappeared (the throat does not hurt, there is no temperature). This may be due to a more advanced stage of the disease.
Causes of the disease
This disease can be caused by a huge number of reasons. Paresis appears as a result of unsuccessful surgical intervention on the thyroid gland and not only. About 6% of cases end with paresis of the vocal cords. Various injuries and damage to nervous structures, bruises at home and at work, etc. can also cause the appearance of an ailment.
The main causes of vocal cord paresis are:
- appearance of metastases, tumors of the neck, chest, larynx and trachea;
- enlargement of the thyroid gland, occurring against the background of other diseases;
- benign tumors in the larynx;
- hematomas after injuries;
- stroke, congenital heart disease;
- neuritis that occurs against the background of infectious viral diseases.
The vocal apparatus is subjected to serious stress in people who are engaged in professional vocals. They most often develop paresis of the larynx. Sometimes this ailment appears as a result of stress and mental illness.
Symptoms of vocal cord paresis
The clinical picture of the disease will depend on the degree of damage to the larynx and vocal cords, as well as on the duration of the disease. The most striking signs appear with unilateral paresis with impaired functioning of the vocal cords:
- hoarse voice;
- fatigue;
- lost voice (no sore throat, no fever);
- shortness of breath;
- pain in the pharynx;
- problems with tongue mobility;
- feels like a foreign body in the throat, sensation of a coma;
- coughing or violent bout of coughing;
- insomnia, headache.
There are cases when paresis does not manifest itself outwardly. With such a development of events, the disease can only be detected by a doctor with a thorough examination. As for bilateral lesions of the larynx, they are characterized by aphonia and respiratory failure. Sometimes there is a barking cough with paresis of the vocal cords. In rare cases, the disease develops so quickly that emergency medical attention is required after a few hours.
Diagnosis
When the first signs of paresis appear, you should immediately contact an otolaryngologist. The main task of the doctor is to correctly determine the cause of the disease. To do this, you need to go through several examinations, as well as get advice from other specialists, for example, a neurologist, endocrinologist, surgeon, psychiatrist, etc. It is especially necessary to carefully examine the patient's medical history and find out the presence of operationalinterventions.
To make a correct diagnosis use:
- laryngoscopy or microlaryngoscopy;
- tomography of the larynx, brain, chest;
- electromyography;
- stroboscopy and phonography;
- ultrasound examination of the heart and thyroid gland;
- general and biochemical blood tests.
If organic changes were not detected, then the diagnosis of "functional paresis of the larynx" is often made.
Treatment methods
In fact, paresis of the vocal cords is only subject to complex treatment. The peculiarity of therapy is that before prescribing a course of recovery, it is necessary to identify the cause of the disease. Hospitalization of the patient is recommended for full treatment. Treatment of vocal cord paresis in a hospital is carried out using the following options:
- antihistamines, decongestants;
- antibiotics, antivirals, vitamins;
- psychotropic drugs, nootropics;
- hormonal drugs, electrophoresis;
- acupuncture, electrical nerve stimulation, massage.
Very often in the treatment of paresis it is necessary to use surgical intervention. It is used in the presence of tumors, scarring, or the futility of drug therapy. There are several methods of such treatment, the most common of which is the surgery of the organs in which the cause of the disease lies, and the placement of implants.
Surgical intervention is quite effective, but depends on the individual characteristics of the organism and the duration of the disease. After the operation, the paresis of the vocal cords recedes, and the doctor recommends the patient to do breathing exercises. On average, rehabilitation lasts about 3-4 months. During this time, it is forbidden to give strong loads on the larynx, as a relapse is possible.
Gymnastics during rehabilitation
As already noted, the doctor almost always recommends to train the respiratory process and use phonopedia after the operation. These methods are good at all stages of treatment. Gymnastics is aimed at increasing the motor activity of the ligaments and muscles. The following exercises are quite effective:
- blowing/drawing air slowly;
- use the harmonica;
- puffing out the cheeks and blowing through the slit.
During these exercises it will be useful to train the neck. Voice exercises are recommended to be carried out under the control of a phoniatrist. The patient must correct the pronunciation of each sound, syllable and word.
Prevention and prognosis
Why treat a disease if you can prevent it. The issue of prevention of paresis of the vocal cords is particularly acute. In order to avoid the appearance of an ailment with the maximum probability, you should do the following:
- correctly treat infectious and viral pathologies;
- avoid intoxication;
- do not overload the vocal cords;
- do not get cold;
- follownormalization of the thyroid gland and other internal organs.
Prognosis strongly depends on the causes of the disease and the methods of treatment. If all problems have been completely prevented, then with the right course of rehabilitation, the respiratory and separation functions of the larynx are restored. If the patient has functional paresis, he can recover on his own. Of course, with the correct distribution of the load on the larynx. With the development of the disease for a long time, muscle atrophy and complete loss of voice occur. In the most difficult situations, paralysis of the larynx is manifested, which can bring great harm to he alth.
