The main function of the recurrent laryngeal nerve is the process of innervation of the laryngeal muscles, as well as the vocal cords, along with ensuring their motor activity, and in addition, the sensitivity of the mucous membrane. Damage to nerve endings can cause disruption of the speech apparatus as a whole. Also, due to such damage, the organs of the respiratory system can suffer.
Garyngeal nerve dysfunction: clinical manifestations and causes of the disease
Often, damage to the recurrent laryngeal nerve, which is medically referred to as neuropathic laryngeal paresis, is diagnosed on the left side as a result of the following factors:
- Transferred thyroid surgery.
- After surgery on the organs of the respiratory system.
- After surgery in the region of the great vessels.
- Viral and infectiousdiseases.
- Vascular aneurysms.
- Presence of oncological tumors of the throat or lungs.
Other causes of paresis of the recurrent laryngeal nerve can also be various mechanical injuries along with lymphadenitis, diffuse goiter, toxic neuritis, diphtheria, tuberculosis and diabetes mellitus. Left-sided lesion, as a rule, is explained by the anatomical features of the position of the nerve endings, which can be injured due to surgical intervention. Congenital ligament paralysis can be found in children.
Inflammation of nerve endings
Against the background of the pathology of the recurrent laryngeal nerve, nerve endings become inflamed, which occurs as a result of certain viral and infectious diseases. The cause may be chemical poisoning along with diabetes mellitus, thyrotoxicosis and a deficiency of potassium or calcium in the body.
Central paresis can also occur against the background of damage to brain stem cells, which is caused by cancerous tumors. Another reason may be atherosclerotic vascular disease, and in addition, botulism, neurosyphilis, poliomyelitis, hemorrhage, stroke and severe skull trauma. In the presence of cortical neuropathic paresis, bilateral nerve damage is observed.
As part of laryngeal surgery, the left recurrent laryngeal nerve can be inadvertently damaged by an instrument. Excessive pressure with a napkin during operations, squeezing the suture material,the resulting hematomas can also damage the laryngeal nerve. Among other things, there may be a response to anesthetics or disinfectant solutions.
Symptoms of damage to this nerve
The main symptoms resulting from damage to the recurrent laryngeal nerve include the following manifestations:
- Difficulties when trying to pronounce sounds, which manifests itself in a hoarse voice and a decrease in its timbre.
- The development of dysphagia, in which swallowing food becomes difficult.
- Whistling, and besides, noisy breaths of air.
- Total loss of voice.
- Suffocation due to bilateral nerve damage.
- Presence of shortness of breath.
- Violation of the general mobility of the tongue.
- Loss of soft palate sensation.
- Feeling of numbness of the epiglottis. In this case, food can enter the larynx.
- Development of tachycardia and high blood pressure.
- With the development of bilateral paresis, noisy breathing can be observed.
- The presence of a cough with the throwing of gastric juice into the region of the larynx.
- Respiratory disorder.
Features of the condition of patients against the background of damage to the recurrent laryngeal nerve
In the event that the recurrent nerve is not cut during the operation, then speech will be able to recover in two weeks. Against the background of partial intersection of the right recurrent laryngeal nerve, the recovery period takes asusually up to six months. Symptoms of numbness of the epiglottis disappear within three days.
Surgery on both lobes of the thyroid gland can lead to bilateral nerve paresis. In this case, paralysis of the vocal cords can form, as a result of which a person will not be able to breathe on his own. In such situations, a tracheostomy, an artificial opening in the neck, may be needed.
Against the background of bilateral paresis of the recurrent nerve, the patient is constantly in a sitting position, and the skin is pale in color, while the fingers and toes are cold, in addition, a person may experience a feeling of fear. Attempting to perform any physical activity only worsens the condition. After three days, the vocal cords can take an intermediate position and form a small gap, then breathing normalizes. But nevertheless, during any movements, the symptoms of hypoxia return.
Cough along with permanent damage to the mucous membranes of the larynx can lead to the development of inflammatory diseases such as laryngitis, tracheitis and aspiration pneumonia.
Methods for diagnosing a disease
The anatomy of the recurrent laryngeal nerve is unique. It will be possible to accurately determine the damage only after consulting an otolaryngologist. In addition, you will need an examination by specialists such as a neuropathologist, neurosurgeon, pulmonologist, thoracic surgeon and endocrinologist. Diagnostic examinations against the background of paresis of the larynx are performed as follows:
- Examining the patient's larynx and taking anamnesis.
- Performing a CT scan.
- Carrying out x-rays of the larynx in frontal and lateral projection.
- As part of the laryngoscopy, the vocal cords are in the middle position. During a conversation, the glottis does not increase.
- Carrying out phonetography.
- Performing electromyography of the muscles of the larynx.
- Carrying out a biochemical blood test.
As part of additional diagnostic procedures, it may be necessary to perform computed tomography and ultrasound. It will not be superfluous for the patient to undergo an x-ray of the brain, organs of the respiratory system, thyroid gland, heart and esophagus.
Differentiation of paresis from other diseases
It is extremely important to be able to differentiate paresis of the laryngeal nerve from other diseases that also cause respiratory failure. These include:
- Laryngospasms.
- Clogging of blood vessels.
- The appearance of a stroke.
- Development of multiple system atrophy.
- Asthma attacks.
- Development of myocardial infarction.
Against the background of bilateral paresis, as well as in severe conditions in patients and asthma attacks, first of all, emergency care is provided, after which a diagnosis is made and the necessary method of therapy is selected.
Classification of symptoms for this disease
Based on the results of diagnostic measures, and in addition, examination of patientsall symptoms of damage to the recurrent nerve are divided into the following conditions:
- The development of unilateral paralysis of the left recurrent nerve manifests itself in the form of severe hoarseness, dry cough, shortness of breath when talking and after physical exertion. In addition, at the same time, the patient cannot talk for a long time, and while eating, he may choke, feeling the presence of a foreign object in the larynx.
- Bilateral paresis accompanied by shortness of breath and bouts of hypoxia.
- A condition that mimics paresis is formed against the background of unilateral damage to the nerve of the larynx. In this case, a reflex spasm of the vocal fold can be observed on the opposite side. The patient has difficulty breathing, is unable to clear his throat, and chokes on food while eating.
Reflex spasms can develop due to calcium deficiency in the blood, a condition often seen in people who suffer from thyroid disease.
What will be the treatment of the recurrent laryngeal nerve?
Methods of treating pathology
Garyngeal nerve paresis is not considered a separate disease, therefore, its treatment begins, first of all, with the elimination of the main causes that cause this pathology. As a result of the growth of cancerous tumors, the patient requires surgical removal of such tumors. And the enlarged thyroid gland is subject to mandatory resection.
Emergency care is required for patients with bilateral paresis, otherwiseasphyxia. In such situations, a tracheostomy is performed for the patient. This operation is performed under local or general anesthesia. In this case, a special cannula and a tube are inserted into the trachea, which is fixed with a Chassignac hook.
Drug therapy
Drug treatment of recurrent laryngeal nerve paresis includes antibiotics along with hormonal drugs, neuroprotectors and B vitamins. In the event that there is an extensive hematoma, agents are prescribed that accelerate the resorption of bruises.
Reflexology is carried out by acting on sensitive points that are located on the surface of the skin. Such therapy restores the functioning of the nervous system, accelerating the regeneration of damaged tissue. Voice and vocal function is normalized through special classes with a phoniatrist.
Against the background of a long-term violation of voice functions, atrophy can occur along with the pathology of the functioning of the muscles of the larynx. In addition, fibrosis of the cricoarytenoid joint may form, which will interfere with the restoration of speech.
Surgical laryngoplasty
When conservative treatment is ineffective, as well as against the background of bilateral paresis of the recurrent nerve, patients are prescribed a reconstructive operation to restore respiratory functions. Surgical intervention is not recommended in the elderly, and in addition, in the presence of malignant tumors of the thyroid gland or severe systemic pathologies.
