Laryngeal paresis

Laryngeal paresis
Laryngeal paresis is a painful condition of reduced motor activity of the laryngeal muscles, which leads to impaired voice and respiratory function. Laryngeal paresis may be a consequence of pathology of the laryngeal muscles, as well as damage to innervating nerves or a disorder that has arisen in the cerebral cortex. The clinical manifestation of laryngeal paresis is expressed in weakness, hoarseness and hoarseness of the voice, and sometimes by the presence of aphonia. Difficulty breathing to complete asphyxia is also one of the possible severe symptoms.

The content of the article:
Causes of laryngeal paresis
Symptoms of laryngeal paresis
Diagnosis of laryngeal paresis
Treatment of laryngeal paresis
Prognosis and prevention of laryngeal paresis
Laryngeal paresis
Diagnosis of laryngeal paresis is based on CT, laryngoscopy, laryngeal radiography and backpossing of smears taken from the pharynx. Electromyography, various studies related to phonation, examination of the chest cavity, brain and, of course, thyroid gland are also carried out. As for the treatment of laryngeal paresis, it primarily consists in eliminating the cause that caused the disease and in fully restoring voice function.

As you know, the larynx is called the section of the upper respiratory tract located between the trachea and the pharynx, which performs voice-forming and respiratory functions. The larynx has transversely stretched vocal cords and a glottis located between them. The very process of vocalization, that is, the process of phonation, occurs as a result of vibrations of the vocal cords during the passage of air through this glottis. If the vocal cords are too closed, this leads to difficulty in getting air through the respiratory tract, which means that the respiratory function of the larynx itself is disrupted. As for the expansion and narrowing of the glottis, the degree of tension of the vocal cords, this is regulated by the internal muscles of the larynx. The very work of the muscular apparatus of the larynx is carried out by means of nerve impulses that come through the branches of the vagus nerve from the cortex and the brainstem. In case of a violation in any part of this system, laryngeal paresis develops.

Laryngeal paresis is equally common in both men and women. Due to the large number of reasons that cause the appearance of laryngeal paresis, various disciplines are engaged in its research, diagnosis and treatment: otolaryngology, neurosurgery, neurology, cardiology, psychology, pulmonology, neurology and others.

Classification of laryngeal paresis

Usually, laryngeal paresis is classified based on their etiology. So, for example, the following types are distinguished:

myopathic laryngeal paresis (it occurs as a result of various kinds of pathological changes occurring in the laryngeal muscles themselves);
neuropathic laryngeal paresis (this type develops in the case of damage to the part of the nervous apparatus that provides innervation of the laryngeal muscle. If we are talking about a pathology associated with the vagus nerve, which innervates the larynx, then peripheral laryngeal paresis is usually assumed. If the nucleus of the vagus nerve located in the brain stem is damaged, then we are talking about a bulbar type of paresis. If violations occur at the level of the pathways and other areas of the cerebral cortex, then we are dealing with cortical paresis of the larynx);
functional paresis of the larynx (caused by a violation associated with the work of the cerebral cortex — the occurrence of an imbalance between the processes of inhibition and excitation).
It should also be said that laryngeal paresis can be both unilateral and bilateral. The functional and cortical type of laryngeal paresis are only bilateral in nature.

Causes of laryngeal paresis
Laryngeal paresis is a polyethological pathology that often develops against the background of another disease. For example, laryngeal paresis can be observed during the course of an inflammatory disease, which may be laryngitis. Also, laryngeal paresis can occur in parallel with infections such as influenza, acute respiratory viral infections, tuberculosis, typhoid (or typhus), secondary (tertiary) syphilis or botulism. Traumatic brain injury, myasthenia gravis, polymyositis, syringomyelia, as well as tumors and vascular disorders (ischemic stroke, atherosclerosis, etc.) — all this can also accompany laryngeal paresis.

The development of laryngeal paresis may also be associated with damage to the branch of the vagus nerve, that is, the recurrent nerve, which exits the thoracic cavity and passes to the larynx, contacting the aortic arch, heart, mediastinum, thyroid gland and other organs.

Among the pathological changes in organs that can damage or transfer the recurrent nerve, it is possible to distinguish pericarditis, aortic aneurysm, tumor (or enlargement) of mediastinal lymph nodes, as well as esophageal tumor, possible cervical lymphadenitis, thyroid cancer, which proceeds with the formation of goiter.

Increased vocal load, as well as inhalation of cold or dusty air can also provoke laryngeal paresis. The functional type of laryngeal paresis can occur as a result of stress or a strong psycho-emotional experience. It happens that laryngeal paresis develops against the background of hysteria, neurasthenia, psychopathy and VSD.

Symptoms of laryngeal paresis
The first and main symptoms of developing laryngeal paresis is a violation of the voice (or dysphonia), as well as a violation of the breathing process. Manifestations of voice disorders are a decrease in its sonority (sometimes there is complete aphonia, that is, the absence of a voice), the transition to whispering, loss of the usual timbre of the voice, hoarseness, hoarseness of the voice or its rattling, rapid fatigue with vocal loads.

Violation of breathing in the case of laryngeal paresis is associated with a very difficult intake of air into the respiratory tract due to narrowing of the glottis. The latter can be expressed to varying degrees, including even asphyxia. Also, breathing disorders can be caused by forced exhalation in order to carry out phonation. Clinical manifestations of laryngeal paresis depend on its type.

So, for example, myopathic laryngeal paresis is usually characterized by a bilateral lesion. He is characterized by violations of phonation or breathing, which is expressed in the form of asphyxia (in the case of paresis of the muscles-the dilating larynx).

If we talk about neuropathic laryngeal paresis, it is often one-sided, characterized by the slow development of weakness in the muscle itself, as well as an enlarged glottis. A few months after the disease, the restoration of phonation begins by compensatory reduction of the vocal cords on the side that is healthy. Asphyxia threatens bilateral neuropathic laryngeal paresis only in the first days of the disease.

If we are talking about functional laryngeal paresis, then this type is observed in those people who have a labile nervous system. The latter, as a rule, happens after severe emotional stress or respiratory illness. This type of paresis is characterized by the incoming nature of the disturbed phonation. The voice with this type of paresis is quite sonorous, especially during crying or laughing, there are such pronounced sensations as tickling, tickling or scratching. The latter is characteristic of the larynx and pharynx. Irritability, sleep disturbance, headache, anxiety and unbalance can also be characteristic symptoms of this type of laryngeal paresis.

Diagnosis of laryngeal paresis
It will take several specialists to diagnose laryngeal paresis. So, for example, a patient cannot do without an otolaryngologist, neurologist, neuropsychiatrist, thoracic surgeon, endocrinologist, phoniatrist and psychiatrist. The collection of anamnesis is of great importance. It is the anamnesis that can determine the type of the underlying disease, which caused the laryngeal paresis in the future, as well as the patient’s tendency to psychogenic reaction. Great importance is also given to previously transferred operations performed in the chest area, on the thyroid gland, because of which the recurrent nerve could be damaged.

Any examination of a patient with laryngeal paresis begins with a microlaryngoscopy, which allows you to assess the position of the vocal cords, as well as the distance between them and their condition. The study helps to determine the condition of the laryngeal mucosa, the presence of various inflammatory processes, including hemorrhages.

An effective diagnostic method can be CT of the larynx or radiography. To assess the contractility of the laryngeal muscles, you can use electromyography or electroneurography. Any study of the vocal function in the case of laryngeal paresis also involves stroboscopy, electroglottography, phonetography, and more.

In case of suspicion of peripheral laryngeal paresis, additional CT, chest X-ray, ultrasound of the heart and thyroid gland, X-ray of the esophagus and CT of the mediastinum can be used. In order to exclude central laryngeal paralysis, doctors prescribe brain CT and MRI. If morphological changes are not detected during the examination, then laryngeal paresis is most likely of a functional type. In order to confirm the latter, psychological testing and examination of the patient by a psychiatrist are carried out. During the examination, the doctor’s task is also to differentiate laryngeal paresis with croup, arthritis, fused stridor or subluxation.

Treatment of laryngeal paresis
Of course, the therapy of laryngeal paresis depends on its etiology. Such therapy consists in the elimination of the main disease, which later caused laryngeal paresis. The treatment of laryngeal paresis itself is carried out both medically and surgically.

Medicinal methods include antibiotic therapy, antiviral therapy (in the case of infectious and inflammatory etiology of laryngeal paresis), the use of neuroprotectors, as well as B vitamins (in the case of recurrent nerve neuritis). Biogenic stimulants, as well as muscle activity stimulants, can be part of drug therapy. The use of psychotropic drugs such as antidepressants, various tranquilizers, neuroleptics will also serve as a good treatment if the patient is ill with functional laryngeal paresis. An integral component in the treatment of laryngeal paresis can be one of the vascular drugs or nootropics.

If we talk about surgical methods for the treatment of laryngeal paresis, first of all, surgery is provided for the tension of the vocal cord, as well as the removal of diverticula, possible tumors in the esophagus, removal of tumors in the mediastinum, resection of the thyroid gland and more. Sometimes an urgent procedure is a tracheostomy or tracheotomy.

Regardless of the type of laryngeal paresis and the appointment of the main type of treatment (medical or surgical), in addition, doctors also prescribe physiotherapy methods. In the case of neuropathic or myopathic laryngeal paresis, electrical stimulation, magnetic therapy, drug electrophoresis, DDT, microwave therapy are used. If we talk about functional laryngeal paresis, then physiotherapy includes massage reflexology, hydrotherapy and electroson. The doctor also prescribes a course of psychotherapy.

After surgery, during the recovery of voice functions, various phonopedic classes are usually prescribed, which include the acquisition of high-quality phonation skills, the development of the working capacity of the voice apparatus.

Prognosis and prevention of laryngeal paresis
It is possible to talk about the prognosis of laryngeal paresis only based on its type. If the treatment was carried out in a timely manner, and the etiological factor of laryngeal paresis was eliminated, then the patient can be sure that the voice function will be restored completely, but vocal data may be lost forever. If we are talking about functional paresis, then spontaneous recovery is characteristic of the disease. If laryngeal paresis is not treated and continues to torment the patient for a long time, then the irreversibility of atrophic changes in the laryngeal muscles with the further development of phonation disorders is not excluded.

The main prevention of laryngeal paresis is the alternation of vocal loads and rest. Anyone should avoid hypothermia of the larynx and not stay in dusty rooms for a long time. Also, timely treatment of any inflammatory processes in the upper respiratory tract, treatment of infectious diseases, neurosis, thyroid gland, as well as compliance with the correct operating technique during intervention in the thyroid gland will serve as prevention.

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