Currently, the larynx is one of the most complex human organs. Even in antiquity, 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 ailment makes up one 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 development of the disease occur?
The anatomy of the larynx suggests the presence of vocal cords located parallel to each other. Between them is the glottis. When you exhale air through this hole, vibration is formed, the ligaments oscillate and a voice is created. Thus, the mechanism of the larynx works, performing the function of phonation.
The muscles of this organ respond to impulses that enter the small branches from the central nervous system. If any damage or pathology occurs, then the relationship between the brain, nervous system and muscle system is disturbed. As a result of this development of events, paresis of the vocal cords and, accordingly, the larynx appears.
Typology of the disease
This disease is divided into three types: myopathic (associated with the muscle 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 one-sided or two-sided. In addition, the pathology is congenital and acquired. The first is characterized by the development of the most severe form - laryngeal paralysis. Those who suffer from this disease cannot make organ movements with their muscles.
Myopathic appearance
Consider each of the types of paresis of the vocal cords in more detail. The myopathic form of the disease is formed as a result of inflammatory changes in the larynx apparatus due to an increase in the number of microorganisms. Infectious viruses act in approximately the same way.
This type of disease also appears when dust and dirty substances get into the throat. Cold air and excessive tension can become factors in the paresis of the right vocal cord or left. Sometimes there is a bilateral nature of the disease. Of the symptoms here, one can distinguish:
- hoarse voice;
- tone change;
- it is impossible to reproduce high sounds;
- intermittent speech;
- the ability to speak only in a whisper.
Neuropathic view
This type of paresis of the vocal cords 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 injury to the trunk and cortex.
If a one-sided pathology develops, then breathing and the voice-forming function work fine, a bit later hoarseness appears. Recovery of the laryngeal nerve takes several months. However, if the patient is a singer, then he will have to be upset, his vocal abilities will never be the same. Bilateral pathology is characterized by a very serious condition, which can lead to suffocation.
Symptoms
- noisy breathing;
- to facilitate the process, the patient in a sitting position rests on something with his hands;
- the skin turns blue.
Functional view
The peculiarity of this type of laryngeal paresis is that it manifests itself only against the background of instability of the nervous system. The main symptom of the functional form of the disease is a whisper, turning into aphonia. If the patient is passionate about some business, he may not even notice that the voice either disappears or appears.
Usually paresis is formed as a result of laryngitis or another disease. Imaginary patients, which are now quite a lot, talk in a whisper until they cure the underlying disease. They often reprimand doctors that they are being treated improperly. Typically, these patients experience the following symptoms:
- a sore throat;
- tickling and tickling;
- dizziness and pain in the head;
- insomnia.
Treatment of the functional type of laryngeal paresis takes quite a long time. It is recommended that you connect a therapist 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 serious stage of the disease.
Causes of the disease
This disease is 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 nerve structures, bruises in everyday life and at work, etc. are also capable of causing the appearance of an ailment.
The main causes of paresis of the vocal cords are:
- the appearance of metastases, tumors of the neck, chest, larynx and trachea;
- enlargement of the thyroid gland, which occurs against the background of other diseases;
- benign tumors in the larynx;
- hematomas after damage;
- stroke, congenital heart disease;
- neuritis that occurs against the background of infectious viral diseases.
The voice apparatus is subjected to severe 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 paresis of the vocal cords
The clinical picture of the disease will depend on the degree of damage to the larynx and vocal cords, as well as on the limitation of the development of the disease. The most striking signs appear with unilateral paresis with violations in the work of the vocal cords:
- hoarseness of voice;
- fast fatiguability;
- lost voice (throat does not hurt, no temperature);
- dyspnea;
- pain in the throat;
- problems with language mobility;
- foreign body is felt in the throat, sensation of coma;
- coughing or severe coughing fit;
- insomnia, headache.
There are cases when paresis does not manifest itself externally. With this development of events, only a doctor can detect an ailment with a thorough examination. As for bilateral lesions of the larynx, they are characterized by aphonia and respiratory failure. Sometimes a barking cough is observed with paresis of the vocal cords. In rare cases, the disease develops so quickly that in a few hours emergency medical intervention is required.
Diagnostics
When the first signs of paresis appear, you should immediately contact an otolaryngologist. The main task for the doctor is to correctly determine the cause of the ailment. To do this, it is necessary to undergo several examinations, as well as get advice from other specialists, for example, a neurologist, endocrinologist, surgeon, psychiatrist, etc. It is especially necessary to examine the patient’s medical history and find out the presence of surgical interventions.
To make the correct diagnosis, use:
- laryngoscopy or microlaryngoscopy;
- tomography of the larynx, brain, chest;
- electromyography;
- stroboscopy and phonography;
- ultrasound of the heart and thyroid gland;
- general and biochemical blood test.
If organic changes have not been detected, then the diagnosis of "functional paresis of the larynx" is often made.
Treatment methods
In fact, paresis of the vocal cords is susceptible only to complex treatment. The peculiarity of therapy is that before the appointment of a recovery course, it is necessary to identify the cause of the disease. For a full treatment, hospitalization of the patient is recommended. Treatment of paresis of the vocal cords in a hospital is carried out using the following options:
- antihistamines, decongestants;
- antibiotics, antiviral agents, vitamins;
- psychotropic drugs, nootropics;
- hormonal drugs, electrophoresis;
- acupuncture, electrical stimulation of nerves, massage.
Very often, in the treatment of paresis, it is necessary to use surgical intervention. It is used in the presence of tumors, scars or the futility of drug therapy. There are several methods of such treatment, the most common of which is surgery of the organs that comprise the cause of the disease, and implant placement.
Surgical intervention is quite effective, but depends on the individual characteristics of the body and the duration of the disease. After surgery, paresis of the vocal cords recedes, and the doctor recommends that the patient do breathing exercises. On average, rehabilitation lasts about 3-4 months. During this time, it is forbidden to give strong loads on the larynx, since a relapse is possible.
Gymnastics during rehabilitation
As already noted, the doctor almost always recommends after the operation to train the respiratory process and use phonopedia. These methods are good at all stages of treatment. Gymnastics is aimed at increasing the motor activity of ligaments and muscles. The following exercises are quite effective:
- blowing / drawing in air slowly;
- use of harmonica;
- blowing cheeks and blowing through the gap.
During these exercises it will be useful to train the neck. Voice exercises are recommended under the supervision of a phoniatrist. The patient must adjust 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 maximize the probability of avoiding the appearance of an ailment, the following should be done:
- properly treat infectious and viral pathologies;
- avoid intoxication;
- Do not overload the vocal cords;
- do not supercool;
- monitor the normalization of the thyroid gland and other internal organs.
The prognosis is highly dependent on the causes of the disease and treatment methods. If all problems were completely prevented, then with the right course of rehabilitation, the respiratory and dividing 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, muscle atrophy and complete loss of voice occur for a long time. In the most difficult situations, laryngeal paralysis is manifested, which can cause great harm to health.