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, organs of the respiratory system can be affected.
Laryngeal nerve dysfunction: clinical manifestations and causes of the disease
Often, damage to the recurrent laryngeal nerve, which in medicine is called neuropathic laryngeal paresis, is diagnosed on the left side as a result of the following factors:
- Surgical manipulation of the thyroid gland.
- Surgical manipulation of the respiratory system.
- Surgical manipulation in the region of the great vessels.
- Viral and infectious diseases.
- Aneurysm of the vessels.
- The presence of cancer of the throat or lung.
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 paralysis of ligaments can be found in children.
Inflammation of the nerve endings
Against the background of the pathology of the recurrent laryngeal nerve, the nerve endings become inflamed, which occurs as a result of certain transferred viral and infectious diseases. The cause may be chemical poisoning along with diabetes, 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 cause may be atherosclerotic vascular damage, and in addition, botulism, neurosyphilis, poliomyelitis, hemorrhage, stroke and severe skull injuries. In the presence of cortical neuropathic paresis, bilateral nerve damage is observed.
In the framework of surgical operations in the area of the larynx, the left recurrent laryngeal nerve can be inadvertently damaged by some instrument. Excessive tissue pressure during operations, squeezing of suture material, hematomas formed can also damage the laryngeal nerve. In addition, a response to anesthetics or disinfectant solutions may occur.
Symptoms of this nerve damage
The main symptoms resulting from damage to the recurrent laryngeal nerve include the following manifestations:
- Difficulties in trying to pronounce sounds, which is manifested in the hoarseness of the voice and lowering its timbre.
- The development of dysphagia, in which swallowing food becomes difficult.
- Whistling, and in addition, noisy breaths of air.
- Total loss of voice.
- Choking on the background of bilateral nerve damage.
- The presence of shortness of breath.
- Violation of the general mobility of the tongue.
- Loss of sensitivity of the soft palate.
- Numbness of the epiglottis. In this case, food can enter the larynx.
- The development of tachycardia and high blood pressure.
- With the development of bilateral paresis, noisy breathing can be observed.
- The presence of cough with a throwing of gastric juice in the larynx.
- Respiratory distress.
Features of the condition of patients on the background of damage to the recurrent larynx
In the event that the recurrent nerve was not dissected during the operation, then speech will be able to recover in two weeks. Against the background of a partial intersection of the right recurrent laryngeal nerve, the recovery period usually takes up to six months. The symptomatology of numbness of the epiglottis disappears within three days.
Surgical intervention 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, tracheostomy, an artificial opening on the neck, may be necessary.
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, and the fingers and toes are cold, in addition, a person may experience a sense of fear. An attempt to perform any physical activity only leads to a worsening of the condition. Three days later, the vocal cords can occupy an intermediate position and form a small gap, then breathing normalizes. Nevertheless, during any movement the symptoms of hypoxia return.
Coughing 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.
Diagnosis Methods
The anatomy of the recurrent laryngeal nerve is unique. It will only be possible to establish the exact damage only after consultation with an otolaryngologist. In addition, examination by specialists such as a neuropathologist, neurosurgeon, pulmonologist, thoracic surgeon and endocrinologist will be required. Diagnostic examinations against the background of laryngeal paresis are performed as follows:
- Inspection of the patient's larynx, as well as an anamnesis.
- Performing computed tomography.
- X-ray of the larynx in direct and lateral projection.
- As part of laryngoscopy, the vocal cords are in the middle position. During a conversation, an increase in the glottis does not occur.
- Conducting phonetography.
- Performing electromyography of the muscles of the larynx.
- Conducting a biochemical blood test.
As part of additional diagnostic techniques, computed tomography and ultrasound may be required. Radiography of the brain, respiratory system, thyroid gland, heart and esophagus will not be superfluous for the patient.
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.
- Blockage of blood vessels.
- The appearance of a stroke.
- The development of multiple systemic atrophy.
- Attacks of bronchial asthma.
- The 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 given, after which a diagnosis is made and the necessary treatment technique is selected.
Classification of symptoms with this disease
Based on the results of diagnostic measures, and in addition, examination of patients, all the symptoms of recurrent nerve damage are divided into the following conditions:
- The development of unilateral paralysis of the left recurrent nerve is manifested in the form of a pronounced hoarseness of the voice, dry cough, shortness of breath during conversation and after physical exertion. In addition, while the patient can not talk for a long time, and directly during meals can choke, sensing the presence of a foreign object in the larynx.
- Bilateral paresis is accompanied by shortness of breath and hypoxia attacks.
- A condition that mimics paresis is formed against the background of unilateral damage to the nerve of the larynx. In this case, on the opposite side, a reflex spasm of the vocal fold may be observed. It is difficult for the patient to breathe, he does not manage to clear his throat, and during eating he chokes on food.
Reflex cramps can develop due to a deficiency of calcium in the blood, a similar condition is often found in people who suffer from thyroid diseases.
What will be the treatment of the recurrent-laryngeal nerve?
Methods of treating pathology
Paresis of the laryngeal nerve is not considered a separate disease, so 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 neoplasms. And an enlarged thyroid gland is subject to mandatory resection.
Emergency care is required for patients with bilateral paresis, otherwise asphyxiation may occur. In such situations, a tracheostomy is performed for the patient. Such an operation is carried out under local or general anesthesia. At the same time, a special cannula and a tube are inserted into the trachea, which are fixed with a Chassignac hook.
Drug therapy
Drug treatment for paresis of the recurrent laryngeal nerve includes taking 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 bruising.
Reflexotherapy is carried out by acting on sensitive points that are located on the surface of the skin. Such therapy restores the nervous system, accelerating the regeneration of damaged tissue. Voice and vocal function is normalized due to special classes with a phoniatrist.
Against the background of a prolonged violation of the vocal functions, atrophy can occur along with the pathology of the functioning of the muscles of the larynx. In addition, fibrosis of the cricoid joint can form, which will interfere with the restoration of speech.
Surgical laryngoplasty
If the conservative treatment is ineffective, as well as against the background of bilateral paresis of the recurrent nerve, patients are prescribed reconstructive surgery to restore respiratory functions. Surgical intervention is not recommended in old age, and in addition, in the presence of malignant tumors of the thyroid gland or severe systemic pathologies.