Laryngeal Paralysis

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Laryngeal paralysis

Laryngeal paralysis now ranks second in a number of serious chronic ENT diseases. It manifests itself in the form of a unilateral or bilateral disorder of the functions of the larynx, in which the natural movements of the vocal cords are completely absent. The reasons for this dangerous condition are a violation of the innervation of certain muscles, as well as a certain inflammatory process. Varieties of laryngeal paralysis depend on the level of damage: unilateral, bilateral, central, peripheral.

The causes of paralysis are varied. These include craniocerebral injuries, injuries of the spine, neck, strokes, surgical intervention in the cervical spine, chest, skull, etc. Dangerous damage to the nerve endings of the throat can form due to compression of the recurrent nerve or during tumor processes and hematomas.

Quite often, the recurrent nerve is damaged during thyroid surgery. And the more often the intervention, the more significantly the percentage of complications increases.

Diagnosis of paralysis of the larynx is mainly based on the results of a special laryngoscopic picture. Laryngeal paralysis is characterized by sounded inhalation. With laryngoscopy, the folds are always in a central location, the mobility of the tongue and palate is also seriously impaired, and there is a significant disorder in the articulation of speech.

Initially, a patient with suspected laryngeal paralysis is examined by computed tomography, microlaryngoscopy and chest x-ray. A clinical biochemical blood test is mandatory. If the patient's breathing is difficult, heavy, then first it is normalized, and then the necessary examinations are continued. The same diagnostics is carried out with other diseases that are a prerequisite for respiratory failure, for example, laryngospasm, myocardial infarction and stem stroke.

If the patient's state of health does not give indications for urgent surgery, then the patient undergoes a general clinical examination, ultrasound examination of the neck and sternum. In addition, with the help of an endoscope, the larynx, esophagus, trachea, lungs are examined and an ultrasound examination of the thyroid gland is performed. To make a definitive diagnosis for each patient, it is not uncommon to consult with specialists such as a neurologist, endocrinologist, thoracic surgeon and pulmonologist.

The clinical picture of laryngeal paralysis

To compile a complete picture of the characteristics of the patient's condition, to establish an accurate diagnosis and correct treatment, it is important to take into account all the patient's complaints, the course of the disease and its specific characteristics. The lumen level of the larynx can be easily determined during a general thorough examination of the patient, as well as after the necessary general examination.

With paralysis of the larynx, the voice, respiratory and protective functions of the throat are greatly impaired. The voice is sonorous, sometimes aspirated hoarseness is noticed. Disorder of the function of the respiratory tract matures when the size of the glottis does not match the physical structure of a person, with overweight, thorough physical exertion, with chronic laryngitis, acute respiratory infections and various lung diseases.

Often, the patient has labored breathing, he feels apathy or, in contrast to apathy, anxiety. Cyanotic spots are noted on the fingers and face, shortness of breath even in a calm state and with little physical exertion, the patient breathes loudly and often. Along with this, blood pressure rises significantly. Patients with acute stenosis of the throat have a more pronounced clinic than with chronic stenosis, although their glottis is more open.

If paralysis of the larynx has occurred as a result of injury to the recurrent nerve during the operation, then within one and a half to two weeks this problem is treated with conservative methods, if there are no specific symptoms of acute breathing. Next, antibacterial drugs and effective hormone treatment are prescribed. If hematomas are expressed, then the necessary drugs are prescribed that clot the blood, as well as vitamin and vascular therapy.

Positive dynamics is an indication for the appointment of a course of special exercises. Until complete recovery, the patient should be observed by an otolaryngologist. After a full month of rehabilitation after surgery, if the patient has bilateral paralysis of the larynx, treatment is prescribed individually. The appointment takes into account the severity of respiratory failure, the size of the glottis, the key disease that accompanies the pathology.

In order to normalize breathing as quickly as possible with the help of local anesthesia or anesthesia, an urgent tracheostomy is performed. As a rule, the majority of patients with bilateral paralysis of the larynx require surgery. Indications for such an operation are damage to the physical activity of the vocal cords, the inability to breathe naturally, and the ineffectiveness of conservative cure.

It is not recommended to carry out such operations for elderly patients, those who have a severe concomitant anomaly, thyroid disease.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".