Laryngeal paresis

Laryngeal paresis is a pathological condition in which the motor activity of the muscles of the larynx decreases, which causes difficulty breathing and swallowing, and a change in voice. The disease can occur in people of all age groups as a result of various factors. Characteristic symptoms include hoarseness and difficulty swallowing.
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Causes

Paresis of the larynx develops due to the following reasons:

  • Inflammatory processes (pharyngitis)
  • Infectious diseases (flu, ARVI)
  • Neurological disorders
  • Injuries to the head or larynx
  • Tumors and other diseases affecting the nervous system
  • Neuropathy or damage to the vagus nerve resulting from neck or chest surgery

Factors contributing to the development of paresis of the laryngeal ligaments include professional activities associated with vocal stress and inhalation of poor quality air. The disease can also occur against the background of strong emotional experiences and chronic stress.

Causes

Types of laryngeal paresis

Depending on the location of the lesions and the severity of symptoms

Depending on the location of the lesions and the severity of symptoms, doctors distinguish several types of paresis and paralysis of the larynx:

  • Partial and complete - characterized by varying degrees of damage to the laryngeal muscles and the ability of the vocal cords to perform their functions
  • Unilateral and bilateral laryngeal paresis - accompanied by serious breathing problems. In critical cases, urgent surgical intervention is required to ensure airway patency

Patients are also diagnosed with idiopathic paresis - sudden, unilateral paralysis of the facial nerve. To determine the type of paresis, a comprehensive diagnosis is carried out.

Depending on the causes of paresis

Depending on the causes of paresis, they are divided into myopathic, neuropathic and functional. Let's take a closer look at each of them.

Myopathic type

Characterized by damage to the laryngeal muscles themselves. The cause may be diseases such as myasthenia gravis and inflammatory myopathies (dermatomyositis, polymyositis) and genetic myopathies (muscular dystrophies). They directly affect muscle tissue, causing it to become weak or lose function.

Neuropathic type

It occurs due to damage to the part of the nervous system that is responsible for controlling the laryngeal muscles. Depending on the location of the damage, several types of paresis are distinguished:

  • Peripheral - develops due to disturbances in the functioning of the vagus nerve or its branches
  • Bulbar - associated with damage to the nucleus of the vagus nerve located in the brain stem
  • Infectious – occurs as a complication after infectious diseases affecting the nervous system
  • Cortical - appears due to disturbances in the cortical areas of the brain responsible for planning and coordinating movements of the larynx

Thanks to timely and properly selected treatment for laryngeal paresis, doctors are able to prevent the occurrence of dangerous complications.

Functional type

No physical damage to the nervous system or laryngeal muscles. It is associated with psychological factors that disrupt the normal functioning of the brain processes that regulate the functions of the larynx. Cortical and functional paresis of the larynx often occurs bilaterally.

General information about the treatment of laryngeal paresis

Clinical picture of laryngeal paresis

The larynx performs three main functions:

  • Voice formation
  • Providing breathing
  • Protection of the respiratory tract from food and liquid

With laryngeal paresis, symptoms occur that can develop suddenly or gradually. These include:

  • Hoarseness of voice
  • Feeling of a lump in the throat
  • Cough
  • Difficulty swallowing

During the examination, you may find that the vocal cords do not close completely, forming a gap.

Diagnostics of paresis of the laryngeal ligaments

First, the doctor takes a medical history to identify potential risk factors. The patient then receives a referral for laryngoscopy. The method allows you to assess the condition of the vocal cords, identify inflammation or other pathologies. To complete the picture, X-rays and computed tomography of the larynx are used. Electromyography and electroneurography help examine the activity of the laryngeal muscles and the quality of the neuromuscular signal.

Important! To study the vibrations of the vocal cords, voice duration analysis and stroboscopy are performed. Phonetography and electroglottography are also prescribed to assess the functioning of the ligaments.

If peripheral disorders are suspected, the following studies are additionally used:

  • Chest X-ray
  • Ultrasound examination of the thyroid gland and heart
  • CT scan of the mediastinum and esophagus

If central brain damage is suspected, examination includes MRI and CT. If no structural abnormalities are found, the doctor may diagnose functional laryngeal paresis. Consultation with a psychiatrist and psychological testing are required to confirm the diagnosis.

Treatment of laryngeal paresis

Treatment of paresis of the laryngeal ligaments is aimed at eliminating the root cause that caused the dysfunction of the larynx. With unilateral laryngeal paresis, therapy is aimed at restoring vocal functions. For this purpose, doctors prescribe a set of speech therapy exercises, medications and, if necessary, phonosurgery methods.

In the case of bilateral paresis of the larynx, it is important to ensure not only the restoration of the voice, but also the normalization of respiratory functions. Surgery is considered the most effective. During the operation, the doctor widens the airways, preventing acute respiratory failure.

Drug treatment involves taking the following medications:

  • Antibacterial or antiviral drugs in case of infectious origin of paresis
  • Muscle relaxants to stimulate muscle activity in myopathic paresis
  • Psychotropic drugs, including antidepressants and sedatives, for functional damage
  • Vascular and nootropic drugs for paresis caused by neurological disorders

Operations are aimed at correcting the position of the vocal cords and removing formations in the larynx or mediastinum. In critical cases, such as asphyxia, a tracheostomy is performed.

Additionally, physiotherapeutic procedures are prescribed:

  • Electrical stimulation and electrophoresis to improve neuromuscular transmission
  • Magnetic therapy and microwave therapy to reduce inflammation
  • Hydrotherapy, massage and reflexology to eliminate symptoms of functional paresis

Phonopedic classes are also conducted aimed at restoring the voice, developing correct breathing techniques and phonation. A special set of exercises increases the effectiveness of the vocal apparatus. In more complex cases, surgical treatment is required.

Preparation and types of operations

Before any surgical intervention on the larynx, the patient undergoes thorough preparation. It involves a comprehensive medical examination to assess your general health, identify risks and contraindications, such as cardiovascular disease or bleeding disorders.

Major studies include:

  • Electrocardiogram
  • Functional breathing tests
  • Laboratory tests of blood and urine
  • Chest X-ray

The anesthesiologist must conduct a preoperative examination in order to select the optimal method of pain relief, taking into account the individual characteristics of the patient.

Surgeries on the larynx in our clinic are performed using minimally invasive technologies and modern microsurgical equipment. This allows you to minimize recovery time and minimize risks.

Types of operations:

  • Chordotomy or arytenoid chordotomy. Removal of fixed structures of the larynx under a microscope to improve breathing and preserve vocal functions
  • Chordopexy. Fixation of the vocal fold to the wall of the larynx to expand the respiratory lumen, which helps restore breathing and voice

The duration of the operation varies from 10 minutes to several hours, depending on the complexity of the case. Patients usually stay in the hospital for one to two days.

Postoperative laryngeal paresis requires compliance with a number of restrictions:

  • Avoid communicating in whispers and in raised voices
  • Avoid singing during colds
  • Do breathing exercises regularly (for example, diaphragm breathing, vocal cord relaxation exercises, and exhalation control)
  • Limit physical activity for 1-2 weeks after surgery

Doctors strongly recommend that during the recovery period you eat well and ensure yourself quality rest. This facilitates a quick return to normal life and restoration of voice functions.

Our doctors
Sadikov
Ilya Sergeyevich
Head of the Clinic for Otorhinolaryngology, Otorhinolaryngologist
Tetzoeva
Zalina Muratovna
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Anastasia Andreevna
Otolaryngologist, audiologist
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Andrew Stanislavovich
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Maria Pavlovna
Audiologist-otorhinolaryngologist
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Galina Rustemovna
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Liliya Sergeevna
Otorhinolaryngologist, phoniatrist
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