Paralysis of the larynx today is in second place in a number of serious chronic ENT diseases. It manifests itself in the form of unilateral or bilateral reversal of the functions of the larynx, in which the natural movements of the vocal cords are completely absent. The causes of such a dangerous condition are the violation of the innervation of certain muscles, as well as a certain inflammatory process. Types of paralysis of the larynx depend on the level of damage: one-sided, bilateral, central, peripheral.
The causes of paralysis are different. These include craniocerebral trauma, spine trauma, neck, strokes, surgical intervention in the cervical, thorax, skull and so on. Dangerous damage to the nerve endings of the throat may form due to compression of the recurrent nerve or in tumor processes and hematomas.
Quite often the recurrent nerve is damaged during operations on the thyroid gland. And the more often the intervention, the more the percentage of complications increases.
The diagnosis of laryngeal paralysis mainly occurs on the basis of the results of a special laryngoscopic picture. Paralysis of the larynx is characterized by a sounded inspiration. At laryngoscopy, the folds are always in the central position, the mobility of the tongue and palate is seriously impaired, and there is a significant disorder in the articulation of the speech.
Initially, patients with suspicion of laryngeal paralysis are examined on a computer tomography scan, doing a microlaringoscopy and a chest X-ray. A clinical biochemical blood test is mandatory. If the patient’s breathing is difficult, severe, then it is normalized first, and then the necessary examinations are continued. The same diagnosis is also carried out with other diseases, which are a prerequisite for respiratory failure, for example, laryngospasm, myocardial infarction and stroke.
. If the patient’s state of health does not give evidence of an urgent operation, the patient is subjected to a general clinical examination, ultrasound examination of the neck and sternum. In addition, an endoscope examines the larynx, esophagus, trachea, lungs and conduct ultrasound examination of the thyroid gland. In order to make a definitive diagnosis for each patient, they often consult with specialists such as a neurologist, endocrinologist, thoracic surgeon and pulmonologist. The clinical picture of laryngeal paralysis
For drawing up a complete picture of the patient’s condition, establishing an accurate diagnosis and correct treatment, it is important to take into account all complaints of the patient, the course of the disease and its specific characteristics. The level of laryngeal lumen can be easily determined during a general thorough examination of the patient, and also after the necessary general examination.
When the larynx is paralyzed, the voice, respiratory and protective functions of the throat are severely impaired. The voice is sonorous, at times the aspirated friability is seen. Disorder of the function of the respiratory tract matures when the size of the glottis does not match the physical structure of the person, with excessive weight, substantial physical exertion, chronic laryngitis, acute respiratory disease, and various lung diseases.
Frequently, the patient experiences confused breathing, he feels apathy or as opposed to apathy, anxiety. On the fingers and hands are marked cyanotic spots, dyspnea even in a calm state and with little physical exertion, the patient loudly and often breathes. Along with this, blood pressure is significantly increased. Patients with acute stenosis of the throat have a more pronounced clinic than with a chronic one, although their voice gap is more open.
If the larynx paralysis occurred as a result of injuring the recurrent nerve during the operation, then this problem is treated conservatively for one and a half to two weeks if there are no specific symptoms of acute respiration. Further, antibacterial drugs and effective hormone treatment are prescribed. If hematomas are expressed, then prescribe the necessary drugs that fold 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 with an otolaryngologist. After a full month of rehabilitation after surgery, if the patient has bilateral paralysis of the larynx, treatment is appointed individually. The appointment takes into account the severity of respiratory insufficiency, the size of the glottis, a key disease that accompanies pathology.
To urgently normalize breathing with local anesthesia or anesthesia, urgent tracheostomy is performed. Typically, most patients with bilateral laryngeal paralysis need surgical intervention. Indications for such surgery are damage to the physical activity of the vocal cords, the inability to breathe naturally, and the ineffectiveness of conservative cure.
Do not recommend such operations to patients of advanced age, those who have a severe concomitant anomaly, thyroid disease. p