laryngeal paralysis
Introduction
Introduction to laryngeal paralysis Paralysis ofvocalcord or laryngeal paralysis is a clinical manifestation, not an independent disease. When the motor nerve (throat recurrent nerve) of the larynx is damaged, there are three types of paralysis: vocal cord abduction, adduction, or muscle tension relaxation. Where the lesion occurs mainly in the recurrent laryngeal nerve or the vagus nerve leaving the jugular foramen and even before the recurrent laryngeal nerve is removed, the laryngeal spasm caused by it is peripheral. Skull base fracture, thyroid surgery, neck and throat trauma, throat, neck or skull base, malignant tumor compression, mediastinal or esophageal metastatic tumor, nasopharyngeal carcinoma invasion of skull base, pulmonary tip tuberculosis adhesion , pericarditis, peripheral neuritis, etc. can cause vocal cord paralysis. Band paralysis should be treated for the cause of the disease. Unilateral non-complete paralysis, no significant disturbance in pronunciation and breathing, often without treatment, unilateral complete paralysis, such as long-term still can not compensate, and patients who require improved pronunciation, can be injected under the mucosal submucosal teflon (teflon ), the collagen fiber or fat can be made to widen the vocal cords and move closer to the center line. Bilateral abduction paralysis, if there is difficulty breathing, tracheotomy should be performed, and surgery should be performed later. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: chronic laryngitis, vocal cord nodules, vocal cord polyps
Cause
Cause of laryngeal paralysis
According to the different parts of the nerve damage, it can be divided into two types: central and peripheral, and the surrounding is more common.
Caused by central nervous disease (40%):
The laryngeal motor center of both sides of the cerebral cortex has a nerve bundle connected with the two sides of the suspected nucleus, so each side of the muscle receives impulse from both sides of the cerebral cortex, so the laryngeal paralysis caused by cortical lesions is clinically rare. Cerebral hemorrhage, basilar aneurysm, posterior fossa inflammation, medulla oblongata and bridge brain tumors can cause vocal cord paralysis.
Caused by peripheral neuropathy (40%):
Where the lesion occurs mainly in the recurrent laryngeal nerve or the vagus nerve leaving the jugular foramen and even before the recurrent laryngeal nerve is removed, the laryngeal spasm caused by it is peripheral. Skull base fracture, thyroid surgery, neck and throat trauma, throat, neck or skull base, malignant tumor compression, mediastinal or esophageal metastatic tumor, nasopharyngeal carcinoma invasion of skull base, pulmonary tip tuberculosis adhesion , pericarditis, peripheral neuritis, etc. can cause vocal cord paralysis.
Prevention
Throat paralysis prevention
1. Drink 1000 to 2000 ml of boiled water a day to keep the throat moist, to supplement the vocal cords and lose moisture due to long-term use.
2. Use the appropriate volume to speak and use the microphone flexibly. Have a stable mood, adequate sleep, proper exercise to maintain good vocal cord elasticity.
3, do not smoke, drink, other such as coffee, tea, pepper, cold drinks, chocolate or dairy products should be avoided. Pay attention to the tone of the speech, not too low or too high, so as to reduce the resistance and vocal cord tension during vocalization. You can't often use whispers to talk. Some people think that whispering can make the vocal cords rest. In fact, whispering is a sound that is pronounced in a state where the vocal cords are tense. For a little longer, the vocal cords will be more fatigued.
4. The first word of each sentence should sound easily, and the airflow and sound come out at the same time (this is the soft sounding method). In the case of a need to speak loudly and without a microphone, you should use the power of Dantian to avoid the pronunciation of breath holding (that is, using the strength of the abdominal muscles). The speaking speed is moderate, the number of words in a sentence is limited to seven to ten words, and there is a pause between the sentence and the sentence. Pay attention to the vocal cords to rest, avoid screaming at work, and avoid long hours of chat after work. Try to reduce the vocalization when you have a cold. When there is a vocal dysfunction, vocal cord rest is the best method. If the symptoms persist for more than two weeks, you should go to a professional hospital for treatment as soon as possible. Laryngeal sugar, mangosteen or fat sea, etc., are ineffective for people with existing vocal cord lesions, so they should not be over-reliant.
5, patients undergoing laryngoscopy microsurgery, should be banned for about two weeks, after the wound (sound vocal cord mucosa) healed and then trained to pronounce, such surgery rarely relapse.
Complication
Throat paralysis complications Complications, chronic pharyngitis, vocal cords, vocal cord polyps
If the vocal cord paralysis is not treated promptly, mistreated or treated poorly, it is prone to prolonged to chronic laryngitis, pharyngitis, vocal cord nodules, polyps, etc. and the disease is easy to recurrent and increase the difficulty of treatment.
Vocal cord paralysis due to motor nerve innervation disorders of the vocal cords, caused by vocal cord motion abnormalities called vocal cord paralysis, the cause may include central or peripheral neuropathy. Vocal cord paralysis can be the result of a suspected nucleus and its nuclear pathway, vagus nerve trunk or recurrent laryngeal neuropathy. Recurrent laryngeal nerve paralysis can be caused by neck and chest lesions, trauma, thyroidectomy, neurotoxin (lead), neurotoxic infection (diphtheria), cervical spine injury or surgery, or viral disease.
Symptom
Throat paralysis symptoms common symptoms pronunciation disorder dyspnea hoarseness cough
Type 4 paralysis can occur due to varying degrees of neurological damage:
1, the recurrent laryngeal nerve is not completely paralyzed: unilateral symptoms are not significant, often found in physical examination. There was a short period of vocalization and it resumed. In addition to shortness of breath during strenuous exercise, there is often no difficulty breathing. Indirect laryngoscopy, in the inhalation, the median vocal cords in the affected side can not be abducted, and the sound band abduction is normal. The glottis can still be closed when pronounced. Bilateral recurrent laryngeal nerve is not paralyzed, because the vocal cords on both sides can not be abducted, can cause laryngeal obstruction, dyspnea is its main symptom, if not treated in time, can cause asphyxia. Indirect laryngoscopy showed that the vocal cords on both sides were in the middle position. Only small cracks remain in the meantime. The vocal cords can still be closed when speaking.
2, recurrent laryngeal nerve paralysis: unilateral sexual hoarseness, fatigue, speech and cough have a leak. In the later stage, there is compensatory effect and the pronunciation is improved. Indirect laryngoscopy, due to complete loss of function of the affected side abductor and adductor muscle, the affected side of the vocal cord is fixed in the paramedian position, that is, between the middle position (cadaveral position) and the median position (sound position). In the initial pronunciation, the healthy side vocal cords were closed to the median position, and there were fissures between the two vocal cords; in the later stage, the modern sacs were retracted, and the healthy side vocal cords were taken over the midline to the affected side, and the pronunciation improved. When breathing, the movement of the vocal cords on the healthy side is normal, so there is no difficulty in breathing. When the recurrent laryngeal nerves on both sides are completely paralyzed, the pronunciation is hoarse and weak, the audio is monotonous, and the speech is laborious, like a whisper, and cannot last. Self-conscious, but no difficulty breathing. Because the glottis loses normal reflection, it can't be closed, it is easy to cause misunderstanding, and there is often secretion in the trachea, and it is difficult to drain and breathe. Indirect laryngoscopy, the bilateral vocal cords are fixed in the paramedian position, the edges are relaxed, they cannot be closed, and they cannot be abducted. In the onset of acute illness, the bilateral vocal cords are in the median position, resulting in difficulty breathing, but less common.
3, laryngeal nerve paralysis: vocal cord tension loss after paralysis of the laryngeal nerve. Can't make a high voice, the sound is thick and weak. Indirect, laryngoscopy, vocal cords shrink, the edges are wavy, but abduction and adduction are still normal. In unilateral, the sensation of the contralateral laryngeal mucosa still exists. Both sides of the disease due to numbness of the laryngeal mucosa, diet, saliva mistakenly into the lower respiratory tract, aspiration pneumonia can occur.
4, mixed type of laryngeal nerve system, recurrent laryngeal nerve and superior laryngeal nerve, unilateral sex is common in neck trauma, surgical injury. The pronunciation of hoarseness is more significant. Laryngoscopy showed that the vocal cord on the affected side was fixed in the middle position. Later, due to the compensation of the vocal cords on the healthy side, the pronunciation was slightly better. The bilateral vocal cords on both sides are in the middle position.
Examine
Throat paralysis
1, the recurrent laryngeal nerve is not completely paralyzed: unilateral recurrent laryngeal nerve incontinence paralysis indirect laryngoscopy, in the inhalation, the affected side of the vocal cords in the median can not be abducted, and the sound band abduction is normal. The glottis can still be closed when pronounced. Indirect laryngoscopy of bilateral recurrent laryngeal nerves showed that the vocal cords on both sides were in the paramedian position. Only small cracks remain in the meantime. The vocal cords can still be closed when speaking.
2, recurrent laryngeal nerve paralysis: unilateral recurrent laryngeal nerve completely paralyzed indirect laryngoscopy, due to the complete loss of the abduction and adductor function of the affected side, the affected side of the vocal cord is fixed in the paracentral position, that is, in the middle position (corpse) Bit) and the median (sound position). The recurrent laryngeal nerves on both sides were completely paralyzed for laryngoscopy. The bilateral vocal cords were fixed in the paramedian position, the edges were relaxed, they could not be closed, and they could not be abducted. In the onset of acute illness, the bilateral vocal cords were in the median position.
3, laryngeal nerve paralysis: indirect, laryngoscopy, vocal cords shrink, the edge is wavy, but abduction, adduction is still normal.
4, mixed type of laryngeal nerve fistula: laryngoscopy to see the affected side of the vocal cord fixed in the middle position. Later, due to the compensation of the vocal cords on the healthy side, the pronunciation was slightly better. The bilateral vocal cords on both sides are in the middle position.
Diagnosis
Diagnosis and differentiation of laryngeal paralysis
Differential diagnosis
(1) The vocal cord paralysis is mostly one-sided, both sides of the light see; and the functional aphasia is the adductive paralysis of the vocal cords on both sides.
(2) Functional aphasia can find certain incentives, such as anger, excessive grief and so on.
(3) Functional aphasia is examined under indirect laryngoscopy, so that when the patient coughs, the vocal cords move normally.
(4) Functional aphasia suggestive therapy is effective.
