Laryngeal paralysis is the result of damage to the tenth cranial nerve and its branches and can occur unilaterally or bilaterally. In the majority of cases, paralysis of the larynx can be treated well within the framework of speech therapy and/or surgical measures.
What is laryngeal paralysis?
Laryngeal paralysis manifests itself through characteristic symptoms such as hoarseness, abnormal breathing noises and shortness of breath. In severe cases, the affected person loses his or her voice. See AbbreviationFinder for abbreviations related to Laryngeal Paralysis.
Laryngeal paralysis is a partial or complete paralysis of the laryngeal muscles, which is associated with a restricted movement or misalignment of the vocal cords and/or glottis (glottis).
Laryngeal paralysis is usually due to damage to the vagus nerve (tenth cranial nerve) and its two branches (superior laryngeal nerve and recurrent laryngeal nerve). Paralysis of the superior laryngeal nerve causes reduced tension of the vocal cords due to failure of the cricothyroid muscle, which severely limits the articulation of high-pitched tones, while failure of the recurrent laryngeal nerve results in a loss of respiratory mobility of the affected vocal cords.
In addition, depending on the position of the affected vocal cord, hoarseness manifests itself in different degrees. In the case of bilateral laryngeal paralysis, the focus is on shortness of breath, which is all the more pronounced the narrower the glottis. Damage to the vagus nerve, on the other hand, can lead to a complete failure of the larynx musculature with paralysis of the pharyngeal musculature and the soft palate and is associated with a pronounced voice disorder and swallowing disorders.
Causes
Various causes affecting the vagus nerve and its branches can lead to laryngeal paralysis. In most cases, paralysis of the larynx is due to surgical interventions in the neck area (including thyroid surgery, oesophageal surgery, laryngeal endoscopy), in which the risk of injury to the recurrent laryngeal nerve (recurrent laryngeal paralysis) is increased.
In addition, various tumors (bronchial carcinoma, esophageal carcinoma, schwannoma, Garcin syndrome), infectious-toxic causes (herpes zoster, poliomyelitis, toxins, medication), congenital impairments (hydrocephalus, spina bifida, Arnold-Chiari syndrome) and immunological factors (Guillain -Barré syndrome) cause laryngeal paralysis.
Central paralysis of the larynx can manifest as a result of lesions in the central motor nerve tracts and are expressed by abnormal movements of the vocal cords, which often indicate neurological diseases (including multiple sclerosis, Wallenberg syndrome) associated with dysarthria (central speech disorders). In rare cases, laryngeal paralysis cannot be assigned a cause (idiopathic laryngeal paralysis).
Symptoms, Ailments & Signs
Laryngeal paralysis manifests itself through characteristic symptoms such as hoarseness, abnormal breathing noises and shortness of breath. In severe cases, the affected person loses his or her voice. This is usually preceded by difficulty swallowing, a dry cough and occasionally pain. Symptoms can be unilateral or bilateral and vary in severity.
In the case of mild laryngeal paralysis, only wheezing and slight breathing difficulties occur, which subside after a few days. With severe paralysis, temporary loss of voice may occur. In addition, any nerve damage can cause coughing attacks and problems with swallowing. Bilateral laryngeal nerve damage can be life-threatening.
Then acute shortness of breath is possible, which is associated with circulatory problems, a lack of oxygen supply to the body and panic attacks. In general, laryngeal paralysis causes dry cough, sore throat and the typical foreign body sensation. Many sufferers feel a scratchy throat. If food debris gets into the lungs, it can cause pneumonia.
Pneumonia is associated with other health problems and initially manifests itself as malaise, fever and indefinable pain in the lungs. If the laryngeal paralysis is treated early, the signs of the disease will soon weaken. In the absence of therapy, a life-threatening condition can set in.
Diagnosis & History
Laryngeal paralysis can be diagnosed on the basis of the characteristic clinical symptoms (hoarseness, cadaver dislocation, weakened cough, inspiratory stridor, loss of voice and shortness of breath in bilateral paralysis).
The diagnosis is secured by an ENT medical examination with larynx and glottis mirroring. Nerve function tests can reveal impairment of the nerves. Imaging diagnostic methods (computed tomography, magnetic resonance imaging, X-ray or sonography) provide information about tumors and other underlying factors.
Laryngeal paralysis should be differentiated from myogenic (myopathy of the vocalis muscle, myastenia gravis pseudoparalytica) and articular (interarytenoid fibrosis, ankylosis of the cricoarytenoid joint) impairments in the differential diagnosis. With early diagnosis and timely start of therapy, laryngeal paralysis usually has a good prognosis and about two-thirds of the symptoms of paralysis develop within six to eight months.
Complications
Paralysis in the larynx, the so-called recurrent paresis, can lead to considerable complications. These depend entirely on the position of the paralyzed vocal folds, whether the paralysis occurs on one side or both sides, and on the tension and ability to vibrate. Paralysis becomes particularly dangerous when both vocal cords are paralyzed and are also in the middle position (median).
Then they close the entrance to the trachea and shortness of breath occurs. It may be necessary to have a tracheotomy done and the patient fitted with a tracheostomy tube through which the patient can then breathe. However, this extreme case rarely occurs. Unilateral paralysis is more common. If recurrent paralysis occurs, the healthy voice is lost.
Prompt voice therapy can prevent long-term damage. However, the paralysis may persist. However, the healthy side of the vocal cords is able to compensate in such a way that the paralysis can no longer be heard. Without treatment, the voice is more likely to sound hoarse, dull, and harsh for a long time. The diseased voice often poses a major problem in communication at work. In addition to the limited voice function, swallowing difficulties and coughing are the most common complications of laryngeal paralysis.
When should you go to the doctor?
A doctor should be consulted if there is a persistent change in voice. If there are impairments of the usual voice color or the strength of the vocalization, a doctor’s visit is necessary. If the person concerned can only whisper or make barking noises, a doctor is needed to clarify the cause. See a doctor if you have a hoarse voice, an inability to speak, or a persistent scratchy sensation in your throat and throat. If whistling noises occur when breathing, a dry cough and sputum production when coughing, a doctor should be consulted.
A doctor must be consulted in the event of problems with swallowing, a refusal to eat or a decrease in the usual intake of fluids. There is a risk of an undersupply of the organism, which in severe cases can result in the premature death of the patient. Disturbances in breathing, a feeling of tightness in the throat or interruptions in breathing must be clarified by a doctor. If you experience shortness of breath and a racing heart at the same time, it is advisable to consult a doctor immediately. In severe cases, an ambulance must be called. If you feel sick, if you are afraid of suffocating or if you suffer from dizziness, you should see a doctor. If the frequency of swallowing increases sharply when eating, a doctor is needed.
Treatment & Therapy
In the case of laryngeal paralysis, the therapeutic measures depend on the extent of the impairment and the underlying cause. In the case of laryngeal paralysis, which is accompanied by a unilateral loss of the vocal cords, early voice therapy is usually used to prevent muscle atrophy in combination with faradisation (low-frequency electrical stimulation) of the affected nerves.
Here, the goal of logopedic therapy is to compensate the affected vocal cord with the healthy one. In some cases, anti-inflammatory and decongestant medications are also recommended. If the laryngeal paralysis is caused by a bacterial infection, antibiotic therapy is indicated.
If these treatment measures do not lead to the desired success (at the earliest after about 6 months), phonosurgical measures such as thyroplasty or vocal fold augmentation may be indicated, in the course of which a median shift of the affected vocal cords creates a renewed complete closure of the vocal folds or glottis in order to improve vocalization and – to ensure volume.
If there is bilateral laryngeal paralysis, surgical measures (endolaryngeal laser resection of the arytenoid cartilage, laterofixation) are aimed at optimizing respiratory function by laterally shifting the paralyzed vocal cords to expand the glottis. In addition, in the case of bilateral laryngeal paralysis as a result of acute shortness of breath, a tracheotomy (tracheostomy) with subsequent insertion of a speech cannula may be necessary.
Outlook & Forecast
Whether and to what extent those affected can alleviate their symptoms themselves depends on both the cause and the severity of the disease. The psychological burden of laryngeal paralysis should not be underestimated. The perception of a psychotherapeutic therapy or the exchange of experiences within the framework of a self-help group helps to look positively into the future again.
The voice therapy carried out as part of the treatment of unilateral vocal cord failure can also be deepened by the patient at home with specific exercises. Drug therapy can also be supported with homeopathic active ingredients under certain circumstances. However, due to the risk of interactions, this must be clarified in advance with the doctor treating you.
After about six months, it will be decided whether the chosen measures had the desired success or whether a surgical intervention might be necessary. If this is the case, the patient must take the necessary bed rest postoperatively and must not strain his voice and speak as little as possible for the first few days.
In order to relieve the surgical wound, the patient must first resort to liquid nutrition. It should also be neither too hot nor too cold or too heavily seasoned. The doctor treating you will draw up an individual nutrition plan in advance, which will also ensure a sufficient supply of vitamins and nutrients.
Prevention
Depending on the underlying cause, laryngeal paralysis can be partially prevented. Infectious diseases of the upper respiratory tract should be treated early and consistently in order to avoid damage to the nerves supplying the larynx muscles. In addition, surgical interventions in the neck area, especially thyroid operations, should only be carried out with appropriate injury-prevention measures.
Aftercare
The extent to which follow-up care is necessary depends on the type and outcome of the initial therapy. A basic distinction must be made here between conservative methods and surgical intervention. Outpatient therapies continue until the best possible result has been achieved. If there are no symptoms, no follow-up care is necessary.
If there are restrictions, doctors try to keep them as small as possible with medication or other therapies. Since the ability to speak often suffers, this often results in psychological and social problems. Psychotherapy then leads to more stability. Long-term treatment may be indicated in severe cases.
If, on the other hand, a surgical intervention took place, the surgeon initially takes over the aftercare. In the first few months, he checks the resilience of the voice and breathing capacity several times. This is followed by a long-term check, which is usually scheduled once a year. A local ear, nose and throat doctor can also perform this. In this, the remaining symptoms of laryngeal paralysis are discussed.
If complications are suspected, a laryngoscopy and imaging procedures can be performed. If laryngeal paralysis was caused by a tumor, a detailed aftercare plan is drawn up. This is intended to ensure that new cancer is detected as early as possible. Doctors promise themselves an optimal treatment option.
You can do that yourself
The measures that those affected can take themselves in the event of laryngeal paralysis depend on the severity of the impairment, the underlying causes and the type of treatment.
In the case of laryngeal paralysis associated with a unilateral vocal cord failure, voice therapy is usually carried out, which can be supported by voice exercises at home. Drug treatment can sometimes be supported by natural remedies. The responsible doctor must decide whether homeopathic remedies may be used. After an operation, the usual measures such as rest and bed rest apply. The voice must not be strained in the first few days after an operation. The diet shortly after the operation should consist of liquid food that is not overly irritating, spicy, hot or cold. As a rule, the doctor will create an individual diet together with the patient.
Since paralysis of the larynx is often a considerable burden for those affected, a therapeutic consultation makes sense. The patient should contact the treating doctor for this. This person can put you in touch with a specialist and, if necessary, also suggest a suitable self-help group.