Hoarseness of voice

If the hoarseness of the voice lasts more than 3 weeks, the patient needs urgent urgent examination to exclude laryngeal cancer. Hoarseness occurs when the normally very smooth vocal cords for one reason or another do not close together. The reasons for the hoarseness of the voice may be different - neurological, muscular (with paralysis of the vocal cords), but the vocal cords as such may be responsible for this. Laryngeal problems usually occur in adult patients due to hoarseness, but this can also be a cause of breathing disorders.

Inspection of the patient. First of all, it is necessary to perform laryngoscopy in order to observe the mobility of the vocal cords, assess the condition of the mucous membrane and exclude local causes.

Causes hoarseness:

• Acute: laryngitis, angioedema, laryngeal abscess, trauma (sharp screaming, coughing, vomiting, inhalation of harmful substances);
• Chronic (in this case hoarseness lasts more than three weeks): laryngitis, granulomatous lesions of the larynx (syphilis, tuberculosis, sarcoidosis, Wegener's granulomatosis); paralysis of the vocal cords; laryngeal cancer; endocrine disorders (acromegaly, addison's disease, myxedema); functional disorders; dry syndrome (with a poor lubrication of the vocal cords).

Laryngitis. More often it is a viral self-limiting disease. But the cause can serve as a secondary streptococcal or staphylococcal infection. In addition to hoarseness of voice, with laryngitis, patients usually complain of poor health, quick fatigue and fever. There may also be pain in the lower pharynx, dysphagia and pain during phonation. With direct laryngoscopy, edema is seen. If necessary, it is advisable to appoint penicillin-Fau 500 mg every 6 hours during the week.

Laryngeal abscess (abscess of larynx). This is a rare disease that occurs again in response to trauma (for example, after endotracheal intubation). In this case, there are sharp pain, fever, pain when swallowing (dysphagia), sometimes respiratory distress. Cervical lymph nodes may increase. The attempt to slightly move the larynx to the lateral side causes severe pain. On the lateral x-ray of the neck, a "level" (the boundary between fluid and air) and deformation of the larynx can be detected. With the help of fibro-optical laryngoscopy, the size of the larynx entrance is estimated and the necessity of tracheostomy is determined. The disease is usually caused by Pseudomonas, Proteus, Staphylococcus, so treatment should be aimed at suppressing their growth. Assign neetilmicin at a rate of 2-3 mg / kg every 12 hours intravenously (it is necessary to monitor the concentration of the drug in the blood) and flucloxacillin 500 mg after 6 hours intravenously. If no improvement occurs after 24 hours, you should think about surgical drainage.

Nodules of Singer. They are the result of speech (vocal) overload. These are small fibrous nodules that occur at the junction of the anterior and posterior 2/3 vocal cords. Nodules can be removed.

Functional disturbances. This is a functional hysterical paralysis of the adductor muscles (leading muscles) of both vocal cords during phonation. This condition usually occurs in young women during emotional stress. In this case, the voice can disappear completely (an aphonia occurs). More often, such a patient begins to talk in a whisper. But the vocal cords are still closed when coughing, so patients are usually not able to speak, but can cough. It is most advisable in such cases to talk with the patient and calm him.

Paralysis of the laryngeal nerve. In this case, the law Seeds: in the case of a lesion of the recurrent laryngeal nerve, the abductors, and then the adductors, are first paralyzed.

Causes: in 30% of cases, paralysis is idiopathic, in 10% - of central origin (for example, due to poliomyelitis, syringomyelia); thyroid cancer; trauma (thyroidectomy); cancus cervical lymph nodes, esophagus, hypopharynx or bronchial cancer; tuberculosis; aortic aneurysm; neuritis. With partial paralysis of the recurrent laryngeal nerve, the vocal cords are fixed along the midline; with complete paralysis, they are fixed on the "halfway".

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