Laryngeal paralysis (laryngeal paresis): treatment

Carry out etiopathogenetic and symptomatic therapy. Treatment begins with the elimination of the cause of immobility of the half of the larynx, for example, decompression of the nerve; detoxification and desensitizing therapy in case of damage to the nerve stem of an inflammatory, toxic, infectious or traumatic nature.

Methods of treatment of laryngeal paralysis

Etiopathogenetic treatment

• Decompression of the nerve
• Removal of a tumor, scar, removal of inflammation in the area of damage
• Desintoxication therapy (desensitizing, anti-edema and antibiotic therapy)
• Improvement of nerve conduction and prevention of neurodystrophic processes (triphosphadenine, vitamin complexes, acupuncture)
• Improvement of synaptic conductivity (neostigmine methyl sulfate)
• Simulation of regeneration in the area of damage (electrophoresis and medical-medicamentous blockade of neostigmine methylsulfate, pyridoxine, hydrocortisone)
• Stimulation of nervous and muscular activity, reflexogenic zones
• Mobilization of the arytenoid joint
• Surgical methods (reinnervation of the larynx, laryngotracheal plastic)

Symptomatic treatment

• Electrostimulation of the nerves and muscles of the larynx
• Acupuncture
• Phonopedia
• Surgical methods (tiro-, laryngoplasty, implantation surgery, tracheostomy)

Objectives of treatment

The goal of the treatment is to restore the mobility of larynx elements or to compensate for lost functions (breathing, swallowing and voice).

Indications for hospitalization

In addition to the cases when surgical treatment is planned, it is desirable to hospitalize the patient early in the course of the disease for a course of restorative and stimulating therapy.

Non-drug treatment

Effective use of physiotherapy - electrophoresis with neostigmine methyl sulfate on the larynx, electrostimulation of the larynx muscles.

External methods are applied directly to laryngeal muscles and nerve trunks, electrostimulation of reflexogenic areas by diadynamic currents, endolaryngeal electrostimulation of muscles by galvanic and faradic current, and also anti-inflammatory therapy.

Of great importance is holding respiratory gymnastics and phonopelia. The latter is used at all stages of treatment and at any time of the disease, with any etiology.

Medication

Thus, with neurogenic paralysis of the vocal fold, regardless of the etiology of the disease, immediately begin treatment aimed at stimulating the regeneration of the nerves on the affected side, as well as the crossover and residual innervation of the larynx. Apply medicines that improve the nervous, synaptic conductivity and microcirculation, slowing the neurodystrophic processes in the muscles.

Surgery

Methods of surgical treatment of unilateral paralysis of the larynx:

• re-innervation of the larynx;
• thyreoplasty;
• implantation surgery.

Surgical reinnervation of the larynx is carried out by neuro-, myo-, neuromuscular plastic. A wide variety of clinical manifestations of laryngeal paralysis, the dependence of the results of intervention on the duration of denervation, the degree of atrophy of the internal muscles of the larynx, the presence of concomitant pathology of the arytenoid cartilage, the various individual features of regeneration of nerve fibers, the presence of Syukinesias and poorly predicted perversion of laryngeal innervation with the formation of scars in the operation area limit the application of the technique in clinical practice.

Of the four types of tiroplasty, the first (medial displacement of the vocal fold) and the second (lateral displacement of the vocal fold) are used for laryngeal paralysis. With tyroplasty of the first type, in addition to medialisation, the head of the fold, the arytenoid cartilage is laterally displaced and sealed with a window in the plate of the thyroid cartilage. The advantage of this method is the possibility of changing the position of the voice fold not only in the horizontal but also in the vertical plane. The use of this technique is limited when fixing the arytenoid cartilage and muscle atrophy on the side of paralysis.

The most common method of medialisation of the vocal fold in the unilateral paralysis of the larynx is implantation surgery. Its effectiveness depends on the properties of the implant material and the method of its administration. The implant must have a good tolerance to absorption, a fine dispersion, which provides an easy introduction; have a hypoallergenic composition, did not cause a pronounced productive tissue reaction and do not have carcinogenic properties. The implant is Teflon, collagen, autogyro and other methods of injecting the material into the paralyzed vocal fold under anesthesia with direct microlaringoscopy, under local anesthesia, endolaryngeal and transdermal. G, F. Ivanchenko (1955) developed the method of endolaryngeal fragmented Teflon-collagenplast: a Teflon paste is introduced into the deep layers, which forms the basis for the subsequent plastics of the outer layers.

Among the complications of implant surgery are:

• acute swelling of the larynx.
• formation of granuloma.
• migration of Teflon paste into soft tissues of the neck and thyroid gland.

Further management

Treatment of paralysis of the larynx is gradual, consistent. In addition to medicamental, physiotherapeutic and surgical treatment, patients are shown long-term occupations with a phonopede, the purpose of which is the formation of correct phonation breathing and voice, correction of the violation of the laryngeal function. Patients with bilateral paralysis should be observed at intervals of 1 time every 3 or 6 months, depending on the clinic for respiratory failure.

Patients with paralysis of the larynx are advised by the phoniatrist to determine the possibilities of rehabilitation of the lost functions of the larynx, restore voice and breathing at the earliest possible time.

The period of incapacity for work is 21 days. With bilateral paralysis of the larynx, the patient's capacity for work is severely limited. When unilateral (in the case of the voice profession) - may limit the ability to work. However, when restoring the voice function, these restrictions can be removed.

Forecast

For patients with unilateral paralysis of the larynx, the prognosis is favorable, as in most cases it is possible to restore voice and compensate for respiratory functions (under certain physical exertion restrictions, since when the vocal folds are closed, the vocal cuff on inspiration remains half-narrowed). The majority of patients with bilateral paralysis of the larynx need stage surgical treatment. If it is possible to carry out the whole course of restorative treatment, it is likely that decanulation and breathing through natural ways are possible, the voice function is partially restored.

Prevention

Prevention consists in the timely treatment of laryngeal trauma and the pathology of the pustnecherpalovidnogo joint.

[1], [2], [3], [4], [5], [6], [7]