Laryngeal paralysis (laryngeal paresis) - Treatment

Etiopathogenetic and symptomatic therapy is performed. Treatment begins with eliminating the cause of immobility of half of the larynx, for example, nerve decompression; detoxification and desensitization therapy in case of damage to the nerve trunk of an inflammatory, toxic, infectious or traumatic nature.

Methods of treatment of laryngeal paralysis

Etiopathogenetic treatment

• Nerve decompression
• Removal of tumor, scar, removal of inflammation in the damaged area
• Detoxification therapy (desensitizing, decongestant and antibiotic therapy)
• Improving nerve conduction and preventing neurodystrophic processes (triphosphadenine, vitamin complexes, acupuncture)
• Improving synaptic conductivity (neostigmine methylsulfate)
• Simulation of regeneration in the damaged area (electrophoresis and medicinal blockades of neostigmine methyl sulfate, pyridoxine, hydrocortisone)
• Stimulation of nervous and muscular activity, reflexogenic zones
• Mobilization of the arytenoid joint
• Surgical methods (laryngeal reinnervation, laryngotracheoplasty)

Symptomatic treatment

• Electrical stimulation of the nerves and muscles of the larynx
• Acupuncture
• Phonopedia
• Surgical methods (thyro-, laryngoplasty, implant surgery, tracheostomy)

Treatment goals

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

Indications for hospitalization

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

Non-drug treatment

The use of physiotherapeutic treatment is effective - electrophoresis with neostigmine methyl sulfate on the larynx, electrical stimulation of the laryngeal muscles.

External methods are used: direct impact on the muscles of the larynx and nerve trunks, electrical stimulation of reflexogenic zones with diadynamic currents, endolaryngeal electrical stimulation of muscles with galvanic and faradic current, as well as anti-inflammatory therapy.

Of great importance is the implementation of breathing exercises and phonopelia. The latter is used at all stages of treatment and at any stage of the disease, for any etiology.

Drug treatment

Thus, in case of neurogenic paralysis of the vocal fold, regardless of the etiology of the disease, treatment aimed at stimulating the regeneration of nerves on the affected side, as well as the crossed and residual innervation of the larynx, is immediately started. Medicines are used that improve nerve, synaptic conductivity and microcirculation, slowing down neurodystrophic processes in the muscles.

Surgical treatment

Methods of surgical treatment of unilateral laryngeal paralysis:

• laryngeal reinnervation;
• thyroplasty;
• implant surgery.

Surgical reinnervation of the larynx is performed by neuro-, myo-, neuromuscular plastic surgery. A wide variety of clinical manifestations of laryngeal paralysis, dependence of the results of the 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, various individual features of the regeneration of nerve fibers, the presence of synkinesia and poorly predictable perversion of laryngeal innervation with the formation of scars in the area of the operation limit the use of the technique in clinical practice.

Of the four types of thyroplasty for laryngeal paralysis, the first (medial displacement of the vocal fold) and the second (lateral displacement of the vocal fold) are used. In the first type of thyroplasty, in addition to medialization of the vocal fold, the arytenoid cartilage is displaced laterally and fixed with sutures using a window in the thyroid cartilage plate. The advantage of this method is the ability to change the position of the vocal fold not only in the horizontal but also in the vertical plane. The use of this technique is limited by fixation of the arytenoid cartilage and muscle atrophy on the side of paralysis.

The most common method of vocal fold medialization in unilateral laryngeal paralysis is implantation surgery. Its effectiveness depends on the properties of the implanted material and the method of its introduction. The implant should have good tolerance to absorption, fine dispersion, ensuring easy introduction; have a hypoallergenic composition, not cause a pronounced productive tissue reaction and not have carcinogenic properties. Teflon, collagen, autofat and other methods of injecting the material into the paralyzed vocal fold under anesthesia with direct microlaryngoscopy, under local anesthesia, endolaryngeally and percutaneously are used as an implant. G.F. Ivanchenko (1955) developed a method of endolaryngeal fragmentary Teflon-collagenplasty: Teflon paste is injected into the deep layers, which forms the basis for subsequent plastic surgery of the outer layers.

Complications of implant surgery include:

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

Further management

Treatment of laryngeal paralysis is staged and sequential. In addition to drug, physiotherapeutic and surgical treatment, patients are prescribed long-term sessions with a speech therapist, the purpose of which is to form correct phonation breathing and voice production, and correct the violation of the dividing function of the larynx. Patients with bilateral paralysis should be observed with a frequency of examinations of 1 time in 3 or 6 months, depending on the clinical picture of respiratory failure.

Patients with laryngeal paralysis are advised to consult a phoniatrist to determine the possibilities of rehabilitating lost laryngeal functions and restoring voice and breathing as early as possible.

The period of incapacity for work is 21 days. In case of bilateral laryngeal paralysis, the patients' ability to work is severely limited. In case of unilateral (in case of a voice profession) - limitation of ability to work is possible. However, when the voice function is restored, these restrictions can be lifted.

Forecast

For patients with unilateral laryngeal paralysis, the prognosis is favorable, since in most cases it is possible to restore the voice and compensate for the respiratory functions (with some limitations of physical activity, since when restoring the closure of the vocal folds, the glottis remains half-narrowed during inhalation). Most patients with bilateral laryngeal paralysis require staged surgical treatment. If it is possible to carry out the entire course of restorative treatment, decannulation and breathing through natural pathways are likely, the voice function is partially restored.

Prevention

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

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