Treatment of paresis of the vocal cords

Not many consider a violation of sound pronunciation a significant reason for consulting a doctor, believing that over time it will go away by itself. But the problem is that you can count on this only when muscle paresis is one of the symptoms of inflammatory diseases of the throat, intoxication, excessive muscle strain (myopathic paresis), or we are talking about a functional disorder caused by overexcitation of the psyche in neuropsychiatric disorders. In these cases, the functionality of the vocal cords is restored as the patient's condition normalizes, i.e. We have a relatively easily reversible process.

In case of inflammatory diseases that have caused a decrease in the functionality of the vocal apparatus, anti-inflammatory therapy is carried out, including gargling, taking antiseptics (lozenges for resorption) and NSAIDs, thermal procedures, and, if necessary, the introduction of corticosteroids, antibiotics, antiviral drugs, immunostimulants. To increase the body's resistance to infections and improve the trophism of the tissues of the larynx, vitamins and vitamin-mineral complexes are prescribed.[1]

Doctors insist on limiting the use of speech in order to rest the ligaments damaged by the disease, additional moistening of the inhaled air, quitting smoking and limiting the contact of the vocal apparatus with irritating substances in the air. In milder forms of laryngitis and hoarseness of the voice, non-drug treatment is often sufficient.

If we are talking about myopathic paresis, the cause of which was muscle overstrain or metabolic disorders in them, associated with intoxication of the body or endocrine pathologies (in this case, the treatment of the vocal cords should be carried out in parallel with the underlying disease), then physiotherapeutic treatment comes to the fore . Physiotherapy can include diathermy, electrophoresis, magnetotherapy, electromyostimulation, microwave therapy, exposure to fluctuating currents, galvanization and other procedures for indications associated with the main and concomitant disorders.

Also, medicinal stimulants of muscle activity (neostigmine, proserin, neuromidin), biogenic stimulants that promote the regeneration of affected tissues (for example, aloe preparations), drugs that improve muscle trophism and blood circulation (ATP) can be prescribed. Most drugs are injected into the affected muscle.

Treatment of functional paresis caused by psychoemotional and neuropsychiatric disorders, depending on the severity of these disorders, can be carried out by different methods. In some cases, psychotherapy and sedation are sufficient. For more severe mental disorders, antidepressants, tranquilizers, antipsychotics, physiotherapy sessions, phonation exercises are additionally prescribed. [2]

With paresis of the vocal cords of a neurogenic nature, a special medication, physiotherapy (similar to what is carried out with myopathic paresis), and, if necessary, surgical treatment is prescribed. With weakness of the muscles of the vocal apparatus, resulting from craniocerebral trauma and organic lesions of the brain, doctors conduct therapy with nootropics that improve the metabolism of the nervous tissue and its performance. When it comes to paresis due to a stroke (cerebral hemorrhage), vascular drugs are prescribed. With neuritis (inflammation of the nerve), special attention is paid to anti-inflammatory therapy and the introduction of group B drugs into the body, which improve the functionality of the nervous system.

Treatment of postoperative paresis of the vocal cords  has its own characteristics. Regardless of the existing symptoms and the localization of the lesion (bilateral or unilateral paresis), non-surgical treatment is first performed: anti-inflammatory and detoxification therapy, restoration of microcirculation in tissues and the possibility of sound production (with the help of speech therapy and exercise therapy).

Most often, postoperative paresis of the muscles of the vocal folds is diagnosed after surgical interventions on the thyroid gland with damage to the recurrent nerve. In this case, bilateral paresis of the vocal cords develops. If the pathology is detected in the early postoperative period (within 10-14 days), then its treatment is carried out medically and includes:

• antibiotic therapy (broad-spectrum drugs)
• hormonal anti-inflammatory therapy (prednisone, dexamethasone),
• the introduction of angioprotectors (pentoxifylline),
• administration of drugs that affect tissue metabolism (actovegin, vinpocetine),
• the introduction of neuroprotective agents (neostigmine, proserin, neurovitan, etc.),
• with the formation of a hematoma - the introduction of homeostatics, drugs that improve the composition of blood and its properties, vascular drugs that strengthen the walls of blood vessels
• the introduction of multivitamin complexes and vitamins of group B.

Preference is given to injection treatment carried out in a hospital setting. Additionally, sessions of hyperbaric oxygenation, medicinal electro- and phonophoresis, magnetic laser and other physiotherapy procedures, reflex and acupuncture are prescribed.

If monthly therapy does not give results and the diagnosis of "bilateral paresis of the vocal cords" remains valid, they no longer speak of paresis, but of paralysis of the vocal apparatus.

In the presence of respiratory failure, a tracheostomy is prescribed (introduction of a breathing tube with the trachea). [3],  [4]Sometimes this operation is carried out in parallel with the injection laringoplastikoy, allows you to restore the shape of the vocal cords. The operation is carried out under the control of laryngoscopy and involves the introduction into the vocal fold of adipose tissue (own or donor), collagen, special preparations from bone tissue, Teflon. [5]

One of the types of  surgical treatment for  paresis of the vocal cords are operations on the bones of the larynx, which make it possible to change both the location of the vocal folds and their tension. Medialization or displacement of the paralyzed ligament to the middle helps to restore the functioning of the vocal apparatus with unilateral paresis. The displacement of the cartilage of the larynx, which increases the tension of the folds, is also effective in bilateral postoperative paresis, but it is carried out only 6-8 months after surgery on the thyroid gland. An alternative method is laser surgery, which changes the length and tension of the vocal folds, thyroplasty (using implants), reinnervation (replacing the damaged nerve with another taken from the neck). [6]

Surgical treatment of bilateral paresis of the vocal cords provides for a thorough examination of the patient, determination of the scope of intervention and effective treatment options, since the doctor has virtually no room for error. The primary surgery must be virtually 100% successful. If they resort to injection plastic, then there is an opportunity to experiment with different materials for filling the damaged fold.

Surgical treatment for paresis of the vocal cords can be prescribed in connection with the removal of neoplasms compressing the nerves (tumors, esophagus, mediastinum, thyroid gland: thyroidectomy and stumectomy), as well as in case of impaired respiratory function and asphyxia. [7], [8]

Rehabilitation of patients with paresis of the vocal cords

Violation of voice production with paresis of the vocal cords is not always an easily solvable problem. If, in respiratory diseases, the voice is restored on its own after the course of treatment carried out in connection with the underlying disease, then pathologies caused by neuropsychiatric disorders, impaired innervation of the vocal apparatus, pathologies of the brain require not only drug and physiotherapeutic treatment, but also rehabilitation therapy.

A careful attitude to your vocal apparatus, turning to whispering speech (only if necessary) is recommended only in the initial stages of treating paresis, and at the end of the course of treatment, it is time to train your voice. When a person does not use his vocal apparatus for a long time, the conditioned reflexes that underlie the formation of sounds fade somewhat, so with the help of special exercises you need to make your brain remember forgotten reflexes or form new ones. It is this task that is solved during the rehabilitation of patients.

The effectiveness of patient rehabilitation is in direct proportion to the mood for a positive result and the fulfillment of the requirements of the psychotherapist, neurologist, speech therapist. The participation of the latter is necessary at the final stage of treatment, because without special breathing and phonetic exercises a person in most cases cannot regain his original sensitive speech.

The rehabilitation stage begins with psychotherapy sessions, which will help instill in the patient confidence in the reversibility of voice disturbances, hope for a positive outcome of rehabilitation therapy. If the patient simply mechanically repeats all the movements behind the speech therapist, a positive result will have to wait for a very long time. [9]

Often, the first sessions do not bring the expected result and patients very quickly fall into despair, give up, do not make any efforts or even refuse to practice. And if we also take into account that rehabilitation is a long process that can take from 2 to 4 months (in some cases, in the presence of concomitant disorders, even more), not every patient is able to gain strength and patience to achieve success, therefore, breakdowns sometimes occur even after weeks after the start of classes. To prevent this from happening, the help and support of the psychologist should be carried out throughout the entire period of training in physiological and phonation breathing, correct sound pronunciation and the formation of words.

Vocal cord paresis are of varying difficulty. In some cases, it is possible to completely restore the voice and its characteristics, in others, the speech becomes more intelligible, but it is not possible to fully achieve the original functionality of the vocal apparatus. Patients should understand this and strive for the best possible results. In any case, their efforts will be rewarded, because even in cases where the voice is not fully restored, its strength and sonority increase, breathing returns to normal, fatigue during speech load occurs later and is not so pronounced.

At the initial stages of the recovery period, special attention should be paid to remedial gymnastics. Therapeutic gymnastics for paresis of the vocal cords  involves the implementation of breathing exercises, combined with the tension of the muscles of the neck and throat and the normalization of breathing. The use of a harmonica gives a positive effect. This is both a stimulating massage of the larynx and training to lengthen the exhalation necessary for the formation of sound (it is possible only on exhalation).

Exercises for setting breathing involve alternating exhalation and inhalation through the mouth and nose, changing the speed of inhalation and exhalation, jerky breathing, and the formation of diaphragmatic breathing skills. Such classes are held both in the speech therapist's office and in the exercise therapy office.

After 1-1.5 weeks, they switch to motor exercises with tension of the muscles of the head, lower jaw, tongue, palate. These exercises prepare the vocal apparatus for phonation exercises, i.e. Correct sound pronunciation. [10]

Now is the time to move on to speech therapy classes. Phonopedic exercises for paresis of the vocal cords is  a training in sound pronunciation, which is combined with training in correct phonation breathing. In other words, this is a voice production. Speech therapy classes begin with the pronunciation of the sound "m", which is considered the optimal physiological basis for the formation of correct pronunciation of phonemes. First, patients learn to correctly reproduce this sound, which does not require a lot of tension in the muscles of the vocal cords, then how to combine it with various vowel sounds. Further, all voiced consonants are pronounced in the same sequence.

Particular attention is paid not to the simple pronunciation of sounds and syllables, but to speech kinesthesia, i.e. Perception and memorization of the movement of the organs of speech during sound pronunciation, tension of the larynx when reproducing different sounds, expiratory strength, etc. Kinesthetic skills are strengthened by the pronunciation of pairs of syllables, with the emphasis on the second syllable.

Subsequently, the stresses are moved, the syllables are lengthened, and they move on to pronouncing longer sound combinations (nanana, mumumumu, etc.). With the established normal pronunciation of combinations of vowels and consonants, they switch to the formation of combinations of vowel sounds with the sound "y" (ah, oh, hey, etc.) and vowel sounds among themselves (yi, aowy, eao, etc.).

When the pronunciation of individual sounds and their combinations is mastered, it's time to move on to the formation and pronunciation of words. Speech development classes are combined with vocal exercises to help improve and stabilize the restored vocal function, make the voice more sonorous and fluent speech.

The effectiveness of the sessions is controlled by the characteristics of the patient's voice, indicators of his fatigue and sonority. Additionally, diagnostic procedures are prescribed (usually glottography). If the result is positive, the latter shows uniform vibrations of the vocal cords with clearly defined phases.

In some cases, rehabilitation classes are prescribed even during the course of medical procedures, because the earlier classes with a speech therapist begin, the more efficiently compensatory mechanisms will work, allowing to restore the voice even without fully restoring the functionality of the affected ligament, the less likely the formation of pathological skills (reflexes) of sound pronunciation, which it will be hard to fix afterwards. At the same time, the load on the vocal apparatus should be strictly dosed so as not to overstrain the diseased organ, therefore, it is not recommended to deviate from the requirements of a specialist in the hope of a faster recovery.

Cordotomy

Cordotomy is another endoscopic surgical procedure for enlarging the glottis. Chordotomy is performed through an incision in the vocal cord, ligament, and thyroarithienoid muscle at the back where it attaches to the thistle. Cordotomy, like arytenoidectomy, is prone to granulomas and scarring. Revision chordotomy may be required in up to 30% of patients due to reduced glottis diameter due to scarring or granulation tissue. [11]The most common complication associated with chordotomy was a change in voice quality due to damage to the vocal cords. [12]Laser endoscopic chordotomy has become the preferred therapeutic intervention for VCP over arrytenoidectomy because it is less invasive and reduces the frequency of aspiration. Voice quality may deteriorate after resection, but overall voice outcomes are often better than arrytenoidectomy, especially in adult patients. 

Reinnervation

The purpose of reinnervation is to abduct the vocal cords by restoring the activity of the posterior cricoid muscle (ZPS) muscle. Although this procedure can restore spontaneous vocal cord abduction, it does not affect adduction. RLN anastomosis is difficult due to the variability and complexity of its delivery. The phrenic nerve has been used to re-innervate the PCA muscle; One study found that inspiratory vocal fold abduction was achieved in 93% of cases. [13]Although the patients suffered from paralysis of the hemidiaphragm, within 12 months they had significant recovery in diaphragmatic movement and respiratory function. Marina et al. Have previously shown that only a phrenic nerve branch can be used to minimize loss of phrenic function and maintain respiratory parameters. A more modern technique is the use of an ansa cervicalis pedunculated neuromuscular flap to avoid phrenic complications associated with phrenic nerve sacrifice. This procedure is technically very difficult and is most successful when it is performed by several surgeons with significant experience in its use. All of these procedures for laryngeal reinnervation are much more commonly used for unilateral vocal cord paralysis. [14], [15]

Gene therapy

This treatment remains in preclinical stages, but opens up several promising avenues of treatment in the future. With this method, the delivery of genes to damaged or denervated muscles enhances the growth of damaged neurons to help rejuvenate damaged muscles in the larynx. These genes code for neurotrophic factors or growth factors that help stimulate muscle differentiation and growth. [16]Delivered either directly to the muscles of the larynx or to the RLN, they are taken up by neuronal cell bodies via retrograde axon transport. [17]After transduction into target cells, they produce peptides that promote RLN growth, synaptic formation, and regeneration. 

Effective medicines

We will not dwell on drugs used to treat  paresis of the vocal cords of an  inflammatory nature, since they are used in the treatment of laryngitis and are described in the relevant sections, as well as drugs prescribed by psychotherapists (they are purely individual). Let's pay attention to drugs that can be prescribed to patients to improve muscle activity and innervation of the vocal cords in myopathic and neuropathic paresis.

The drug "Proserin" belongs to the category of anticholinesterase drugs (indirect cholnomimetics) that improve the motor activity of muscles, enhance their contractile ability by potentiating the effect of the neurotransmitter acetylcholine on them. It is prescribed for muscle weakness (myasthenia gravis), paresis and paralysis of muscles of various origins, to stimulate labor by increasing uterine contractions, as an antidote to muscle relaxants, etc.

The drug is administered subcutaneously at a dosage of 1-2 ml 1-3 times a day (mainly in the morning and afternoon hours) for a course of 25-30 days. In this case, the daily dose of the drug should not exceed 6 mg. If necessary, the course of treatment with the drug is repeated after 3-4 weeks.

The drug is not prescribed for hypersensitivity to its constituents (neohistamine and auxiliary components), status epilepticus, hyperkinesis, decreased heart rate (pulse), bronchial asthma, cardiac arrhythmias, severe vascular atherosclerosis, thyroid hyperfunction, prostatic hypertrophy and some other pathologies. In other words, the drug is strictly not recommended to be taken without the appointment of a specialist.

The use of the drug may be accompanied by unpleasant sensations: excessive salivation and sweating, frequent urge to urinate, disorders of the digestive and visual systems, muscle twitching (nervous tics), nausea, migraine-like headaches and dizziness.

The drug "Amiridin" also has an anticholiesterase effect, i. E. Stimulates neuromuscular transmission and improves the contractility of the muscles of the body, including the muscles of the larynx, vocal folds. In the indications for prescribing the  drug,  we find myasthenia gravis, neuritis and some other neurological diseases, organic diseases of the brain, in which various disorders of motor activity, paresis and paralysis are noted, provoked by damage to the nuclei of the cranial nerves.

It is also used to treat conditions accompanied by a decrease in higher mental functions, and primarily memory (for example, Alzheimer's disease or weakening of memory and attention with mental overexertion).

The drug has a strong effect, increasing the effect on smooth muscles not only of acetylcholine, but also of other substances involved in the transmission of air along the nerve fiber to the muscles and in the opposite direction. Such substances are called mediators. These include: adrenaline, histamine, serotonin, oxytocin.

This drug has various uses. It is produced in tablets (20 mg), which are taken by mouth ½ to 1 tablet three times a day. In the case of severe pathologies of neuromuscular transmission, the drug is given in a dosage of up to 40 mg 5-6 times a day or a short course of injections at an increased dosage (up to 30 mg) is carried out.

Injections have a faster and stronger effect. The drug in the form of ampoules (1 ml 0.5% and 1.5%) is used for this purpose subcutaneously or intramuscularly. Single dose - 1 ampoule (5 or 15 mg amiridine). It is administered 1 or 2 times a day. Therapeutic course - 1-2 months

Like the previous drug, "Amiridin" has enough contraindications that must be taken into account. These include: epilepsy, a tendency to vestibular disorders, pathologies of the pathways of the brain and spinal cord, accompanied by involuntary movements (hyperkinesis), pain in the heart (angina pectoris, coronary heart disease), decreased heart rate (bradycardia), hyperthyroidism (hyperthyroidism, thyrotoxicosis).

The drug should also not be prescribed to patients with bronchial asthma and gastroenterological diseases during their acute periods (the effect of the drug on the gastrointestinal mucosa is especially dangerous in case of ulcerative lesions of the stomach and duodenum). It is not recommended for pregnant women (except when the drug is used to stimulate labor), nursing mothers, patients with hypersensitivity to amiridine and / or other substances in the dosage form.

With diseases of the heart, stomach and thyroid gland, there is the possibility of treatment with the drug, but special care should be taken.

Side effects of the drug are mainly characterized by disorders of the gastrointestinal tract: increased salivation (hypersalivation), nausea (vomiting is possible), increased bowel contractions and diarrhea, impaired appetite. Such disorders as disorder of the coordination of muscle movements (ataxia), dizziness, decreased pulse rate occur less often and usually after repeated administration of the drug, but in general, the drug is well tolerated, and unwanted symptoms occur very rarely.

During treatment with the drug, it is undesirable to take alcohol, since such a combination is largely capable of inhibiting the activity of the central nervous system and enhancing the sedative effect of ethanol.

"Neuromidin" is a drug of the same class with a different active ingredient (ipidicrin). Its action is similar to the drugs described above, i.e. It enhances the action of almost all known neurotransmitters on muscle tissue and thereby improves the transmission of impulses from the central nervous system to the periphery and vice versa, improves memory, has a stimulating effect on the central nervous system with a slight sedative effect, and has an analgesic and antiarrhythmic effect.

The medicine is produced in the form of tablets and injections. With paresis of the vocal cords of various origins, the doctor may prescribe injection or combination treatment. Most often, they start with injections, and then move on to taking pills.

In diseases of the central and peripheral nervous systems with an observed weakening of the functionality of the vocal folds, injection treatment is carried out in doses from 5 to 15 mg of the drug up to 2 times a day. The drug must be administered subcutaneously or intramuscularly. The duration of the course of treatment, depending on the severity of pathological changes in the nervous system, is from 1.5 to 4 weeks, after which, if it is necessary to continue therapy, it is necessary to switch to taking pills.

Tablets are taken in a dosage of 10-20 mg (1 / 2-1 tablet) up to 3 times a day. The course of treatment is usually long. With pathologies of the peripheral nervous system, it is 1-2 months, with diseases of the central nervous system - up to six months with the possibility of repeating the course according to indications.

Contraindications to the use of the drug are similar to those described above. I would also like to note that increased intestinal motility while taking anticholinesterase drugs can be dangerous for patients with mechanical intestinal obstruction. It is worth beware of those who have erosive and ulcerative diseases of the gastrointestinal tract. It is imperative to warn the attending physician about such pathological disorders.

Anticholinesterase drugs are used to enhance the contraction of the uterine muscles on the eve of childbirth; at other times, their effect may have undesirable consequences for pregnant women, stimulating miscarriages and premature birth. The active substance of the drug can also penetrate the placental barrier and into breast milk. The last moment suggests that during the treatment with the drug, it is worth stopping breastfeeding of the child.

Neuromidin is well tolerated by most patients. Side effects develop only in isolated cases and do not require drug withdrawal. Usually, doctors resort to lowering the dose or recommend that the drug be taken again after a short break (1-2 days). Undesirable symptoms are: increased heart rate and decreased pulse rate, headaches, dizziness and convulsions (usually occurring while taking high doses), increased secretion of sputum from the bronchi and saliva, gastrointestinal disorders, hyperhidrosis (excessive sweating), bronchial spasm, increased uterine tone.

Allergic (rash, itching, Quincke's edema) and skin reactions at the injection site are possible (with injection treatment). In case of allergic reactions, the drug must be replaced with another one.

We have already mentioned that for most diseases accompanied by a decrease in the functionality of the vocal apparatus, doctors prescribe vitamins, multivitamin and vitamin-mineral complexes. With the neurogenic nature of paresis of the vocal cords, the most relevant are multivitanium complexes of B vitamins.

" Neurovitan " is a combined preparation, which contains B vitamins, which have a positive effect on the functioning of the nervous-muscular system.

Octothiamine is a derivative of vitamin B1 (thiamine) with a prolonged action and provides a complete carbohydrate metabolism necessary for the good functioning of the nervous system. Like "Prrzerin" and its analogues, it enhances and prolongs the action of the neurotransmitter acetylcholine, improves tissue trophism, and regulates the functions of the muscular and nervous systems.

Vitamin B2 in the composition of the drug is an active participant in redox processes, an antioxidant. It improves blood counts (erythrocyte count and hemoglobin level), tissue respiration, takes part in metabolic processes, the formation of ATP (the main source of energy in living organisms).

With the assistance of vitamin B6, almost all metabolic processes take place (proteins, fats, carbohydrates are converted into easily digestible forms necessary for the energy supply of the body and the formation of cellular structures). This component of the drug is also actively involved in the synthesis of some neurotransmitters (in particular serotonin and histamine), breaks down cholesterol, and improves the nutrition of the peripheral nerve sheaths. It is believed that a deficiency of vitamin B6 in the body can cause a decrease in the properties and functionality of neuromuscular tissues and the appearance of convulsive syndrome.

Vitamin B 12 is also an active participant in metabolic processes, lowers cholesterol, has a positive effect on the state of the liver (prevents fatty hepatosis) and hematopoiesis, stimulates protein synthesis - the main building material for cells, helps to increase the body's resistance to infections. With the assistance of vitamin B12, the myelin sheath of peripheral nerve fibers is formed, which prevents the death of nerve cells.

All of the above B vitamins have a general healing effect on the nervous and vascular systems, improving trophism and innervation of muscle tissue. Moreover, a pronounced analgesic effect was noticed for the vitamins of this group, which helps to relieve most of the unpleasant neurological symptoms, or at least reduce their intensity.

The complex of vitamins "Neurovitan" is considered a useful addition to stimulants of neuromuscular conduction, despite the fact that its effects are useful not only for neurological pathologies.

The drug is produced in the form of tablets, which can be prescribed even to children (in dissolved form). The dosage for babies under 3 years old does not exceed half the tablet. Preschoolers are given 1 tablet a day, children under 14 years old - from 1 to 3 tablets a day.

Patients over 14 years old take the drug in an adult dosage (up to 4 tablets per day) for a course of 2 weeks to 1 month.

The vitamin complex has few contraindications. This is hypersensitivity to its individual components and some diseases in which the vitamins in the complex can be harmful. For example, vitamin B1 is not recommended for allergies, B6 - for exacerbations of gastroenterological diseases against the background of increased acidity of gastric juice (helps to lower pH), B12 is contraindicated in some blood disorders, thrombus formation.

Side effects of the drug are extremely rare and are reduced to dyspeptic disorders, allergic reactions, weakness, hyperthermia, hyperhidrosis, tachycardia, fluctuations in blood pressure.

Despite all the benefits of stimulants of neuromuscular activity, they can only be used as directed by a doctor. Mild forms of paresis of the vocal cords caused by overstrain of the vocal apparatus or sore throat do not require such cardinal treatment. In most cases of myopathogenic paresis, the voice can be restored by alternative methods, many of which have been known for many decades.

Produced by  Clostridia, botulinum toxin is a neurotoxin that prevents the release of acetylcholine from the presynaptic terminals of axons, resulting in peripheral paralysis of the target muscle. In patients with vocal cord paralysis, a toxin injection is used to block the aberrant reinnervation of the adductor muscles by the inspiratory motor neurons. This allows the abducting inspiratory motoneurons to work more efficiently and to open up the glottis. [18]  This method only affects temporary symptom relief for about three to six months at a time, requiring repeated injections for longer lasting relief. It is an effective option for idiopathic spasmodic dysfunction of the vocal cords or in cases where full recovery of function is expected but at a sustained rate.

Alternative treatment for vocal cord paresis

Probably there are no such diseases in the world that a person would not try to treat with alternative methods. Another thing is that such treatment does not help in all cases and not for every disease. With regard to paresis of the vocal cords, herbal treatment and alternative prescriptions are applicable in the case of myopathic pathology and neuropathogenic disorders. But in the first case, it can even be the main treatment, which makes it possible to avoid taking medications that both help fight the disease and negatively affect the state of the body, and in the second,  alternative treatment  can be considered only as an auxiliary therapeutic method.

Weakness of the muscles of the vocal folds, manifested in hoarseness and muffledness of the voice as a result of overexertion of the vocal apparatus, is perfectly treated with ordinary rest, moist air and medicinal herbs with anti-inflammatory and soothing effects.

The situation is similar with inflammation of the tissues of the larynx and trachea (laryngitis and laryngotracheitis). In addition to the main treatment, which, with the bacterial nature of the pathology, consists in taking antibiotics and anti-inflammatory drugs, with allergic - antihistamines, with polyposis - in the surgical removal of polyps, rest, humidified air and alternative methods are needed to restore the voice. These include: drinking warm fluids that are not irritating to the throat and gargling with a mild solution of salt, baking soda, or herbal decoction.

Recommended liquids: tea, milk, still mineral water, non-acidic juices, and it is better to abstain from coffee, carbonated water (especially with chemical dyes) and alcohol. Drinks for laryngitis and ligament paresis help maintain the water-salt balance in the body and provide hydration to damaged tissues of the larynx. Rinsing helps to moisturize, listens to inflammation and swelling of soft tissues (especially infusion and decoction of chamomile), helps to remove infection (salt and soda are well-known antiseptics), supports the inflammatory process, which disrupts trophism (nutrition and respiration) and the functionality of the mucous membrane and muscles of the vocal cords.

With functional paresis, provoked by neuropsychic disorders, herbs with a sedative effect usually come to the rescue: valerian, mint, lemon balm, angelica, ivan tea, lavender, St. Central nervous system.

It is important to remember that the longer the period of low intensity of work of the vocal cords, the harder it will be to restore their function. After all, the stable operation of the vocal apparatus is supported by daily training of the ligaments during verbal (speech) communication. If the muscles do not work for a long time, their atrophy occurs.

 Even doctors support herbal treatment for functional paresis, but the effect of herbs is not always sufficient, and the effect does not come as quickly as we would like. In some cases, herbs are recommended to be used as sedatives, replacing medicines with the same effect, but to do this in combination with antidepressants, which are many times stronger and faster. Medicinal plants will help reduce the course of taking potent drugs and consolidate the effect obtained if taken during the rehabilitation period and in stressful situations in the future. Indeed, in most cases, functional paresis of the vocal cords is diagnosed in people with a labile psyche, prone to psycho-emotional breakdowns.

With the neurogenic nature of paresis and organic brain diseases, alternative treatment is ineffective. But this does not mean at all that it should be abandoned, because many effective recipes enhance the effect of drugs and help to shorten the time of taking them, which reduces the risk of developing severe side effects.

So compression and degenerative processes in the nervous tissue are usually accompanied by inflammation. It also sometimes occurs in the postoperative period. For a quick effect, doctors prescribe hormonal drugs (injectable corticosteroids), long-term therapy with which, especially in high doses, can harm the body, and later oral NSAIDs, which negatively affect the state of the gastric mucosa.

Herbs with anti-inflammatory effect (chamomile, calendula, St. John's wort, yarrow, calamus root, etc.) make it possible to reduce the dosage of hormonal agents and, in some cases, refuse to take NSAIDs. This is very important given the volume of drugs administered to such patients.

But herbs with a pronounced sedative effect (depression of the central nervous system) with neurogenic pathologies should be treated with caution, because their effect may contradict the requirements of therapy with stimulants of muscle activity (excitation of the central nervous system), therefore, you must first consult with your doctor about the possibility and dosages of medicinal herbal drinks. Nevertheless, the calming effect of herbs will come in handy in the rehabilitation period, when the stabilization of the patient's mental state helps to maintain faith in the positive result of treatment, to maintain strength, patience and the desire to get rid of speech defects.

What alternative recipes can help you quickly regain a sonorous loud voice and return to your usual work activity? Here are some of them.

Milk treatment:

• We prepare a warm drink, consisting of equal parts of milk and non-carbonated mineral water. It should be drunk in small sips throughout the day.
• It is recommended to drink eggnog twice a day: add raw yolk, a little butter and honey to a large cup of warm milk.
• It is useful to drink warm milk with turmeric added (at the tip of a teaspoon) several times a day.
• Helps with colds and weakening of the voice and onions boiled in milk. The onion broth should be drunk warm. Adding a spoonful of honey to it enhances the healing effect.

Juice treatment:

• Beet juice has a calming effect, reduces intoxication of the body, improves metabolic processes in the body. In combination with honey, it has anti-inflammatory, immunostimulating and moderate sedative effects. Beet juice should be mixed with honey (or other juices) in equal proportions and consumed up to 4 times a day for 2 tablespoons.
• Blueberry juice will be useful for paresis of the vocal cords caused by infectious and inflammatory diseases. Blueberries contain many natural antibiotics (phytoncides) and substances that help restore voice function. For medicinal purposes, you can drink juice, eat berries or make an infusion (1 tsp berries in a glass of boiling water), which are recommended to gargle.
• Birch sap helps fight inflammation, strengthens nerves, and improves metabolism. You need to take it 1/3 cup three times a day.
• In the summer, to treat paresis of the vocal cords and restore voice, you can drink freshly squeezed juices of herbs: plantain, nettle, celery.

Herbal treatment:

• For myopathic paresis, rinsing the throat with a decoction of bay leaf (3-4 leaves per glass of water), rubbing bay leaf infusion in vegetable oil into the larynx area (30 g of a leaf per glass of oil, insist for 2 months and boil) are effective.
• 1.5-2 tbsp Brew chamomile flowers with a glass of boiling water. Insist for 15 minutes. Take three times a day. Single dose 1/3 cup.
• Boil ½ cup of anise seeds for a quarter of an hour in 200 ml of water, cool until warm, filter, add 3 tbsp. Linden honey and 1 tbsp. Cognac. Drink during the day with an interval of half an hour for 1 tablespoon. The resulting drink.
• With paresis caused by overstrain of the vocal cords, inhalation of a decoction of dill seeds (1 tablespoon seeds per glass of water) helps. Inhalation should be done three times a day for a week.
• There are recommendations for the treatment of paresis with therapeutic baths and compresses. A decoction of pine and birch branches is added to the baths (6 procedures), and after taking the baths, a neck massage is performed and compresses with honey and larkspur are applied, after drinking a glass of warm milk with honey and butter.

Vocal cord paresis in children can be treated with:

• butter (resorption of a piece of butter) and vegetable oil (gargle),
• bran infusion (125 g per 0.5 l of boiling water) - take warm in small sips several times a day,
• eggs (raw eggs restore the voice and make it more sonorous, but you only need to take fresh homemade eggs from trusted suppliers),
• recipes based on milk and herbs.

Some products, recipes and especially herbs can cause allergic and intolerance reactions, so they should be used with caution, carefully observing your well-being.

Homeopathy

Homeopathy is a branch of alternative medicine that is gaining popularity every year. This is facilitated by the widespread belief that homeopathic medicines are safer for health than allopathic (medicinal synthetic) and are close in their action to herbal treatment, to which alternative medicine is usually inclined.

Perhaps the effect of homeopathic remedies in terms of the speed of the onset of the effect is inferior to traditional medicines, but its action is based not only on the removal of the symptoms of diseases. These funds increase the protective functions of the body and its ability to independently fight the disease, which gives a more stable, prolonged effect. In addition, when prescribing them, not only the symptom of pathology itself (for example, hoarseness) is taken into account, but also the time of its occurrence, provoking factors, the individual characteristics of the patient's body, which contribute to the development of pathological processes.

It is not surprising that patients with paresis of the vocal cords are interested in such drugs. After all, one does not want to treat mild forms of the disease with chemical preparations, and in severe cases, the list of necessary "chemistry" is sometimes simply terrifying.

What can homeopaths offer for voice restoration? With pronounced morning hoarseness, Causticum can be prescribed, with evening - Phosphorus or Rus toxicodendron. With paresis caused by overstrain of the vocal cords, Aurum triphilum is effective, and with weakening of the voice due to laryngitis, Aconitum and Apis. Hamomilla (chamomile) is suitable for nervous, easily excitable children with a reduced function of the vocal apparatus.

With an increase in the tone of the vocal muscles (usually with paralysis), Arsenicum album and Kalium arsenicum are shown, with its decrease - Hyocyamus, and in the case of dysphonia or aphonia of unknown etiology - Platinum.

Among the complex homeopathic remedies, Gomeovox has proven itself well and is officially recognized as an effective remedy for restoring voice function. It contains 11 homeopathic components of herbal and natural origin in effective and safe dosages.

The drug is produced in the form of homeopathic pills, which need to be taken 2 pieces first every hour, then at least 5 times a day. It is suitable for both the treatment and prevention of dysphonia.