Treatment of vocal cord paresis

Not many consider a speech impediment to be a significant reason to consult a doctor, believing that it will go away on its own over time. But the problem is that you can only count on this when muscle paresis is one of the symptoms of inflammatory diseases of the throat, intoxication, excessive muscle strain (myopathic paresis) or when 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 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) and NSAIDs, thermal procedures, and, if necessary, the introduction of corticosteroids, antibiotics, antiviral drugs, and immunostimulants. To increase the body's resistance to infections and improve the trophism of the laryngeal tissue, vitamins and vitamin-mineral complexes are prescribed. [ 1 ]

Doctors insist on limiting the use of speech to give rest to the ligaments damaged by the disease, additional humidification of inhaled air, quitting smoking and limiting the vocal apparatus's contact with irritants in the air. In mild forms of laryngitis and hoarseness, non-drug treatment is often sufficient.

If we are talking about myopathic paresis, the cause of which was muscle strain or metabolic disorders in them, associated with intoxication of the body or endocrine pathologies (in this case, treatment of the vocal cords should be carried out in parallel with the main disease), then physiotherapy comes to the fore. Physiotherapy may include diathermy, electrophoresis, magnetic therapy, electrical myostimulation, microwave therapy, exposure to fluctuating currents, galvanization and other procedures according to indications related to the main and concomitant disorders.

Medicinal stimulants of muscle activity (neostigmine, proserin, neuromidin), biogenic stimulants that promote regeneration of damaged tissues (for example, aloe preparations), drugs that improve muscle trophism and blood circulation (ATP) can also 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 using different methods. In some cases, psychotherapy sessions and sedatives are sufficient. In more severe mental disorders, antidepressants, tranquilizers, neuroleptics, physiotherapy sessions, and phonation exercises are additionally prescribed. [ 2 ]

In case of neurogenic vocal cord paresis, special medication, physiotherapy (similar to that used for myopathic paresis) and, if necessary, surgical treatment are prescribed. In case of weakness of the vocal apparatus muscles caused by craniocerebral trauma and organic brain lesions, doctors administer nootropic therapy that improves the metabolism of nervous tissue and its performance. If we are talking about paresis due to a stroke (cerebral hemorrhage), vascular drugs are prescribed. In case of neuritis (nerve inflammation), special attention is paid to anti-inflammatory therapy and the introduction of group B drugs into the body that improve the functionality of the nervous system.

Treatment of postoperative vocal cord paresis has its own characteristics. Regardless of the symptoms and localization of the lesion (bilateral or unilateral paresis), non-surgical treatment is first carried out: anti-inflammatory and detoxification therapy, restoration of microcirculation in tissues and sound production capabilities (using speech therapy and exercise therapy).

Most often, postoperative paresis of the vocal fold muscles 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 with medication and includes:

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

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

If a month of therapy does not produce results and the diagnosis of “bilateral vocal cord paresis” remains in force, they no longer speak of paresis, but of paralysis of the vocal apparatus.

In the presence of respiratory failure, a tracheostomy (insertion of a breathing tube into the trachea) is prescribed. [ 3 ], [ 4 ] Sometimes this operation is performed in parallel with injection laryngoplasty, which allows the shape of the vocal cords to be restored. The operation is performed under the control of laryngoscopy and involves the introduction of fatty tissue (one's own or donor's), collagen, special preparations from bone tissue substances, and Teflon into the vocal fold. [ 5 ]

One of the types of surgical treatment for vocal cord paresis is surgery on the bone tissue of the larynx, which allows changing both the location of the vocal folds and their tension. Medialization or displacement of the paralyzed ligament to the middle helps restore the functioning of the vocal apparatus in case of unilateral paresis. Displacement of the laryngeal cartilages, which increases the tension of the folds, is also effective in case of bilateral postoperative paresis, but it is performed only 6-8 months after thyroid surgery. An alternative method is laser surgery, which changes the length and tension of the vocal folds, thyroplasty (use of implants), reinnervation (replacement of the damaged nerve with another, taken from the neck). [ 6 ]

Surgical treatment of bilateral vocal cord paresis involves a thorough examination of the patient, determination of the scope of intervention and effective treatment methods, since the doctor has virtually no right to make a mistake. The primary operation must be successful virtually 100%. If injection plastic surgery is used, then there is an opportunity to experiment with various materials to fill the damaged fold.

Surgical treatment for vocal cord paresis may be prescribed in connection with the removal of neoplasms that compress the nerves (tumors, esophagus, mediastinum, thyroid gland: thyroidectomy and strumectomy), as well as in case of respiratory dysfunction and asphyxia. [ 7 ], [ 8 ]

Rehabilitation of patients with vocal cord paresis

Impaired voice formation due to paresis of the vocal cords is not always an easily resolved problem. If in case of respiratory diseases the voice is restored on its own after a course of treatment for 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.

Careful treatment of your vocal apparatus, resorting to whispered speech (only when necessary) is recommended only at the initial stages of paresis treatment, 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 underlying the formation of sounds fade somewhat, so with the help of special exercises you need to force your brain to remember forgotten reflexes or form new ones. This is the task that is solved during the rehabilitation of patients.

The effectiveness of patient rehabilitation is directly dependent on the attitude towards a positive result and the fulfillment of the requirements of a psychotherapist, neurologist, and 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 or her original sensitive speech.

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

Often the first lessons do not bring the expected result and patients very quickly fall into despair, give up, do not make efforts or refuse to do the lessons at all. And if we also take into account that rehabilitation is a long process that can take from 2 to 4 months (in some cases, if there are concomitant disorders, even more), not every patient is able to gather strength and patience to achieve success, so breakdowns sometimes happen even weeks after the start of the lessons. To prevent this from happening, the help and support of a psychologist should be provided throughout the entire period of learning physiological and phonatory breathing, correct pronunciation and word formation.

Vocal cord paresis can be of varying complexity. In some cases, it is possible to completely restore the voice and its characteristics, in others, 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 completely restored, its strength and sonority increases, 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 therapeutic exercises. Therapeutic exercises for paresis of the vocal cords involve breathing exercises combined with tension in the muscles of the neck and throat and normalization of breathing. The use of a harmonica gives a positive effect. This is both a stimulating massage of the larynx and training in lengthening the exhalation necessary for the formation of sound (it is possible only on exhalation).

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

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

Now it's time to move on to speech therapy. Phonopedic exercises for vocal cord paresis are sound pronunciation training, which is combined with training in correct phonation breathing. In other words, this is voice training. Speech therapy sessions 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 much tension in the muscles of the vocal cords, then - its combinations with various vowel sounds. Then, in the same sequence, all voiced consonants are pronounced.

Particular attention is paid not to simply pronouncing sounds and syllables, but to speech kinesthesia, i.e. the perception and memorization of the movement of the speech organs during sound pronunciation, the tension of the larynx when reproducing different sounds, the force of exhalation, etc. Kinesthetic skills are reinforced by pronouncing pairs of syllables, with the stress placed 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.). When normal pronunciation of combinations of vowels and consonants is established, they move on to forming combinations of vowel sounds with the sound "y" (ai, oi, ey, etc.) and vowel sounds between themselves (ui, aouu, eao, etc.).

Once the pronunciation of individual sounds and their combinations has been mastered, it is time to move on to forming and pronouncing words. Speech development classes are combined with vocal exercises that help improve and stabilize the restored vocal function, make the voice more sonorous, and speech fluent.

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

In some cases, rehabilitation sessions are prescribed even during the treatment procedures, because the sooner sessions with a speech therapist begin, the more effective the compensatory mechanisms will be, allowing the voice to be restored even without full restoration of the functionality of the affected ligament, and the less likely it is that pathological skills (reflexes) of sound production will develop, which will be difficult to correct later. At the same time, the load on the vocal apparatus should be strictly dosed so as not to overstrain the diseased organ, so it is not recommended to deviate from the specialist's requirements in the hope of a faster recovery.

Cordotomy

Cordotomy is another endoscopic surgical procedure to enlarge the glottis. Cordotomy is performed through an incision through the vocal cord, ligament, and thyroarytenoid muscle posteriorly at the thistle insertion. Cordotomy, like arytenoidectomy, is prone to granuloma and scar formation. Revision cordotomy may be required in up to 30% of patients due to decreased glottal diameter due to scarring or granulation tissue formation.[ 11 ] The most common complication associated with cordotomy was change in voice quality due to vocal cord injury.[ 12 ] Laser endoscopic cordotomy has emerged as the preferred therapeutic intervention for VCP compared with arytenoidectomy because it is less invasive and reduces the incidence of aspiration. Voice quality may deteriorate following resection, but overall voice outcomes are often better than arytenoidectomy, especially in adult patients.

Reinnervation

The goal of reinnervation is vocal cord abduction by restoring activity of the posterior cricothyroid muscle (PCA). Although this procedure restores spontaneous vocal cord abduction, it does not affect adduction. RLN anastomosis is a challenging procedure due to the variability and difficulty of its delivery. The phrenic nerve has been used to reinnervate the PCA muscle; one study found that inspiratory vocal fold abduction was achieved in 93% of cases.[ 13 ] Although patients suffered from hemidiaphragmatic paralysis, they had significant recovery of diaphragmatic movements and respiratory function within 12 months. Marina et al. previously showed that a branch of the phrenic nerve alone can be used to minimize the loss of diaphragmatic function and maintain respiratory parameters. A more modern technique is the use of a pedicled neuromuscular flap from the ansa cervicalis, which avoids the diaphragmatic complications associated with sacrifice of the phrenic nerve. This procedure is technically very challenging and is most successful when performed by several surgeons with considerable experience in its use. All of these laryngeal reinnervation procedures are much more commonly used for unilateral vocal cord paralysis. [ 14 ], [ 15 ]

Gene therapy

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

Effective medicines

We will not dwell on the drugs used to treat inflammatory vocal cord paresis, 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 strictly individual). We will 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 cholonomimetics) that improve muscle motor activity, increasing their contractility by potentiating the effect of the neurotransmitter acetylcholine on them. It is prescribed for muscle weakness (myasthenia), 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 in 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 in case of hypersensitivity to its components (neohistamine and auxiliary components), epileptic status, hyperkinesis, decreased heart rate (pulse), bronchial asthma, heart rhythm disturbances, severe vascular atherosclerosis, hyperthyroidism, prostate hypertrophy and some other pathologies. In other words, it is strictly not recommended to take the drug without a specialist's prescription.

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

The medicine "Amiridine" also has an anticholesterase effect, i.e. it stimulates neuromuscular transmission and improves the contractility of the body's muscles, including the muscles of the larynx and vocal folds. Indications for the prescription of the medicine include myasthenia, neuritis and some other neurological diseases, organic diseases of the brain, in which various disorders of motor activity, paresis and paralysis caused by damage to the nuclei of the cranial nerves are observed.

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

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

This drug has various application possibilities. It is produced in tablets (20 mg), which are taken orally ½-1 tablet three times a day. In 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 is carried out in an increased dosage (up to 30 mg).

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. A single dose is 1 ampoule (5 or 15 mg of amiridine). It is administered 1 or 2 times a day. The therapeutic course is 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 conduction pathways of the brain and spinal cord, accompanied by involuntary movements (hyperkinesis), heart pain (angina pectoris, ischemic heart disease), decreased heart rate (bradycardia), hyperfunction of the thyroid gland (hyperthyroidism, thyrotoxicosis).

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

In case of diseases of the heart, stomach and thyroid gland, there is a possibility of treatment with the drug, but special caution should be exercised.

Side effects of the drug are mainly characterized by gastrointestinal disorders: increased salivation (hypersalivation), nausea (vomiting attacks are possible), increased intestinal contractions and diarrhea, loss of appetite. Such disorders as muscle coordination disorder (ataxia), dizziness, decreased heart rate occur less frequently and usually after repeated administration of the drug, but in general the drug is well tolerated, and undesirable symptoms occur very rarely.

During treatment with the drug, it is undesirable to consume alcohol, since such a combination can significantly depress the activity of the central nervous system and enhance the sedative effect of ethanol.

"Neuromidin" is a drug of the same class with a different active substance (ipidicrine). Its action is similar to the above-described drugs, 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 back, improves memory, has a stimulating effect on the central nervous system with a slight sedative effect, has an analgesic and antiarrhythmic effect.

The medicine is available in the form of tablets and injections. For vocal cord paresis of various origins, the doctor may prescribe injection or combined treatment. Most often, they start with injections and then switch to taking tablets.

In diseases of the central and peripheral nervous systems with 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 should 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 tablets.

The 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. In pathologies of the peripheral nervous system, it is 1-2 months, in diseases of the central nervous system - up to six months with the possibility of repeating the course as indicated.

Contraindications to the use of the drug are similar to the above-described drugs. It should also be noted that increased intestinal peristalsis against the background of taking anticholinesterase drugs can be dangerous for patients with mechanical intestinal obstruction. Those who have erosive and ulcerative diseases of the gastrointestinal tract should also be careful. Such pathological disorders must be reported to the attending physician.

Anticholinesterase agents are used to enhance the contraction of the uterine muscles before childbirth; at other times, their action may have undesirable consequences for pregnant women, stimulating miscarriages and premature births. The active substance of the drug can also penetrate the placental barrier and into breast milk. The latter point suggests that breastfeeding should be stopped for the duration of treatment with the drug.

Neuromidin is well tolerated by most patients. Side effects develop only in isolated cases and do not require discontinuing the medication. Doctors usually resort to reducing the dose or recommend repeating the drug after a short break (1-2 days). Undesirable symptoms include: increased heartbeat and decreased pulse rate, headaches, dizziness and convulsions (usually occur when taking high doses), increased secretion of sputum from the bronchi and saliva, gastrointestinal disorders, hyperhidrosis (excessive sweating), bronchial spasm, increased uterine tone.

Allergic reactions (rash, itching, Quincke's edema) and skin reactions at the injection site (in case of injection treatment) are possible. In case of allergic reactions, the drug should 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. For neurogenic vocal cord paresis, the most relevant are multivitamin complexes of B vitamins.

" Neurovitan " is a combination drug that contains B vitamins, which have a positive effect on the functioning of the nervous and muscular system.

Octothiamin is a derivative of vitamin B1 (thiamine) with prolonged action and ensures full carbohydrate metabolism necessary for the proper functioning of the nervous system. Like "Przerin" and its analogues, it enhances and prolongs the action of the neurotransmitter acetylcholine, improves tissue trophism, regulates the functions of the muscular and nervous systems.

Vitamin B2 in the preparation is an active participant in oxidation-reduction processes, an antioxidant. It improves blood parameters (the number of red blood cells and the level of hemoglobin), tissue respiration, participates 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 occur (proteins, fats, carbohydrates are converted into easily digestible forms necessary for energy supply of the body and formation of cellular structures). This component of the drug also actively participates in the synthesis of some neurotransmitters (in particular serotonin and histamine), breaks down cholesterol, improves nutrition of the peripheral nerve sheaths. It is believed that vitamin B6 deficiency 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, reduces cholesterol levels, has a positive effect on the liver (prevents fatty hepatosis) and hematopoiesis processes, stimulates protein synthesis - the main building material for cells, and helps increase the body's resistance to infections. With the assistance of vitamin B12, the myelin sheath of peripheral nerve fibers is formed, preventing the death of nerve cells.

All the above-mentioned B vitamins have a general health-improving effect on the nervous and vascular systems, improving trophism and innervation of muscle tissue. Moreover, a pronounced analgesic effect has been noted for the vitamins of this group, helping to relieve most of the unpleasant neurological symptoms or at least reduce their intensity.

The vitamin complex "Neurovitan" is considered a useful addition to neuromuscular stimulants, given that its effects are beneficial not only for neurological pathologies.

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

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

The vitamin complex has few contraindications. These include hypersensitivity to its individual components and some diseases in which the vitamins in the complex can cause harm. For example, vitamin B1 is not recommended for allergies, B6 - for exacerbations of gastroenterological diseases against the background of increased acidity of gastric juice (it helps to reduce pH), B12 is contraindicated in some blood disorders, thrombosis.

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

Despite all the benefits of neuromuscular stimulants, they can only be used as prescribed by a doctor. Mild forms of vocal cord paresis caused by overstraining the vocal apparatus or inflammation of the throat do not require such radical treatment. In most cases of myopathogenic paresis, the voice can be restored using folk methods, many of which have been known for many decades.

Produced by Clostridium spp., botulinum toxin is a neurotoxin that prevents the release of acetylcholine from presynaptic axon terminals, resulting in flaccid paralysis of the target muscle. In patients with vocal cord paralysis, injection of the toxin is used to block aberrant reinnervation of the adductor muscles by inspiratory motor neurons. This allows the abductor inspiratory motor neurons to work more effectively and open the glottis.[ 18 ] This method only results in temporary improvement of symptoms for approximately three to six months at a time, requiring repeat injections for longer-term relief. It is an effective option for idiopathic spastic dysfunction of the vocal cords or in cases where full recovery of function is expected, but at a slow rate.

Folk treatment of vocal cord paresis

There are probably no diseases in the world that people would not try to treat with folk methods. Another thing is that such treatment does not help in all cases and not with every disease. As for vocal cord paresis, treatment with herbs and folk recipes is applicable both in the case of myopathic pathology and in neuropathogenic disorders. But in the first case, this 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, folk treatment can be considered only as an auxiliary therapeutic method.

Weakness of the vocal fold muscles, manifested in hoarseness and muffled voice as a result of overstraining the vocal apparatus, is perfectly treated with ordinary rest, humid air and medicinal herbs with anti-inflammatory and calming 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 in the case of bacterial pathology consists of taking antibiotics and anti-inflammatory drugs, in the case of allergies - antihistamines, in the case of polypous - surgical removal of polyps, to restore the voice you need rest, humidified air and folk methods. These include: taking warm liquids that do not irritate the throat and gargling with a weak solution of salt, soda or herbal decoction.

Recommended liquids: tea, milk, still mineral water, non-acidic juices, but 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 moisture to the damaged tissues of the larynx. Rinses promote moisture, relieve inflammation and swelling of soft tissues (especially chamomile infusion and decoction), help remove infection (salt and soda are known antiseptics), supporting the inflammatory process, disrupting trophism (nutrition and respiration) and the functionality of the mucous membrane and muscles of the vocal cords.

In case of functional paresis caused by neuropsychiatric disorders, herbs with a sedative effect usually come to the rescue: valerian, mint, lemon balm, angelica, fireweed, lavender, St. John's wort and herbal infusions, because the restoration of the functionality of the vocal cords in this case directly depends on the stabilization of the central nervous system.

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

Herbal treatment for functional paresis is supported even by doctors, but the effect of herbs is not always sufficient, and the effect does not occur as quickly as desired. In some cases, herbs are recommended to be used as sedatives, replacing drugs with the same effect, but to do this in combination with antidepressants, which act many times stronger and faster. Medicinal plants will help to reduce the course of taking potent drugs and consolidate the effect obtained if they are taken during the rehabilitation period and in stressful situations in the future. After all, in most cases, functional paresis of the vocal cords is diagnosed in people with an unstable psyche, prone to psycho-emotional breakdowns.

In case of neurogenic paresis and organic diseases of the brain, folk treatment is ineffective. But this does not mean that it should be abandoned, because many effective recipes enhance the effect of drugs and help to reduce the time of their administration, which reduces the risk of developing severe side effects.

Thus, 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 (corticosteroids in injections), long-term therapy with which, especially in high doses, can harm the body, and later oral NSAIDs, which negatively affect the condition 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, to refuse to take NSAIDs. This is very important, given the volume of medications administered to such patients.

But herbs with a pronounced sedative effect (CNS depression) in neurogenic pathologies should be treated with caution, because their effect may contradict the requirements of therapy with muscle activity stimulants (CNS excitation), so it is necessary to consult a doctor in advance about the possibility and dosage of medicinal herbal drinks. Nevertheless, the calming effect of herbs will come in handy during the rehabilitation period, when stabilization of the patient's mental state helps to maintain faith in a positive treatment outcome, maintain strength, patience and the desire to get rid of speech defects.

What folk recipes can help you quickly regain your clear, loud voice and return to your usual work activities? Here are some of them.

Milk treatment:

• Prepare a warm drink consisting of equal parts milk and still mineral water. It should be drunk in small sips throughout the day.
• It is recommended to drink eggnog twice a day: add a raw yolk, a little butter and honey to a large cup of warm milk.
• It is useful to drink warm milk with turmeric added (on the tip of a teaspoon) several times a day.
• Onions boiled in milk also help with colds and weakening of the voice. The onion decoction 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 the mixture should be consumed up to 4 times a day, 2 tablespoons each.
• Blueberry juice will be useful for vocal cord paresis caused by infectious and inflammatory diseases. Blueberries contain many natural antibiotics (phytoncides) and substances that help restore vocal function. For medicinal purposes, you can drink juice, eat berries or make an infusion (1 teaspoon of berries per glass of boiling water), which is recommended for gargling.
• Birch sap helps fight inflammation, strengthens nerves, improves metabolism. It should be taken 1/3 cup three times a day.
• In summer, to treat vocal cord paresis and restore the voice, you can drink freshly squeezed herbal juices: plantain, nettle, celery.

Herbal treatment:

• For myopathic paresis, gargling with a decoction of bay leaf (3-4 leaves per glass of water) and rubbing an infusion of bay leaf in vegetable oil into the larynx area (30 g of leaf per glass of oil, leave for 2 months and boil) are effective.
• Brew 1.5-2 tablespoons of chamomile flowers with a glass of boiling water. Leave for 15 minutes. Take three times a day. A single dose is 1/3 cup.
• Boil ½ cup of anise seeds for a quarter of an hour in 200 ml of water, cool to a warm state, strain, add 3 tbsp. of linden honey and 1 tbsp. of cognac. Drink 1 tbsp. of the resulting drink during the day at half-hour intervals.
• In case of paresis caused by overstraining of vocal cords, inhalations with dill seed decoction (1 tbsp. of seeds per glass of water) help. Inhalations should be done three times a day for a week.
• There are recommendations for treating paresis with medicinal baths and compresses. A decoction of pine and birch branches is added to the baths (6 procedures), and after taking baths, a neck massage is done and compresses with honey and comfrey are applied, after drinking a glass of warm milk with honey and butter.

Vocal cord paresis in children can be treated with:

• butter (sucking on a piece of butter) and vegetable oil (gargling),
• 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 resonant, but you should only take fresh home-made eggs from trusted suppliers),
• recipes based on milk and medicinal herbs.

Some foods, recipes and especially herbs can cause allergic reactions and intolerance reactions, so they should be used with caution, carefully monitoring your health.

Homeopathy

Homeopathy is a branch of alternative medicine that is gaining popularity every year. This is due to the widespread belief that homeopathic medicines are safer for health than allopathic (synthetic drugs) and are close in their action to herbal treatment, which is what traditional medicine usually leans towards.

Perhaps, the effect of homeopathic remedies is inferior to traditional medicines in terms of the speed of onset of the effect, but its effect is based not only on the removal of symptoms of diseases. These remedies 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 the pathology itself is taken into account (for example, hoarseness), but also the time of its occurrence, provoking factors, individual characteristics of the patient's body that contribute to the development of pathological processes.

It is not surprising that patients with vocal cord paresis are interested in such medications. After all, you don’t want to treat mild forms of the disease with chemicals, and in severe cases, the list of necessary “chemistry” is sometimes simply terrifying.

What can homeopaths offer to restore the voice? For severe morning hoarseness, Causticum can be prescribed, for evening hoarseness - Phosphorus or Rhus toxicodendron. For paresis caused by overstraining of the vocal cords, Aurum triphyllum is effective, and for a weakened voice due to laryngitis - Aconitum and Apis. For nervous, excitable children with reduced speech function, Chamomile is suitable.

When the tone of the vocal muscles increases (usually due to paralysis), Arsenicum album and Kalium arsenicum are indicated; when it decreases, Hyocyamus is indicated; and in the case of dysphonia or aphonia of unknown etiology, Platina is indicated.

Among the complex homeopathic preparations, the drug "Gomeovox" has proven itself well and is officially recognized as an effective means for restoring vocal function. It contains 11 homeopathic components of plant and natural origin in effective and safe dosages.

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