Laryngeal Palsy

Laryngeal paralysis is a phenomenon in which the larynx does not fulfill the function of speech, breathing, and airway protection in varying degrees due to many causes.
Laryngeal palsy has two groups of causes that are caused by nerve and muscle paralysis. Nervous paralysis accounts for the majority of cases because the nerves control the larynx movement, which runs from the base of the skull to the mediastinum and from the mediastinum to the neck.

Along the way, the larynx nerves are closely related to many adjacent structures of the chest and neck, so the damage of these structures will affect the larynx.
Paralysis of laryngeal motor
When the laryngeal motor is paralyzed, half of the larynx is lost

. The left nerve is more paralyzed than the right because the left nerve is more related to the parts of the chest than the left atrium and the aorta.
- Causes of trauma: surgery to cut the thyroid gland, surgery to open the esophagus, injuries from domestic accidents, traffic, bullets . .

- Causes of compression: dilating aortic loops, dilating the left atrium, esophageal cancer, mediastinal lymphadenopathy due to tuberculosis, cancer, thyroid tumor ...
- Causes of lead poisoning, intoxication of toxins of bacteria, heavy viruses such as influenza, diphtheria, typhoid ...
Symptom
The patient suddenly lost his voice, after a few days he was able to speak again but his voice was changed: not loud, timbre or double voice

Gradually, the voice will recover to almost normal thanks to compensating larynx nerve.




Examination of the larynx showed that the two closed vocal cords were not closed, the vocal cords and cartilage on one side decreased or lost mobility, the inactive vocal cords lost tone and fluttered following the breath.
Laryngeal motor paralysis can occur on both sides of the vocal cords, this is very rare and begins with sudden shortness of breath due to laryngeal paralysis of the larynx, does not allow air into the lungs, and then the closed muscles are also paralysis, the two vocal cords return to the intermediate position.
At this time, the patient stops having difficulty breathing but cannot speak. Patients who drink water are likely to choke, coughing out. Laryngoscopy revealed that the two vocal cords were closed in an intermediate, semi-closed position, although the patient was breathing or pronouncing.
Chest Pain at Work

In this case, there is no clearing phenomenon, only when the cause is solved, the two vocal cords will work again. Mobility recovery is signaled by a coughing cough but the vast majority of these paralysis cases become permanent.
Patients suffering from this disease lose their lung protection reflex, so water and food will fall into the lower respiratory tract causing pneumonia, abscess - lung abscess.




Laryngeal motor paralysis may be accompanied by paralysis of some other cranial nerves such as:
+ Laryngeal paralysis accompanied by pharyngeal paralysis, sternum and paraplegia (Schmidt syndrome), caused by damage to motor maneuver in the brain.
+ Laryngeal paralysis, accompanied by paralysis of the pharynx and tongue (Jackson syndrome).
Good or bad prognosis depends on the cause of paralysis: if due to inflammation, cold, the prognosis is good and if due to damage of the brain and spinal cord, cancer ... the prognosis is very heavy.
Paralysis
Paralysis of each muscle group will change the shape and breathing function of the glottis.
Paralysis of open muscles, function of opening glottis while function of closure.




The main cause is due to syphilis damage due to syphilis, in addition to a number of other causes such as typhoid neuritis, regressive nerve compression but the incidence is negligible.
Open muscle paralysis syndrome includes: laryngeal dyspnea accompanied by suffocation when the voice is not changed. Soi larynx saw two tight wires together.
Treating the cause after opening the trachea. If surgery is needed, fix cartilage on one side and not close the vocal cords

Paralysis of the sphincter: in this case, the glottis group is closed while the opening of the glottis remains active, so the vocal cords remain open, the patient is not short of breath but speechless, the vocal cord is not sagging and the school is missing. force as in nerve paralysis.
Paralysis of the individual muscles due to laryngitis is very common. Whenever the larynx mucosa becomes inflamed, the muscles directly below the mucosa are paralyzed slightly, the voice is often hoarse and small.




The prognosis is good and will resolve completely when the inflammation is gone.
Treatment according to the cause of the disease. These cases must be closely monitored by otorhinolaryngologists..

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