Vocal cord paralysis

Introduction Paralysis of vocal cord, or laryngeal paralysis, is a clinical manifestation, not an independent disease. When the motor nerve (recurrent laryngeal nerve) of the larynx is damaged, there are three types of paralysis: vocal cord abduction, adduction, or muscle tension relaxation. Clinically, due to the long left recurrent laryngeal nerve, the left vocal cord paralysis is more common, skull base fracture, thyroid surgery, neck and throat trauma, throat, neck or skull base, malignant tumor compression, Mediastinal or esophageal metastatic tumors, nasopharyngeal carcinoma invading the skull base, tuberculous adhesions at the tip of the lung, pericarditis, peripheral neuritis, etc. can cause vocal cord paralysis.

Cause

According to the different parts of the nerve damage, it can be divided into two types: central and peripheral, and the surrounding is more common.

(1) Central: The nerves of both sides of the cerebral cortex have a nerve bundle connected to the two sides of the nucleus, so each side of the muscle receives impulses from both sides of the cerebral cortex, so the laryngeal paralysis caused by cortical lesions, clinically extremely Rare. Cerebral hemorrhage, basilar aneurysm, posterior fossa inflammation, medulla oblongata and bridge brain tumors can cause vocal cord paralysis.

(B) Peripheral: Where the lesion mainly occurs in the recurrent laryngeal nerve or the vagus nerve leaving the jugular foramen and even before the recurrent laryngeal nerve is removed, the laryngeal spasm caused by it is peripheral. Skull base fractures, thyroid surgery, various neck and throat injuries, throat, neck or skull base, malignant tumor compression, etc. can cause vocal cord paralysis.

an examination

Related inspection

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(1) Unilateral paralysis: It is mainly a vocal cord abduction disorder, and the symptoms are not significant. Under the indirect laryngoscope, one side of the vocal cord is near the midline position. When inhaling, it cannot be abducted, and the vocal cord can be closed when the sound is pronounced.

(2) Unilateral complete paralysis: the vocal cord abduction and adduction function of the affected side disappeared. Check that the vocal cord is fixed in the paracentral position, the sacral cartilage is tilted forward, the vocal cord on the affected side is lower than the healthy side, the vocal cords cannot be closed when the sound is pronounced, and the pronunciation is hoarse and weak.

(C) bilateral incomplete paralysis: rare, mostly due to thyroid surgery or laryngeal trauma. The vocal cords on both sides can not be abducted and close to the midline. The glottis is small and fissure-like. The patient can be asymptomatic when he is calm, but he often feels difficulty breathing during physical activity. Severe breathing difficulties can occur if there is an upper respiratory tract infection.

(4) Complete bilateral paralysis: the vocal cords on both sides are in the middle position. They can neither be closed nor outreached. The pronunciation is hoarse and weak. Generally, the breathing is normal, but food and saliva are easily inhaled into the lower respiratory tract, causing cough.

(5) Adjacent vocal cords in bilateral vocal cords: more common in functional aphasia, the vocal cords cannot be adducted during pronunciation, but coughing and sounding.

Differential diagnosis

Identification of vocal cord paralysis and functional aphony:

(1) The vocal cord paralysis is mostly one-sided, both sides of the light see, and the functional aphasia is the adductive paralysis of the vocal cords on both sides.

(2) Functional aphasia can find certain lures, such as anger, excessive grief and so on.

(3) Functional aphasia is examined under indirect laryngoscopy, so that when the patient coughs, the vocal cords move normally.

(4) Functional aphasia suggestive therapy is effective.

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