Paresis of the soft palate, after adenotomies and tonsillectomies for the treatment of paresis. Treatment of vocal cord paresis Paralysis and paresis of the velum palatine

How to distinguish paresis (paralysis) of the soft palate from functional nasality?

It is important to distinguish paresis (paralysis) of the soft palate from functional (habitual) nasality. You can do this in the following ways:

The child opens his mouth wide. Speech therapist (parent) presses with a spatula (the handle of a spoon) on the root of the tongue. If the soft palate reflexively rises to the back wall of the pharynx, we can talk about functional nasality, but if the palate remains motionless, there is no doubt that the nasality is of organic origin (paresis or paralysis of the soft palate).

The child lies on his back and says some phrase in this position. If the nasal sound disappears, then we can assume paresis (paralysis) of the soft palate (the nasal sound disappears due to the fact that when lying on the back, the soft palate passively falls to the back wall of the pharynx).

First of all, you will need to activate the soft palate and make it move. For this you will need special massage . If the child is too small, adults do the massage:

1) with a clean, alcohol-treated index finger (pad) of the right hand, in the transverse direction, stroking and rubbing the mucous membrane at the border of the hard and soft palate (in this case, a reflex contraction of the muscles of the pharynx and soft palate occurs);

2) the same movements are made when the child pronounces the sound “a”;

3) make zigzag movements along the border of the hard and soft palate from left to right and in the opposite direction (several times);

4) with your index finger, perform acupressure and jerk-like massage of the soft palate near the border with the hard palate.

If the child is already big enough, then he can do all these massage techniques himself: the tip of the tongue will cope with this task perfectly. It is important to correctly show how all this is done. Therefore, you will need a mirror and the interested participation of an adult. First, the child performs massage with the tongue with his mouth wide open, and then, when there are no more problems with self-massage, he will be able to perform it with his mouth closed, and completely unnoticed by others. This is very important, because the more often the massage is performed, the sooner the result will appear.

When performing a massage, you must remember that you can cause a gag reflex in a child, so do not massage immediately after eating: there should be at least an hour break between meals and massage. Be extremely careful and avoid rough touches. Do not massage if you have long nails: they can damage the delicate mucous membrane of the palate.

In addition to massage, the soft palate will also need special gymnastics. Here are some exercises:

1) the child is given a glass of warm boiled water and asked to drink it in small sips;

2) the child gargles with warm boiled water in small portions;

3) exaggerated coughing with the mouth wide open: at least 2-3 coughs on one exhalation;

4) yawning and imitation of yawning with the mouth wide open;

5) pronouncing vowel sounds: “a”, “u”, “o”, “e”, “i”, “s” energetically and somewhat exaggerated, on the so-called “hard attack”.

Restoring breathing

First of all, it is necessary to eliminate the causes: carry out appropriate operations, get rid of adenoids, polyps, fibroids, deviated nasal septum, inflammatory swelling of the nasal mucosa with a runny nose and allergic rhinitis, and only then restore proper physiological and speech breathing.

It can be difficult, and sometimes even uninteresting, for a small child to perform exercises just for demonstration. Therefore, use gaming techniques, come up with fairy-tale stories, for example these:

“Ventilating the cave”

The tongue lives in a cave. Like any room, it must be ventilated often, because the air to breathe must be clean! There are several ways to ventilate:

Inhale air through your nose and exhale slowly through your wide open mouth (and so on at least 5 times);

Inhale through the mouth and exhale slowly through an open mouth (at least 5 times);

Inhale and exhale through your nose (at least 5 times);

Inhale through your nose, exhale through your mouth (at least 5 times).

"Blizzard"

An adult ties pieces of cotton wool onto strings and fastens the free ends of the threads onto his fingers, thus making five strings with cotton balls at the ends. The hand is held at the level of the child’s face at a distance of 20–30 centimeters. The baby blows on the balls, they spin and deviate. The more these impromptu snowflakes spin, the better.

"Wind"

This is done in the same way as the previous exercise, but instead of threads with cotton wool, a sheet of paper is used, cut with a fringe at the bottom (remember, such paper was once attached to the windows to repel flies?). The child blows on the fringe, it deviates. The more horizontal the strips of paper take, the better.

"Ball"

Tongue's favorite toy is a ball. It's so big and round! He's so much fun to play with! (The child puffs out his cheeks as much as possible. Make sure that both cheeks puff out evenly!)

“The ball deflated!”

After prolonged games, the tongue's ball loses its roundness: air comes out of it. (The child first strongly inflates his cheeks, and then slowly exhales air through his rounded and elongated lips.)

"Pump"

The ball has to be inflated using a pump. (The child’s hands perform the appropriate movements. At the same time, he himself pronounces the sound “s-s-s-..." often and abruptly: the lips are stretched in a smile, the teeth are almost clenched, and the tip of the tongue rests against the base of the lower front teeth. The air comes out of the mouth strongly pushes).

"The tongue plays football."

Tongue loves to play football. He especially likes scoring goals from the penalty spot. (Place two cubes on the side of the table opposite from the child. This is an improvised goal. Place a piece of cotton wool on the table in front of the child. The baby “scores goals” by blowing from a wide tongue inserted between his lips onto a cotton swab, trying to “bring” it to the goal and get into them. Make sure that your cheeks do not swell and the air flows down the middle of your tongue.)

When performing this exercise, you need to make sure that the child does not accidentally inhale the cotton wool and choke.

"The tongue plays the pipe"

Tongue also knows how to play the pipe. The melody is almost inaudible, but a strong stream of air is felt, which escapes from the hole of the pipe. (The child rolls a tube from his tongue and blows into it. The child checks the presence of a stream of air on his palm).

"Block and Key"

Does your child know the fairy tale “Three Fat Men”? If so, then he probably remembers how the girl gymnast Suok played a wonderful melody on the key. The child tries to repeat this. (An adult shows how to whistle into a hollow key).

If you don’t have a key at hand, you can use a clean, empty bottle (pharmacy or perfume) with a narrow neck. When working with glass vials, you must be extremely careful: the edges of the bubble should not be chipped or sharp. And one more thing: watch carefully so that the child does not accidentally break the bottle and get hurt.

As breathing exercises, you can also use playing children's musical wind instruments: pipe, harmonica, bugle, trumpet. And also inflating balloons, rubber toys, balls.

All of the above breathing exercises should only be performed in the presence of adults! Remember that when doing exercises, your child may become dizzy, so carefully monitor his condition, and stop the activity at the slightest sign of fatigue.

Articulation exercises for rhinolalia

For open and closed rhinolalia, it can be very useful to perform articulation exercises for the tongue, lips and cheeks. You can find some of these exercises on the pages of our website in the sections “Classical articulation gymnastics”, “Fairy tales from the life of Tongue”.

Here are a few more. They are designed to activate the tip of the tongue:

1) “Liana”: hang your long, narrow tongue down toward your chin and hold in this position for at least 5 seconds (repeat the exercise several times).

2) “Boa constrictor”: slowly stick your long and narrow tongue out of your mouth (do the exercise several times).

3) “Boa Tongue”: with a long and narrow tongue, sticking out as much as possible from the mouth, make several quick oscillatory movements from side to side (from one corner of the mouth to the other).

4) “Watch”: the mouth is wide open, the narrow tongue makes circular movements, like the hand of a clock, touching the lips (first in one direction and then in the other direction).

5) "Pendulum": the mouth is open, a narrow long tongue is protruding from the mouth, and moves from side to side (from one corner of the mouth to the other) counting “one - two”.

6) “Swing”: the mouth is open, the long narrow tongue either rises up to the nose, then falls down to the chin, counting “one or two.”

7) "Injection": a narrow, long tongue presses from the inside first on one cheek, then on the other.

You can also diversify articulation gymnastics

GASTRONOMIC AND Speech Therapy GAMES

Fun articulation exercises for children that they will have great fun doing because all the exercises are done with sweets!

Paresis of the larynx is one of the types of damage to this organ associated with a pathological change in its neuromuscular functioning. The causes may be associated with various disorders in the body, and treatment must necessarily include searching for and eliminating the influence of etiological factors. Paresis of the larynx (partial paralysis) now accounts for about a third of all cases of chronic diseases of the vocal apparatus, and the pathology carries a high risk of airway stenosis.

Paresis of the larynx and its types

The larynx is a section of the respiratory tract located between the trachea and pharynx. The larynx is responsible for voice formation and is also a direct participant in the act of breathing. This organ contains the vocal cords, which, when vibrating, allow a person to make sounds (phonation function). The internal muscles of the larynx, the work of which is controlled by the brain through the branches of the vagus nerve, are responsible for the degree of narrowing and expansion of the glottis, as well as for all movements of the ligaments.

Paresis of the larynx can occur with any disruption of the activity of the components of the organ. This disease is a decrease in muscle activity, that is, a decrease in the strength or range of motion of muscle tissue. Typically, laryngeal paresis implies temporary disturbances in this part of the body (not more than 12 months in duration), which affect one half of the larynx or both halves.

Pathology can develop at any age, since its causes can be quite diverse - from inflammatory processes to organic damage to the respiratory system. All laryngeal paresis are classified according to several criteria. Depending on the cause, the following types of diseases are distinguished:

neuropathic paresis - associated with disruption of the nervous system in any of its areas;
myopathic paresis - caused by pathology of the muscles of the larynx;
functional paresis - the disease develops against the background of an imbalance of inhibition and excitation in the body.

Among neuropathic paresis the following are distinguished:

Peripheral (caused by pathology of the vagus nerve).
Central (consists of impaired conduction of nerve impulses due to brain pathology). If we are talking about diseases of the brain stem, where the nucleus of the vagus nerve is located, the paresis is called bulbar; if we are talking about damage to the cerebral cortex, it is called cortical.

According to the degree of coverage by pathological processes, paresis can be unilateral or bilateral.

Causes of pathology

This disease can be caused by many reasons. Most often it is associated with unsuccessful surgery, in particular on the thyroid gland. So, now up to 3-9% of operations on the thyroid gland are complicated by laryngeal paresis. In addition, traumatic damage to nerve structures during interventions on the neck, chest, skull, as well as wounds and injuries at home, at work, etc. can cause the development of pathology. Other causes of partial paralysis of the larynx:

metastases, primary tumors of the neck, mediastinum, chest, trachea, larynx, esophagus;
enlargement of the thyroid gland due to hyperthyroidism and other diseases;
benign tumors of the larynx and large vocal cords;
the presence of an inflammatory infiltrate in infectious pathologies of the larynx;
the presence of a hematoma after injury;
some congenital heart defects;
aortic aneurysm, atherosclerosis of coronary vessels;
stroke;
pleurisy;
ankylosis of the arytenoid cartilage;
neuritis due to intoxication, poisoning, infectious diseases (ARVI, influenza, tuberculosis, typhoid, etc.).

People who work in hazardous industries, smokers, and people whose professional activities involve high stress on the vocal cords are most susceptible to the development of paresis. Functional paresis of the larynx can be caused by severe stress, and sometimes accompanies mental illness and neurasthenia.

Symptoms of the disease

The severity of the clinical picture of the disease will depend on the degree of coverage of the larynx and vocal cords by pathological processes (unilateral, bilateral paresis), as well as on the duration of the disease. The most striking symptoms appear with unilateral paralysis with dysfunction of the vocal cord:

hoarseness of voice;
hoarseness after a short conversation;
decreased sonority of the voice down to a whisper;
rapid voice fatigue;
choking on liquid food;
dyspnea;
sore throat;
impaired mobility of the tongue and soft palate;
feeling of a lump in the throat, the presence of a foreign body;
coughing or severe coughing in attacks;
with psychogenic paresis, symptoms are often supplemented by headache, sleep disturbances, and anxiety;
by 1-2 weeks of illness, improvements often occur due to the compensatory inclusion of “spare reserves” by the body, but after some time a sharp deterioration in the person’s condition may occur against the background of atrophy of the laryngeal muscles.

Sometimes paresis does not manifest itself externally, and only a doctor can detect it during a routine examination. Bilateral paralysis is most often expressed by symptoms of laryngeal stenosis, aphonia, and the development of respiratory failure. Sometimes stenosis progresses so quickly that already in the first hours of the disease it reaches grade 2-3 and requires emergency surgical treatment.

Possible complications

The most serious complications arise due to difficulties in the flow of air into the trachea and lungs due to the narrowness of the glottis. They can lead to hypoxia of the body, chronic respiratory failure, and disruption of the functioning of internal organs, but with central bilateral paresis they can cause asphyxia and death of a person within a day. The onset of the stenosis stage is characterized by the following clinical picture:

shortening the intervals between exhalation and inhalation (shallow breathing);
decreased respiratory movements;
inspiratory dyspnea;
noisy breathing;
slow heart rate;
weakness, apathy, followed by anxiety;
blue discoloration of the nasolabial triangle.

With unilateral paresis that occurs without treatment for a long time, the patient may develop various pathologies of the lungs, bronchi, as well as persistent changes in the voice, up to its complete loss.

Diagnosis of laryngeal paresis

The task of the otolaryngologist, if the development of this disease is suspected, is to search for its exact cause, for which a variety of examinations can be carried out and consultations with other specialists (psychiatrist, neurologist, gastroenterologist, surgeon, endocrinologist, etc.) can be prescribed. Particular attention is paid to collecting anamnesis and finding out the facts of surgical interventions in the past.

Among instrumental and laboratory examination methods, the most often planned are:

laryngoscopy and microlaryngoscopy;
radiography, CT, MRI of the larynx, brain, neck, chest;
EEG, electromyography;
phonography, stroboscopy;
Ultrasound of the thyroid gland, heart;
fibrogastroscopy;
general blood test, blood biochemistry.

In the absence of organic changes in the body, a diagnosis of “functional laryngeal paresis” is made. In addition, it is necessary to differentiate the pathology with laryngeal edema, diphtheria, arthritis of the arytenoid-cricoid joint, pulmonary embolism, and myocardial infarction.

Conservative and surgical treatment

Treatment measures should begin with the elimination of etiological factors: for example, if compression of the branches of the vagus nerve is observed, they are decompressed, if neuritis develops against the background of poisoning, detoxification treatment is prescribed, etc.

Almost always, in order for paresis to be fully treated, the patient should be hospitalized. In the hospital, the following types of therapy may be recommended to the patient:

decongestants;
antihistamines, desensitizing agents;
antibiotics, anti-inflammatory, antiviral agents;
vitamins;
biogenic stimulants;
drugs to improve nerve conduction and neuroprotectors;
psychotropic drugs;
nootropics, vascular agents;
hormonal medications;
muscle relaxants;
acupuncture;
electrophoresis;
therapeutic blockades;
electrical nerve stimulation;
endolaryngeal muscle stimulation;
diadynamic currents;
massage.

Laryngeal paralysis often has to be treated surgically. This may be necessary if there are tumors, scars, or if conservative therapy is ineffective. Among the surgical treatment methods:

surgery of the thyroid gland or other organs that cause paresis;
placement of implants (for example, Teflon paste);
reinnervation of the larynx;
thyroplasty (vocal cord displacement);
tracheostomy, tracheotomy as an emergency measure.

The effectiveness of surgical treatment depends on the duration of the disease, as well as on the individual characteristics of the body and the specific course of the disease. After therapy or surgery, it is imperative to recommend the patient long-term phonopedia classes and breathing exercises to form correct voice guidance and normalize the separation function of the larynx. On average, rehabilitation of patients after paralysis of the upper respiratory tract is 3-5 months.

Among the methods of treating paresis with folk remedies, the following are practiced:

Brew 1 spoon of snakehead herb with a glass of water, add a spoon of honey. Drink 3 tablespoons of infusion three times a day on an empty stomach.
2 teaspoons of marina root are poured into 300 ml of water, boiled in a water bath for 10 minutes, left for 1 hour. Take 100 ml three times a day on an empty stomach.
If paralysis occurs after an infectious disease, treatment with purslane can be used. Prepare an infusion from a spoonful of herbs and 300 ml of boiling water, drink 3 tablespoons of the product four times a day after meals

Gymnastics for laryngeal paresis

Breathing exercises and phonopedia are of great importance for recovery. They should be used at all stages of treatment of the disease. The training is aimed at maximizing the motor activity of the vocal cords and laryngeal muscles. Breathing exercises may include the following exercises:

blowing and drawing in air at a slow pace;
use of a harmonica;
puffing out the cheeks, releasing air through the crack;
exercises to form an extended inhalation, etc.

It will be useful to supplement gymnastics with exercises to train the neck muscles. Voice training is carried out under the supervision of a phoniatrist. They consist of correcting the pronunciation of each sound, syllables, words and are carried out over a long period of time.

Prognosis and prevention

The prognosis will depend on the cause that caused the disease. If the etiological factors are completely eliminated, then after timely treatment and phonopedia classes, the voice and respiratory and separation functions of the larynx are restored. With functional paresis, the patient can recover even without treatment on his own. With a long-term illness, atrophy of the laryngeal muscles and loss of voice function are observed.

To prevent the disease from occurring, you need to:

properly treat any infectious pathologies;
prevent poisoning;
normalize the load on the vocal cords;
avoid working in hazardous industries;
do not overcool;
monitor the health of the thyroid gland and chest organs;
if it is necessary to perform operations in the larynx, choose only reliable institutions and qualified specialists to perform interventions.

Simple and effective exercises that allow you to quickly restore your voice if you are tired or hoarse. Alexey Kolyada, author and presenter of the “Opening the Voice” training, shows.

Paresis refers to a number of serious neurological disorders, which is partial paralysis - incomplete loss of the ability to move any organ. Can affect any part of the body. Paresis of the stomach is called gastroparesis, and paresis of all extremities is called tetraplegia.

The disease is caused by a disruption in the nerve pathways. The severity is assessed in the system:

0 points means complete plegia (immobility);
1 point corresponds to a condition in which there is contractile activity in the muscles, but it is so low that it is practically unnoticeable;
2 points are given if there are movements in the horizontal plane, there are movements in the joints, but they are constrained;
3 points equals a situation in which the limbs rise, that is, they work not only horizontally;
4 points correspond to full range of motion with reduced muscle strength;
5 points is the norm for a healthy person.

Depending on the type of paresis, it can be divided into:

Lethargic, with pathological relaxation of muscles with a decrease in their tone - hypotonicity;
Spastic, with excessive tension and increased activity - hypertonicity.

Gastroparesis is a disorder of the nervous activity of the stomach, which does not allow the organ to empty itself of food under normal conditions. Gastric paresis is associated with damage to the vagus nerve, which is responsible for regulating the digestive system. Its damage causes disruption of normal muscle functioning. Because of this, an obstacle is created in the movement of food through the gastrointestinal tract - gastrointestinal tract.

Once conceived, it is impossible to determine the cause of gastroparesis. However, among the factors stand out:

Uncontrolled diabetes mellitus;
Surgical interventions on the stomach with mechanical damage to the vagus nerve;
Negative drug effects of some antidepressants and stimulants;
Parkinson's disease;
Multiple sclerosis;
Amyloidosis;
Scleroderma.

The main symptoms of gastric paresis consist of:

Feelings of heartburn or the presence of GERD - gastroesophageal reflux disease;
Nausea and vomiting;
Feelings of rapid saturation;
Bloating;
Poor appetite and weight loss;
Uncontrolled blood glucose levels.

Paresis is fraught with adverse consequences for the body. Thus, unable to release food normally, the stomach becomes rigid. The food that accumulates in its cavity stagnates and ferments. This causes an increase in the number of bacteria, and as a result, infectious processes.

Food that stagnates in the body for a long time hardens and becomes beozar, almost stone. An obstruction in the digestive tract can cause further stagnation. Gastric paresis is a chronic, long-term process. The drugs Metoclopramide and Erythromycin can be used to treat it.

If gastroparesis reaches critical proportions, an operation is prescribed, which consists of surgically inserting a special tube. It is introduced through the abdomen into the small intestine so that nutrients can reach the intestines without stagnating in the stomach. So, food is absorbed faster.

Another option is intravenous or parenteral nutrition. Substances enter directly into the bloodstream using a catheter. Electrical stimulation is used for treatment. Its purpose is to connect electrodes, which cause contraction of the stomach walls, due to which food moves into the intestines.

Paresis of the soft palate and tongue

Paresis of the tongue and soft palate causes problems with swallowing and speech. The soft palate is a movable muscular aponeurosis that separates the nasopharynx from the oropharynx through the contraction of its muscles. The nerves approaching the tongue and palate are called the vagus, trigeminal, glossopharyngeal and sublingual. Their defeat causes paresis.

Causes of disruption of the innervation of these organs:

Inflammatory and infectious processes such as polio or diphtheria;
Congenital defects;
Decreased blood supply to the brain in the vertebrobasilar system according to the ischemic type;
Injuries that occur due to household injuries, technical errors during intubation or aspiration, as well as probing or endoscopy;
ARVI;
Tumor neoplasms.

This dangerous disease manifests itself symptomatically:

Disorders of swallowing and breathing;
Violation of speech act;
Problems with ventilation of the auditory tube;
Dysphagia - food begins to flow into the nasopharynx, since the septum holding it back no longer fulfills its function;
Violation of phonation, that is, a change in voice. He becomes nasal;
Problems with pharyngeal and palatal reflexes;
Decreased sensitivity in the mucous membrane, soft palate, tongue;
Violation of the act of chewing.

Diaphragm paresis

Paresis of the diaphragm is also called Cofferat syndrome. It manifests itself as a limitation of functioning caused by damage to the phrenic nerve. This disease occurs mainly during childbirth. And often in children who have spent a long time in conditions of asphyxia.

Such children require very careful handling. Obstetric benefits may not be favorable to them. However, the child will not survive without them. Thus, the most common cause of diaphragm paresis during childbirth is tilting of the upper limb of the fetus. This condition is a consequence of difficulty in removing the baby’s shoulders and head.

In addition to obstetric causes, the nature of paresis may be congenital. A striking example is myotonic dystrophy. Symptoms:

Swelling of the chest on the affected side.
Dyspnea;
Rapid and irregular breathing;
Repeated bouts of cyanosis;

80% of cases involve the right side of the chest. About 10% is a two-way process. Paresis is detected using radiography. On it, the dome of the diaphragm appears as a sedentary formation. Diaphragmatic paresis in a newborn baby contributes to the occurrence of pneumonia.

This disease should be treated by providing active pulmonary ventilation. Up to the full volume of respiratory movements. Therapy is carried out using transcutaneous stimulation of the phrenic nerve. The prognosis of treatment will depend on the extent and severity of the process.

Most sick babies recover within 10 to 12 months. Symptoms of the disease in these cases go away earlier, but treatment should not be stopped until the signs of the disease on X-ray disappear. The bilateral process is rightfully considered the most dangerous. Mortality in these cases reaches 50%.

After a stroke

Stroke is often complicated by paresis. The pathology occurs on the side controlled by the affected part of the brain. Each hemisphere is responsible for controlling the opposite part of the body. Thus, paresis on the right occurs due to an ischemic accident of the left hemisphere. It occurs more often, in 60% of cases.

Pathology on the right side is characterized by a more favorable prognosis than on the left side. Paresis after a stroke is of two types:

Spastic;
Peripheral.

Symptoms following a stroke are associated with:

Speech disorders;
Fading of language and verbal memory. Patients forget words and speech patterns, cannot read and write;
Immobility of the limbs on the affected side, while the arm is clenched and pressed against the body, the leg is extended at the knee;
Changes in facial muscles. On the affected side, the corner of the mouth and lower eyelid droop;
Depressed mental state, isolation.

, (Moscow)

Paresis of the soft palate, after adenotomies and tonsillectomies for the treatment of paresis.

The most common operations in otorhinolaryngology are adenotomy and tonsillectomy. According to the literature, the share of tonsillectomies among other otorhinolaryngological interventions is 20-75%, and adenotomies 6.5-40.9%. Despite this, in the extensively studied literature we find relatively few works that comprehensively cover the topic we have raised.

Transient and persistent paresis of cranial nerves - at the level of nuclei, fibers, nerve endings - including those innervating the soft palate, are considered rare complications in the literature.

Paresis of the soft palate is clinically characterized by a violation of its important functions with the development of dysphagia, accompanied by the flow of liquid food into the cavity of the nasopharynx and nose. Speech takes on a nasal, nasal tone because the sound resonates in the nasopharynx, which is not covered by the velum palatine. A unilateral lesion is manifested by drooping of the soft palate on the affected side, immobility or lagging behind on this side during phonation. The tongue deviates to the healthy side. The pharyngeal and palatal reflexes are reduced or lost on the affected side. Damage to sensitive fibers leads to anesthesia of the mucous membrane of the soft palate and pharynx.

In the genesis of paresis of the soft palate after adenotomies and tonsillectomies, a number of factors are important: impregnation with an anesthetic substance or direct injury to the nerve with a needle during anesthesia; blockade or damage to the nerve with a needle during deep injections or rough manipulations; paresis that goes away within a few hours is due to nerve blockade, long-term or persistent – due to mechanical damage. The possibility of such damage is associated with the anatomical proximity of the tonsils to the parapharyngeal space, in the posterior sections of which the glossopharyngeal, vagus, accessory, hypoglossal cranial nerves and the borderline sympathetic trunk pass, and in the retropharyngeal space - the facial one. Direct injury to the nerve by the instrument or compression of the nerve by hematoma, wound discharge and edematous tissue is possible, with subsequent involvement of the nerves in the scarring process. Damage (wound) to the anatomical formations adjacent to the nasal part of the pharynx can lead to paresis of the soft palate, since the muscles and their tendons involved in its movement are injured. Paresis of the soft palate can also be caused by damage to the cranial nerves innervating the soft palate at the level of their nuclei, such as bulbar syndrome, as a result of infection entering the medulla oblongata from the nasopharynx hematogenously or through the perineural spaces, or decompensation of organic pathology of the brain such as tonsillogenic vasculitis .

We treated 9 children with paresis of the soft palate after operations on the lymphoid-pharyngeal ring (after adenotomy - 7, after tonsillectomy - 2). The treatment complex included means that provided improvement or restoration of metabolic processes and regeneration of nervous tissue:

Biogenic simulators: aloe extract, FIBS, humizol, apilak

Vasodilators: nicotinic acid, dibazole

Agents that improve vascular microcirculation: Trental, Cavinton, Stugeron

Agents that improve the conductivity of nervous tissue: proserin, galantamine

Antihistamines and hyposensitizing drugs

Agents that normalize the functional state of the nervous system - glycine, novo-passit.

These groups of drugs are used in combination with physiotherapy (endonasal electrophoresis with dalargin, galvanization with novocaine in the submandibular area, bioelectric stimulation of paralyzed muscles, neck massage).

In 6 children, it was possible to restore the function of the soft palate; treatment for three children continues.

Description:

Laryngeal paralysis (larynx paresis) is a disorder of motor function in the form of a complete absence of voluntary movements due to impaired innervation of the corresponding muscles. Paresis of the larynx is a decrease in the strength and (or) amplitude of voluntary movements caused by a violation of the innervation of the corresponding muscles; implies a temporary, up to 12 months, impairment of the mobility of one or both halves of the larynx.

Causes of paresis (paralysis) of the larynx:

Laryngeal paralysis is a polyetiological disease. It may be caused by compression of the structures innervating it or the involvement of nerves in the pathological process developing in these organs, their traumatic damage, including during surgical interventions on the neck, chest or skull.
The main causes of peripheral laryngeal paralysis:
medical trauma during surgery on the neck and chest;
compression of the nerve trunk throughout due to a tumor or metastatic process in the neck and chest, diverticulum of the trachea or esophagus, or infiltration due to trauma and inflammatory processes, with an increase in the size of the heart and aortic arch (tetralogy of Fallot), mitral disease, ventricular hypertrophy, dilatation pulmonary artery); inflammatory, toxic or metabolic origin (viral, toxic (poisoning with barbiturates, organophosphates and alkaloids), hypocalcemic, hypokalemic, diabetic, thyrotoxic).

The most common cause of paralysis is pathology of the thyroid gland and medical trauma during operations on it. With primary intervention, the complication rate is 3%, with repeated intervention - 9%; with surgical treatment - 5.7%. In 2.1% of patients it is diagnosed at the preoperative stage.

Symptoms of paresis (paralysis) of the larynx:

Laryngeal paralysis is characterized by immobility of one or both halves of the larynx. Violation of innervation entails serious morphofunctional changes - the respiratory, protective and voice-forming functions of the larynx suffer.

Paralysis of central origin is characterized by impaired mobility of the tongue and soft palate, and changes in articulation.
The main complaints with unilateral laryngeal paralysis:
aspiratory hoarseness of varying severity; , increasing with vocal load;
choking;
pain and foreign body sensation on the affected side.

With bilateral paralysis of the larynx, the clinical symptoms of its stenosis come to the fore.

The severity of clinical symptoms and morphofunctional changes in the larynx during paralysis depends on the position of the paralyzed vocal fold and the duration of the disease. There are median, paramedian, intermediate and lateral positions of the vocal folds.

In the case of unilateral laryngeal paralysis, the clinical picture is most striking when the paralyzed vocal fold is in a lateral position. With the median, there may be no symptoms, and the diagnosis is made by chance during a clinical examination. Such laryngeal paralysis accounts for 30%. Bilateral lesions with lateral fixation of the vocal folds are characterized by aphonia. Respiratory failure develops as a type of hyperventilation syndrome; a violation of the separation function of the larynx is possible, especially in the form of choking on liquid food. In case of bilateral paralysis with paramedian, intermediate position of the vocal folds, respiratory dysfunction is noted, up to third degree laryngeal stenosis, requiring immediate surgical treatment. It should be remembered that with bilateral damage, the respiratory function is worse, the better the patient’s voice.

The severity of clinical symptoms also depends on the duration of the disease. In the first days, there is a violation of the separation function of the larynx, shortness of breath, significant hoarseness, a sensation of a foreign body in the throat, sometimes. Subsequently, on days 4-10 and at a later date, improvement occurs due to partial compensation of lost functions. However, in the absence of therapy, the severity of clinical manifestations may increase over time due to the development of atrophic processes in the muscles of the larynx, worsening the closure of the vocal folds.

Treatment of paresis (paralysis) of the larynx:

Etiopathogenetic and symptomatic therapy is carried out. Treatment begins with eliminating the cause of immobility of half 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.

Treatment methods for laryngeal paralysis

Etiopathogenetic treatment
Nerve decompression
Removal of a tumor, scar, relief of inflammation in the damaged area
Detoxification therapy (desensitizing, decongestant and antibiotic therapy)
Improving nerve conduction and preventing neurodystrophic processes (triphosphadenine, vitamin complexes, acupuncture)
Improvement of synaptic conduction (neostigmine methyl sulfate)
Simulation of regeneration in the damaged area (electrophoresis and therapeutic drug blockade with neostigmine methyl sulfate, pyridoxine, hydrocortisone)
Stimulation of nervous and muscle activity, reflexogenic zones
Mobilization of the arytenoid joint
Surgical methods (larynx reinnervation, laryngotracheoplasty)

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

Treatment Goals

The goal of treatment is to restore the mobility of the elements of the larynx 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 laryngeal muscles 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.

Breathing exercises and phonopelia are of great importance. 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 vocal fold paralysis, regardless of the etiology of the disease, treatment is immediately started, aimed at stimulating the regeneration of nerves on the affected side, as well as cross and residual innervation of the larynx. Medicines are used that improve nerve, synaptic conduction and microcirculation, slowing down neurodystrophic processes in muscles.

Surgical treatment

Methods of surgical treatment of unilateral laryngeal paralysis:
reinnervation of the larynx;
thyroplasty;
implant surgery.

Surgical reinnervation of the larynx is carried out by neuro-, myo-, and neuromuscular plastic surgery. A wide variety of clinical manifestations of laryngeal paralysis, the dependence of the results of intervention on the duration of denervation, the degree of internal muscles of the larynx, the presence of concomitant pathology of the arytenoid cartilage, various individual characteristics of the regeneration of nerve fibers, the presence of syikinesia and poorly predictable distortion of the innervation of the larynx with the formation of scars in the surgical area 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 type 1 thyroplasty, in addition to medialization of the ogival fold, the arytenoid cartilage is displaced laterally and fixed with sutures using a window in the plate of the thyroid cartilage. 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 when fixing the arytenoid cartilage and on the side of paralysis.

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

Complications of implant surgery include:
spicy .
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 medication, physiotherapeutic and surgical treatment, patients are shown long-term sessions with a phonopedist, the purpose of which is the formation of correct phonation breathing and voice guidance, and the correction of impaired separation function of the larynx. Patients with bilateral paralysis must be observed with a frequency of examinations once every 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 rehabilitation of lost laryngeal functions, restoration of voice and breathing as early as possible.

The period of incapacity for work is 21 days. With bilateral laryngeal paralysis, patients' ability to work is severely limited. If it is one-sided (in the case of a voice profession), disability may be limited. However, when voice function is restored, these restrictions can be lifted.