Occupational diseases of the vocal apparatus, treatment. Causes, types, treatment of vocal cord paresis

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Human speech is an important part of life. Thanks to the voice, the expression of thoughts and communication, the manifestation of feelings is possible. Although speech is being successfully replaced by sign language, it is only by losing the voice that one can understand its value.

Ligaments and muscles are part of the true folds of the larynx - they are called vocal folds. But the term "vocal cords" continues to be used with success by doctors and speech therapists.

From the density of closure and the degree of tension vocal cords depends on the strength and height of the human voice.

Diseases of the vocal apparatus

Paresis is a partial disorder arbitrary movements folds, due to which the ligaments do not fully open during breathing and do not close enough during phonation (speech). By localization, paresis is unilateral or bilateral.

The complete absence of movement is called vocal cord paralysis.

Clinical manifestations

hoarseness of voice;
hoarseness;
lack of voice (aphonia);
rattling;
inability to pronounce individual sounds;
violation of articulation, tongue movements (with strokes, brain tumors);
sounded breath;
shortness of breath, up to suffocation.

Diagnostics

From laboratory methods diagnostics, general clinical and biochemical analyzes blood, bacterial cultures from the pharynx.

Among the instrumental ones, laryngoscopy, radiography, magnetic resonance and computed tomography, ultrasound, electromyography, stroboscopy, research voice function.

Which doctor diagnoses and treats this disease?

Paralytic diseases of the larynx are at the intersection of neurology and otolaryngology. Therefore, the attending physician can be both an ENT doctor (for laryngitis) and a neurologist (for strokes, neuropathies).

There is a specialty that studies and treats the vocal cords directly - phoniatrics, and the attending physician is called a phoniatrist.

Causes and types of paresis of the vocal folds

With paresis (paralysis) of any origin, the work of the muscles is primarily disrupted. If pathological process affects the muscle fibers themselves, then this disease is called myopathic paralysis.

If the transmission of the nerve impulse is disturbed, neuropathic paralysis and paresis develop.

Myopathic paralysis

For injuries internal muscles larynx with hemorrhages, with the germination of tumors, a violation of the voice occurs. The same happens when muscle fibers are unable to contract normally in response to nerve impulse- for example, when the body is poisoned with lead, heavy metals, toxins.

Neuropathic paralysis and paresis

The work of the nerve conductors and the brain can be disturbed for many reasons. Functional and organic neuropathic lesions are distinguished depending on the type of disorder, the site of damage, and the possibilities for recovery.

Functional paresis

Functional paresis occurs in neurosis, neurosis-like states, hysteria. This is primarily a discrepancy between the processes of inhibition and strong excitation in the cerebral cortex. Psycho-emotional stress causes the formation of a focus in the cerebral cortex, which blocks the production of the correct impulses.

Organic paresis and paralysis

Organic paresis has a worse prognosis as it is always the result of some kind of damage and is often irreversible. Organic neuropathic paresis is divided into central and peripheral.

At central paralysis the lesion is located in the brain, where the production of an impulse is blocked. This occurs with strokes, brain tumors, hemorrhages due to traumatic brain injury, damage to the neck and spine, neurosurgical operations.

This is the most extensive and widespread group of causative factors.

Traumatic recurrent nerve injury

Most often, the recurrent nerve suffers during operations on thyroid gland. It can be crossed completely or injured by instrumentation, suture material formed by a hematoma.

Disinfectants can also injure him. There have even been cases toxic action drugs for anesthesia.

The frequency of postoperative paresis and paralysis of the larynx reaches 3% if the intervention was performed for the first time. At reoperation the risk increases significantly, and the complication rate reaches 9%.

The recurrent nerve can be compressed by tumors of the neck and chest, an enlarged heart with its defects, protrusions of the esophagus or trachea.

Inflammatory processes in the larynx itself (laryngitis), especially with the formation of volumetric seals, also injure the recurrent nerve.

Recurrent nerve neuritis

Inflammatory. Usually caused by viruses;
Toxic. It develops in case of poisoning with organophosphorus compounds, sleeping pills, alkaloids;
Arising from a metabolic disorder, or dysmetabolic. Decreased levels of potassium and calcium, diabetes, enhancement function thyroid gland disrupt the innervation of the folds of the larynx.

Treatment

Psychotherapeutic methods

They are used for functional paresis, when it is necessary to eliminate the cause of the voice disorder. The attending physician in this case will be a psychotherapist or psychiatrist. Psychotherapeutic methods in combination with medication give good results in the treatment of functional disorders.

Phonopedic exercises

Phonopedia is teamwork phoniatrist and speech therapist. It is an excellent method of restoring voice function. It is used in conjunction with other types of treatment and in cases where they are ineffective, for all types of paresis or paralysis.

Phonopedic exercises help even when the work of the ligaments cannot be restored. Teaching a person a special technique of speaking with the help of the esophagus will allow him to return to a full life.

Medical therapy

It includes antibacterial and antiviral treatment with laryngitis, detoxification therapy - with damage by toxins.

Neuropathic forms of paresis require neuroprotective and vitamin therapy, dysmetabolic forms require normalization of metabolism. These can be potassium and calcium supplements, hormonal substances, B vitamins, vascular and metabolic preparations.

In addition, treatment of the underlying disease is mandatory - for example, normalization of glucose levels in diabetes mellitus.

For neuritis, substances that improve nerve conduction as well as anti-inflammatory treatment.

The attending physicians in this case are otolaryngologists, neurologists, endocrinologists, oncologists and other specialists.

Surgical methods

When medical and phonopedic methods do not help, surgeons come to the rescue.

There are different techniques recovery operations, phoniatrists specializing in reconstructive surgery are doing this.

Surgical intervention is used when tumors grow into the larynx, with extensive hemorrhages that are not amenable to conventional drugs, to change the position of the ligaments.

There is also a more gentle method - fixing the vocal cords in the desired position with the help of an implant. Over the past decade, there has been an active development of the most suitable and safe material for implantation. Currently, a biocompatible gel is used, which is injected into the folds of the larynx and securely fixes the vocal cords.

Treatment with implants is used for various options paresis and paralysis and practically does not give complications.

The appearance of sounds that we hear and pronounce during a conversation became possible thanks to the work of the vocal cords located in the human body. When we get sick or overload them excessively, the voice can become hoarse, hoarse, or completely disappear. Until the cause of this disorder is removed, the ability to speak loudly and clearly will not be restored. Why is this happening and how to deal with it?

Voice apparatus

We are able to pronounce sounds aloud thanks to the work of the muscular-connective structures located in the larynx, which are called the vocal cords. Between themselves they form a small gap.

Its size can vary depending on muscle tension.

In their fully closed position, air entering the larynx is excluded, so there are no sounds and, accordingly, no voices either.

Causes of violations

A change in the physiological size of the gap between the vocal cords occurs under the influence of external or internal factors. Among the main causes of diseases are:

hypothermia
overvoltage
Prolonged inhalation of dirty air
Chronic inflammation of the nasal and oral cavity
Infectious lesion
Allergy
Getting injured
Development of neoplasms

Smoking also has a negative effect on the work of the vocal cords. These factors have a direct impact on the health of the muscular-connective structures, from which they normal functioning may be violated. If there are microcracks on the ligaments, the risk of secondary infection increases.

Characteristic diseases

IN Lately often the cause of voice problems are tumors or various formations appearing on the links. It can be:

Granulomas are benign tumors.
Cancer is a malignant tumor.
- benign growths, which are the result of overload of the ligaments.
Polyps are non-threatening neoplasms located in the center of the muscular-connective structures.
Papillomas are warty-type formations caused by the presence of the human papillomavirus in the body.
Cysts - an accumulation on the surface of ligaments of mucus in a thin shell.
Scars - traces mechanical damage vocal cords.

It develops in the background psychological trauma, strong emotional experience or strain of ligaments. If they are annoyed infectious disease, this phenomenon has a name. The most common diseases that have complications on the muscular-connective structures of the ligaments are:

Flu
Rhinitis
Pneumonia

Violations in the work of the ligaments can be due to the presence of injuries or burns. Under the influence of a traumatic factor, tissues can swell, one feels strong pain in the throat, the swallowing function is impaired, a dry pressing cough develops, bleeding may open. Sometimes on the muscles as a result of injury, the presence of a hematoma is recorded. A burn can also affect the voice, not only thermal, but also chemical.

Often, ligament damage is caused by exposure to an allergen that enters the body through digestive tract and when taking medication. Depending on the concentration of the incoming immune-aggressive factor, in addition to problems with the voice, breathing difficulties may occur.

Possible forms of inflammation

Depending on the causes that caused the dysfunction of the vocal cords, there are several forms of their inflammation. Each of them has its own symptoms of manifestation:

Hypertrophic. It usually results from the development chronic disease. Nodules may form on the ligaments, the voice becomes hoarse.
Atrophic. Caused by atrophy of the mucous membrane of the larynx. Accompanied by a dry cough, sometimes coughing occurs with bloody sputum.
Catarrhal. It develops against the background of infection with the flu. Symptoms include itching, sore throat, and cough.
Diphtheria. Characterized by the presence white plaque on ties. Caused by the development of inflammatory processes.
Tuberculous. Wears infectious nature. Manifested by the development of tuberculous sores on the ligaments.

If any of these forms of the disorder occurs, there is a loss of sonority in the voice, the appearance of hissing or wheezing in it. During a conversation, you feel the tension that a person has to apply to communicate.

Diagnosis of diseases of the vocal cords

If problems with the voice are not resolved in about 2-3 days on their own, then most likely their appearance is based on some disease or disorder in the body.

To establish it and determine the appropriate course of treatment, you should consult a doctor. Make an appointment with an otolaryngologist.

It is he who will be engaged in the diagnosis of your ligaments and diagnosis. For this, the following are produced:

Examination of the throat with a medical spatula
External palpation of the cervical organs
Examination of the larynx using a laryngoscope
X-ray studies
Biopsy analysis (in the presence of formations on the ligaments)
Collection and research general analyzes blood and urine

Additionally, the nose and mouth are examined. If necessary, produce laryngastroboscopy. This is a test that evaluates the vibrations of the vocal cords. After determining the cause of voice problems, the most appropriate course of treatment is prescribed.

Treatment methods

In order for the outgoing sound of the voice to be correct, the cords must be well taut. If any problems arise with their muscles, first of all, any tension should be removed from them. After that, you should see a specialist. Treatment can be prescribed in the following areas:

Medical
Physiotherapy
Surgical
With the help of folk remedies

The choice of course directly depends on the degree of complexity of the case and the reasons that caused the disorder. Hospitalization of the patient may be required only in case of surgical intervention. In all other situations, treatment is carried out at home.

Medical therapy

The choice of drugs for treatment remains with the doctor. Their appointment is made taking into account the patient's symptoms:

For expectoration with a dry cough or sputum, Fluimicil, Bromhexidine are prescribed.
It is used to treat sores on the ligaments.
To relieve inflammation by inhalation: and Camphoment.
In chronic laryngitis: Bioparox aerosol.

In the absence of improvements, they can be assigned. They are also prescribed when found in sputum. blood secretions or pus.

If you strictly follow the established dosages and the regimen for the use of drugs prescribed for treatment, then acute inflammatory process managed to overcome within 7 days. With the development of a chronic disease, a temporary improvement in well-being will be achieved.

Physiotherapy

As an independent type of treatment, they are used quite rarely. Most often, a visit to physiotherapy is prescribed as an additional therapy. In diseases of the vocal cords, they are directed to:

microwave therapy
front of the neck

The duration of each procedure and general course repetitions are prescribed by the attending physician. When prescribing inhalations, the patient can perform them at home using a nebulizer apparatus or a container (usually a pan).

Surgery

Surgery on the vocal cords is performed in case of complications, malignant tumors or established inefficiency drug therapy. For proper recovery ligaments after surgical intervention the patient must follow the rules of rehabilitation:

Silence the first day after surgery
Limit voice mode for a week after surgery
Do not eat or drink for 1-2 hours after coming out of anesthesia
Refrain from coughing
Avoid strong odors, including tobacco
Avoid physical activity for a week
Do not visit saunas, baths, pools for 7 days
Do not eat spicy food

If recovery period after the operation was successful, then quite quickly the patient manages to return to habitual life. Sometimes medications or physiotherapy may be prescribed in the postoperative period to speed up the healing process.

Treatment of pathologies

It is a pathology from which it is impossible to recover completely. But if no action is taken at all, the risk of complications increases. This can be avoided by injections of botulinum toxin, which are performed directly into the muscles of the ligaments. Their impact causes paralysis of the muscles, which led to involuntary contractions of the ligaments.

The injection is performed through the tissues of the neck in outpatient settings. After that, the patient is allowed to go home. For a short time after the injection, speech may be aspirated.

Folk methods

At mild form disorders of the vocal cords, procedures performed at home may be enough to restore them. Alternative medicine offers:

Cocktail from butter and chicken yolks
Gargling with a decoction of onion peel
Inhalations over potatoes "in uniform"
Milk and honey cocktail

Quickly relieve pain and sore throat in the absence of medicines at hand will help the resorption of a small piece of sweet chocolate. For all its simplicity and effectiveness folk recipes require approval from the attending physician before use.

Forecast

With strict adherence to all medical advice the prognosis for restoring the functionality of the vocal cords is very favorable. To preserve their health, measures should be taken to prevent the development of inflammation, avoid injuries and negative impact environmental factors on the throat.

- various disorders of the voice function due to pathological condition vocal organs. Voice disorders are manifested by him insufficient force, height, distortion of timbre, voice fatigue, perspiration, pain, "lump" in the throat. In case of voice disorders, the patient should be consulted by an otolaryngologist and a phoniatrist with a study of the voice function, and also examined by a speech therapist. Overcoming voice disorders includes medical measures(medication or surgery, FTL, psychotherapy) and speech therapy (voice mode, breathing and articulation exercises, phonopedic exercises, etc.).

ICD-10

R49

General information

Voice disorders are a group of voice disorders characterized by partial or total absence phonations. Voice disorders are more common in voice-speech professions (teachers, lecturers, actors, singers, etc.) . Thus, about 60% of teachers suffer from voice disorders, 6-24% of adolescents in the period of mutation and 41% of children with speech problems. In turn, voice disorders impede the full development of speech and communication, worsen the neuropsychic state, and impose restrictions on the choice of profession.

Voice disorders are medical and social problem, therefore, they are studied by medical and pedagogical disciplines - otolaryngology (and its highly specialized section - phoniatrics), neurology, psychiatry, speech therapy (and its highly specialized direction - phonopedia).

Classification of voice disorders

According to the degree of phonation disorder, dysphonia (partial violation of the strength, pitch and timbre of the voice) and aphonia (lack of voice) are distinguished. With dysphonia, the voice becomes deaf, hoarse, hoarse, unmodulated, breaking, quickly drying up, sometimes nasalized. Aphonia is characterized by the complete absence of the sound of the voice and the ability to speak only in a whisper.

According to the causes and mechanisms of phonation disorders, there are:

central (psychogenic aphonia or hysterical mutism)
peripheral (phonasthenia, hypotonic and hypertonic dysphonia or aphonia, pathological mutation)

central (dysphonia and aphonia with dysarthria and anartria)
peripheral (dysphonia and aphonia in diseases of the larynx; rhinophonia).

Causes

Central organic voice disorders are associated with paralysis and paresis of the vocal cords, caused by damage to the brain stem or cortex, which conduct neural pathways. Central organic voice disorders are found in children with cerebral palsy.

Causes of peripheral organic disorders voices are various inflammatory diseases or anatomical changes in the vocal apparatus. Among them are chronic laryngitis, burns and injuries of the larynx, peripheral paresis and paralysis (with damage recurrent nerve), “singing nodules”, tumors (papillomatosis) of the larynx, postoperative scars and laryngeal stenoses, a condition following a laryngeal resection or laryngectomy.

With functional disorders of the voice, the activity of the vocal apparatus is impaired in the absence of organic damage. Central functional voice disorders (psychogenic aphonia) are the result of an acute psycho-traumatic situation. More often occurs in women prone to neurotic reactions.

Peripheral functional disorders of the voice by the type of phonasthenia can be caused by excessive vocal loads, non-compliance with the voice mode during respiratory diseases. Pathological voice mutation in adolescents may be due to endocrine disorders, early smoking, overload of the vocal apparatus during this period. Hypotonic dysphonia and aphonia are most often caused by bilateral myopathic paresis (paresis of the internal muscles of the larynx) caused by SARS, diphtheria, influenza, strong tension vote. The development of hypertonic (spastic) dysphonia and aphonia is usually associated with excessive forcing of the voice.

Symptoms of organic voice disorders

Voice disorders in chronic laryngitis caused by damage to the neuromuscular apparatus of the larynx and non-closure vocal folds. A voice defect is expressed by the loss of normal sound, severe fatigue, and sometimes the inability to perform a voice load. Unpleasant subjective sensations in the throat are characteristic - scratching, perspiration, soreness, feeling of a "lump", pain, pressure.

In the case of peripheral paralysis and paresis of the larynx, the voice may be completely absent or have a hoarse sound. Voice disturbance is accompanied by severe speech fatigue, reflex cough, choking, respiratory distress. Discoordination of phonation and respiration significantly aggravates the defect.

Voice disorders associated with benign and malignant tumors of the larynx develop gradually, as the formations grow. After any, even sparing, surgical intervention on the larynx, transient voice disorders. When the larynx is removed, a person completely loses his voice; at the same time, the respiratory function is sharply disturbed, since the trachea and pharynx are separated.

With central paresis and paralysis of the larynx, observed in dysarthria and anarthria, the voice becomes weak, quiet, intermittent, deaf, monotonous, often with a nasal tone.

Organic voice disorders that arose in a child early age, are accompanied by a lag in speech development, delayed vocabulary accumulation and development of grammatical structures, impaired pronunciation, communication difficulties, and limited social contacts. Voice disorders that develop in adulthood can lead to professional unsuitability.

Symptoms of functional voice disorders

Being peripheral functional disorder voices, phonasthenia is a professional "disease" of people in voice professions. The manifestations of phonasthenia include the inability to arbitrarily adjust the sound of the voice, (strengthen or weaken), interruption (misfires) and rapid fatigue of the voice, hoarseness. IN acute period in phonasthenia, the voice may disappear altogether. In most cases, phonasthenia does not require treatment; the voice recovers on its own after a period of rest.

With hypotonic dysphonia due to paresis of the internal muscles of the larynx, non-closure of the vocal folds develops, which is manifested by hoarseness of voice, voice fatigue, pain in the muscles of the neck and neck; in severe cases, only whispered speech is possible. With hypertonic dysphonia, caused by tonic spasm of the laryngeal muscles, the voice is distorted, becomes deaf, rough; with aphonia - does not occur at all.

A pathological mutation can be expressed in the preservation of a high-pitched voice after the expiration of puberty, voice instability (alternating low and high tones), dysphonic sound, etc.

Functional disturbance of the voice of the central character (hysterical mutism, psychogenic aphonia) is characterized by a complete simultaneous loss of voice, the impossibility of whispering speech, but at the same time preserved sonorous laughter and coughing. Important differential sign is the variability of the form of non-closure of the vocal folds. Flow psychogenic disorder voices are long, repeated relapses are possible after restoration of the voice.

Diagnostics

Establishing the causes of voice disorders is carried out by an otolaryngologist, phoniatrist, neurologist; study of the main characteristics of the voice - speech therapist. Laryngoscopy is performed to detect anatomical or inflammatory changes in the vocal apparatus; in order to assess the function of the vocal folds - stroboscopy. In the diagnosis of tumor lesions, radiography and MSCT of the larynx are indispensable. To obtain information about the function of the muscles of the larynx, electromyography is performed. With the help of electroglottography, changes in the vocal apparatus in dynamics are evaluated.

Speech therapy work on the restoration of voice disorders should be started as early as possible in order to prevent the fixation of pathological voicing, to achieve best results, prevent the development neurotic reactions for a defect. Main directions corrective work include psychotherapy, breathing correction, development of phonation and articulation coordination, automation of achieved skills and introduction of voice into free speech communication. In speech therapy classes for the correction of dysphonia, respiratory and articulation gymnastics phonopedic exercises. In patients after extirpation of the larynx, work is carried out on the formation of the esophageal voice.

Forecast and prevention

The effectiveness of the correction of voice disorders largely depends on their cause, the timing of the start of treatment and speech therapy classes. With rough anatomical changes of the vocal apparatus and central paralysis, it is usually possible to achieve only one degree or another of improvement. Functional voice disorders, as a rule, are eliminated completely, however, if the recommendations of a speech therapist are not followed, relapses are possible. Importance in the success of the correction of voice disorders belongs to the organization and perseverance of the patient.

In order to prevent voice disorders, it is necessary to cultivate correct voice habits (do not force the voice), prevention colds, quitting smoking and alcohol, taking excessively chilled and hot food. Persons of vocal professions must master the skills of diaphragmatic breathing and correct voice delivery. Any, even the smallest, cold is unacceptable to endure on your feet; during the period of illness, a sparing voice regimen should be observed.

ICD-10 code

Hygiene and protection of the voice of children

1.2.. Diseases of the vocal apparatus and their prevention

The most common cause of dysfunction of the vocal apparatus are acute inflammatory diseases of the upper respiratory tract, tonsillitis (tonsillitis), coryza(rhinitis), inflammation of the pharynx (pharyngitis), larynx (laryngitis), trachea (tracheitis) and bronchi (bronchitis). In this case, speech loads and singing should be stopped until recovery. For prevention inflammatory diseases upper respiratory tract should avoid hypothermia and harden the body.

Singing nodules are diseases associated with an increased professional load on the voice. They are acute and chronic, chronic. The reason for their appearance increased load on the vocal apparatus, incorrect forced singing. Acute nodules usually resolve spontaneously when vocal rest is provided. Old nodules are usually removed operational way. The appearance of nodules on the ligaments can lead to a change in the timbre of the voice (hoarseness appears), a decrease in its range. In order to avoid their recurrence, it is advisable not to overload the voice apparatus.

The diseases associated with the increased exploitation of the voice also include hemorrhage in the vocal fold. It occurs with a sharp voltage (shout, forcing). The voice immediately “sits down”, and voice formation becomes impossible. With absolute voice rest, the hemorrhage gradually resolves and may pass without a trace.

Dysphonia is a disorder of voice formation, occurring either in the form of a weakening of the activity of the vocal folds (non-closure), or in a spasmodic form (re-opening, spasms). This is usually the result of overvoltage. nervous system, enhanced voice activity, often occurring against the background of some kind of infection.

The voice apparatus sensitively reacts to any negative changes in general condition organism. Mental overload, overwork of the vocal apparatus, abuse of upper sounds, screaming, illness can cause voice diseases.

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