Throat paresis — the reduction of physical activity of muscles of a throat leading to violation of a phonation and respiratory function. Paresis of a throat can be connected with pathology of guttural muscles, damage of the innervating their nerves or functional violations in a cerebral cortex. Clinically paresis of a throat is shown by weakness, hoarseness or an osiplost of a voice, sometimes a full aphonia; various extent of difficulty of breath up to asphyxia. Diagnosis of paresis of a throat is based on a laringoskopiya, KT and a X-ray analysis of a throat, dab bakposeva from a pharynx, an electromyography, a fonation research, according to indications examination of bodies of a chest cavity, thyroid gland and brain is conducted. Treatment of paresis of a throat generally comes down to elimination of the reason which caused them and restoration of voice function.
The throat represents the site of the top airways between a throat and a trachea performing respiratory and golosoobrazuyushchy function. In a throat vocal chords between which crack carries the name voice are cross tense. The phonation (fonation) is carried out due to fluctuations of vocal chords when passing air through a glottis. On the other hand, too dense smykaniye of vocal chords interferes with intake of air in airways and leads to violations of respiratory function of a throat. Narrowing and expansion of a glottis, and also degree of a tension of vocal chords are regulated by internal muscles of a throat. Work of the muscular device of a throat is carried out thanks to the nervous impulses arriving on branches of the wandering nerve from the central nervous system (bark and a trunk of a brain). At emergence of violations on any site of this interconnected system, from muscles to a cerebral cortex, throat paresis develops.
Paresis of a throat can be observed at persons of both floors and any age. Plurality of the reasons leading to emergence of paresis of a throat causes the big list of clinical disciplines which are engaged in diagnostics and treatment of this pathology. It is otolaryngology, neurology, neurosurgery, endocrinology, pulmonology, cardiology, thoracic surgery, psychology and psychiatry.
Classification of paresis of a throat
Paresis of a throat classifies depending on their etiology. Allocate:
- Miopatichesky paresis of a throat — results from pathological changes in muscles of a throat.
- Neyropatichesky paresis of a throat — develops at defeat of any site of the nervous device providing an innervation of muscles of a throat. At pathology of the wandering nerve or its branches innervating a throat speak about peripheral paresis of a throat. At damage of a kernel of the wandering nerve to a brain trunk — about bulbarny paresis. At violations at the level of the appropriate carrying-out ways and sites of a cerebral cortex — about cortical paresis of a throat.
- Functional paresis of a throat — is caused by violations in work of a cerebral cortex with emergence of an imbalance of processes of braking and excitement.
Paresis of a throat can be one - and bilateral. Functional and cortical paresis of a throat always has bilateral character.
Causes of paresis of a throat
Paresis of a throat is polietiologichesky pathology and often develops against the background of other diseases. So, paresis of a throat can be observed at inflammatory diseases of a throat (laryngitis, laryngotracheitis), infections (a SARS, flu, tuberculosis, sypny and a typhoid, secondary and tertiary syphilis, botulism, poliomyelitis), a myasthenia, a polimiozita, a craniocereberal trauma, a siringomiyeliya, tumors and vascular disorders (atherosclerosis, a hemorrhagic stroke, an ischemic stroke) of a brain, throat injuries.
Development of paresis of a throat can be connected with damage of branches of the wandering nerve — the returnable nerves suitable to a throat from a chest cavity and on the way contacting to heart, an aorta arch, lungs, a sredosteniye, a thyroid gland and a gullet. Treat pathological changes of these bodies from which the sdavleniye or injury of a returnable nerve can result: aorta aneurism, perikardit, pleurisy, tumors and increase in lifouzl of a sredosteniye, diverticulums and tumors of a gullet, the gullet cancer, cervical lymphadenitis, cancer of a thyroid gland and its disease proceeding with formation of a craw (autoimmune tireoidit, iodine deficiency diseases, a diffusion toxic craw).
Paresis of a throat can be provoked by the raised voice loading and inhalation during the conversation of the cold, dusty or smoke-filled air that is often connected with professional activity at actors, singers, teachers, front commanders. Functional paresis of a throat arises as result of a stress and strong psycho-emotional experience. They can develop against the background of a psychopathia, hysteria and a neurasthenia, vegeto-vascular dystonia.
Symptoms of paresis of a throat
The clinical picture of paresis of a throat consists of violations of a voice (dysphonia) and violations of breath. Its main manifestations are: decrease in sonority of a voice which in rare instances can reach a full aphonia (lack of a voice); shepotny speech, loss of individual coloring (timbre) of a voice; hoarseness, jingle or osiplost of a voice; fatigue at voice loading. Violations of breath at paresis of a throat are connected with difficulty of intake of air in airways because of narrowing of a glottis and can be expressed in various degree, up to asphyxia. In other cases of violation of breath are caused by need of commission of the forced exhalation for implementation of a fonation. Depending on a type of paresis of a throat its clinical manifestations have some features.
Miopatichesky paresis of a throat is characterized by bilateral defeat. It can be shown by violations of a fonation (at paresis of muscles adductors of a throat) or respiratory violations in the form of asphyxia (at paresis of muscles dilators of a throat).
Neyropatichesky paresis of a throat often happens unilateral and differs in gradual development of weakness in the muscle expanding a glottis and then and in throat adductors in the beginning. At the same time in several months of a disease there is a restoration of a fonation due to the compensatory strengthened reduction of a voice sheaf on the healthy party. Bilateral neyropatichesky paresis of a throat threatens with asphyxia in the first 1-2 days of a disease.
Functional paresis of a throat is usually observed at persons with labile nervous system after the postponed psycho-emotional loading or a respiratory disease. The coming nature of violations of a fonation with sufficient sonority of a voice is characteristic of this type of paresis of a throat during crying, cough and laughter; existence of the expressed subjective feelings (irritation, tickling, a gnash, pain and so forth) in a throat and a throat; neurotic character of the accompanying complaints of the patient: headache, irritability, fatigue, sleep disorder, unbalance, uneasiness.
Diagnosis of paresis of a throat
At diagnosis of paresis of a throat participation of several experts often is required: otolaryngologist, neuropsychiatrist, neurologist, neurosurgeon, thoracic surgeon, pulmonologist, endocrinologist, psychiatrist, foniator. Collecting the anamnesis which can reveal the main disease against the background of which there was throat paresis, and tendency of the patient to psychogenic reactions is important. Important value has the instruction on the postponed surgeries on bodies of a thorax or a thyroid gland as a result of which the returnable nerve could be injured.
Inspection of patients with paresis of a throat is begun with a laringoskopiya during which estimate the provision of vocal chords, distance between them, a condition of a mucous throat, existence of inflammatory changes or hemorrhages. Also the X-ray analysis and MSKT of a throat is carried out. Assessment of sokratitelny ability of muscles of a throat and neuro and muscular transfer is made by means of an electromyography and an elektroneyrografiya. The research of voice function at paresis of a throat includes: definition of time of the maximum fonation, stroboskopiya, fonetografiya, elektroglottografiya.
At suspicion of peripheral paresis of a throat carry in addition out KT and a survey X-ray analysis of bodies of a thorax, ultrasonography of a thyroid gland, ultrasonography of heart, sredosteniye KT, a gullet X-ray analysis. For an exception central (bulbarny or cortical) paralysis of a throat carry out brain MPT and KT, and also spiral KT. Lack of any morphological changes when carrying out comprehensive inspection of the patient speaks about existence of functional paresis of a throat. For confirmation of the last psychological testing of the patient and his survey by the psychiatrist is held.
Treatment of paresis of a throat
Therapy of paresis of a throat directly depends on their etiology and consists first of all in elimination of the main disease which was the reason of paresis. Treatment of paresis of a throat can be carried out as it is medicamentous, and surgically.
Treat medicamentous methods: a course of antibiotic treatment or antiviral therapy at an infectious and inflammatory etiology of paresis of a throat; neuroprotectors and vitamins of group B at neuritis of a returnable nerve; biogenous stimulators and stimulators of muscular activity (, an aloe, ATP) at the miopatichesky nature of paresis of a throat; psychotropic drugs (neuroleptics, antidepressants, sedative, tranquilizers) at functional paresis of a throat; vascular medicines and nootropa at consequences of a craniocereberal trauma or stroke.
From surgical methods at throat paresis according to indications are applied: operation on a tension of vocal chords, removal of diverticulums and tumors of a gullet, removal of new growths of a sredosteniye, tireoidektomiya or resection of a thyroid gland and so forth. In an urgent order at development of asphyxia tracheotomy and a trakheostomiya is made.
Physiotherapeutic methods of treatment are demanded at any kind of paresis of a throat. At neyropatichesky and miopatichesky paresis of a throat electrostimulation, a medicinal electrophoresis, magnetotherapy, microwave therapy, DDT are applied, at functional paresis of a throat — massage, balneotherapy, reflexotherapy, an electrodream. At the functional nature of paralysis the rational psychotherapy is also shown.
In an initial stage of paresis of a throat it is recommended to patient to avoid voice loading, to observe a work-rest schedule. During recovery for restoration of voice function the fonopedichesky classes including development of skills of the correct fonation and fonatsionny breath, increase in operability of the voice device are given. If necessary the patient also attends vocal classes.
Forecast and prevention of paresis of a throat
The forecast of paresis of a throat depends on its look. At elimination of an etiologichesky factor of paresis and in due time carried out treatment the complete recovery of voice function usually is observed, however vocal skills of a voice often are irrevocably lost. In case of functional paresis there can be a sudden spontaneous recovery of the patient. It is long the existing paresis of a throat leads to irreversible atrophic changes of guttural muscles with development of permanent violations of a fonation.
Prevention of paresis of a throat is rationing of voice loading; avoiding overcooling of a throat and long stay in dusty rooms; timely and adequate treatment of inflammatory diseases of the top airways, infectious diseases, neurosises, diseases of bodies of a thorax and thyroid gland; observance of operating rooms the technician at interventions on a thyroid gland.