Recurrent palsy

Synonyms

Vocal cord paralysis, vocal cord paralysis, dysphonia
English: vocal cord paresis / paralysis

definition

Recurrent palsy (vocal cord or vocal cord paralysis) refers to the weakness or failure of the larynx muscles and the vocal cords as a result of damage to the Vocal cord nerves (Recurrent laryngeal nerve).

The term is made up of the name of the nerve (Recurrent laryngeal nerve), which is damaged, and the Greek term for paralysis (paresis).

introduction

The Vocal folds or vocal cords belong to the voice-forming apparatus of the Larynx.
It is made up of:

• one left and
• one right Vocal cord.

Through the Recurrent laryngeal nerve are movement instructions to the inner Larynx muscles given what is important for voice training.

The recurrent laryngeal nerve gets its name because of its special nature anatomical Course, as it first extends into the neck area into the Rib cage leaves, but then turns back and goes to Larynx comes back (from Latin: recurrere).

In the Voice training (Phonation) the vocal cords, which are appropriately tensioned by the larynx muscles, are removed from the lung blown in Vibrations offset and thus create the voice of each individual.

One of those nerves falls out, the vocal cords can no longer be adequately tensioned and thus cannot be made to vibrate properly. If this occurs, it can lead to typical symptoms Recurrent palsy come.
These arise because the vocal cords for a perfect voice down to a few millimeters approach must, but at the same time also when breathing as far as possible from each other away must be so that air can be inhaled and exhaled undisturbed. These two important functions are disturbed in recurrent palsy.

Symptoms

Regarding the symptoms of a Recurrent palsy you have to choose between one one-sided and one bilateral Recurrent palsy is different depending on whether just one or both vocal cords fail due to the nerve damage.

In the one-sided Recurrent palsy due to the failure of the Vocal nerve on this side the vocal cord stands on the affected side in the so-called Paramedian position. This means that the agility this vocal cord is restricted. Due to this misalignment, it can be moderately pronounced in the affected patient hoarseness as well as one Volume loss come in the voice. Often times, patients also lose the ability to scream or to to sing.

In the bilateral Recurrent palsy, i.e. a failure of the entire larynx muscles, occurs more serious Symptoms.
Among other things, patients complain about:

• Shortness of breath,
• Strength hoarseness such as
• Stridor, which means a loud hissing or whistling sound when you breathe.

The Shortness of breath arises from the fact that both vocal folds in the so-called Paramedian position and thereby reduce the size of the window for air flowing in and out so that there is a risk of breathlessness.
In addition, the Removal of mucus from the bronchi and the lungs is made more difficult by the narrow position of the vocal cords, so that it is more common in the wake of viral and bacterial Infections can come.

causes

Since the nerve is in close proximity to the thyroid (Thyroid gland), surgery on the thyroid gland, for example because of a tumor or a goiter, is the most common cause of recurrent palsy.

However, recurrent palsy can also result from:

• a large thyroid tumor,
• due to a tumor from another neighboring area,
• through a metastasis or
• from a viral infection involving the nerves.

In general, all surgical interventions in the neck and thyroid area, such as operations on the cervical spine or operations on the heart, are considered to be a risk of recurrent palsy.

Rarer causes of recurrent palsy can also be a large bulge in the main artery (aortic aneurysm), Parkinson's disease and various forms of nerve inflammation (neuritis) be. In addition to these causes, there are also drugs that, as side effects, can cause symptoms that can be similar to recurrent palsy.

Recurrent palsy can also occur in the context of a stellate ganglion blockage if the local anesthetic spreads in the tissue. The consequences are hoarseness, coughing and even shortness of breath. Read more about this under: Stellate ganglion blockage

diagnosis

The diagnosis is mostly made by the ENT doctor or the Phoniatristbased on classic findings such as hoarseness and Shortness of breath the position of the vocal folds in a Larynxoscopy (Laryngoscopy) can check. This can be used to ascertain whether the symptoms are due to vocal cord paralysis or other possible reasons.

therapy

Also with the therapy must be between one-sided and one bilateral Recurrent palsy can be distinguished.

At a one-sided Recurrent palsy can often result in the full vocal training ability through targeted Voice training to be restored.

At a bilateral Recurrent palsy usually involves the elimination of the therapy Shortness of breath in the foreground. Often a Tracheal incision (Tracheotomy) and then a Breath piece (Tracheostomy) should be placed in this slot so that the patient can breathe better.
In this tracheostoma a Speaking cannula can be used so that the patient can communicate again despite complete recurrent palsy.

If the vocal cord nerve is only partially damaged, the nerve function can be targeted Electrical stimulation to be restored. If there is no improvement in function after one year, it is surgery indicated to avoid permanent use of a tracheostoma for infection. In the operations that are then possible, the glottis is surgically enlarged by a laser so that breathing becomes easier again and the agonizing feeling of shortness of breath disappears.

Prophylaxis and prognosis

Since the Recurrent palsy occurs particularly frequently during operations, great caution and the surgeon's expertise are crucial for the likelihood that the patient will suffer from recurrent palsy after the operation.

Today, many injuries can be avoided by having an accurate one during surgery monitoring of both Nervi laryngei recurrens (Neuromonitoring) takes place, so that the surgeon immediately through a acoustic Signal notices when it gets too close to the nerve.