A vocal cord paralysis can have many causes and may affect speaking, breathing and swallowing. The left vocal cord is affected twice as often as the right, and women are affected (in a ratio of 3: 2) more often than men. The diagnosis is based on the findings of laryngoscopy. To determine the cause an extensive investigation may be necessary. If the cause can not cure, there are several surgical methods to choose from.

A vocal cord paralysis can originate from nerve lesions in the area of ??the nucleus ambiguous supranuclear or webs of the vagus main trunk, or the recurrent laryngeal nerve. The left vocal cord is more common than the right paralyzed, because the left recurrent nerve takes a longer path from the brain stem to the larynx, which is more opportunity for compression, traction or surgical injury.

A vocal cord paralysis can have many causes and may affect speaking, breathing and swallowing. The left vocal cord is affected twice as often as the right, and women are affected (in a ratio of 3: 2) more often than men. The diagnosis is based on the findings of laryngoscopy. To determine the cause an elaborate investigation may be necessary. If the cause can not cure, there are several surgical methods to choose from. A vocal cord paralysis can originate from nerve lesions in the area of ??the nucleus ambiguous supranuclear or webs of the vagus main trunk, or the recurrent laryngeal nerve. The left vocal cord is more common than the right paralyzed, because the left recurrent nerve takes a longer path from the brain stem to the larynx, which is more opportunity for compression, traction or surgical injury. The unilateral vocal fold paralysis is most common. Approximately one third of the unilateral paralysis is due neoplastic, another third traumatic and the remaining third idiopathic. Intracranial tumors, vascular insults and demyelinating diseases cause damage to the nucleus ambiguus to a Vagusparalyse can be caused by tumors at the base of the skull or neck injury. Lesions in the neck or Thorakalraum (such as aortic aneurysm, mitral stenosis, mediastinal lymph node tuberculosis, thyroid, esophagus, lung, or mediastinal tumors), trauma, thyroidectomy, neurotoxins (z. B. lead, arsenic, mercury), neurotoxic infections (eg. B . diphtheria), cervical spine injury or operation, Lyme disease or viral infections can cause Rekurrenslähmung. For most idiopathic cases a viral neuronitis may be responsible. A bilateral vocal cord paralysis is life-threatening. It can occur after a thyroid or neck surgery, endotracheal intubation, trauma or neurodegenerative and neuromuscular diseases. Symptoms and complaints When a vocal cord paralysis go abduction and Adduktionsfähigkeit the vocal cords lost. This can affect breathing, speaking and swallowing, so solid and liquid food is sometimes aspirated into the trachea. The paralyzed vocal cord differs generally about 2-3 mm from the center line from (paramedian). In a Rekurrenslähmung she can probably during phonation, but do not move when inhaled. A unilateral vocal cord paralysis can be the voice hoarse and breathy (breathy) sound, but rarely leads to airway obstruction, since the normal vocal fold is wide enough abducted. With a two-sided paralysis are generally both vocal folds 2-3 mm paramedian; the voice quality is good, though not very strong (loud) and has pitch modulation. But the breathing air can not flow properly, because both vocal folds are drawn by a Bernoulli effect by inhalation to the middle of the larynx; induces inspiratory stridor and performs even moderate effort dyspnea. There is also risk of aspiration. Diagnostic laryngoscopy Various tests for possible causes The diagnosis of vocal cord paralysis based on laryngoscopic examination. It should be always looking for the cause. Here you can be guided by patient history or signs on physical examination findings discovered. In the medical history, the doctor should by all possible causes of peripheral neuropathy ask – heavy metals (arsenic, lead, mercury), side effects of medications (phenytoin or vincristine) or connective tissue disease, Lyme disease, sarcoidosis, diabetes and alcoholism in prehistory. As further investigations CT may be considered with contrast enhancement or MRI (head, neck, thorax), thyroid scintigraphy, barium swallow or bronchoscopy and esophagoscopy. Since the articulation cricoarytenoidea may be fixed by a arthritis, must be the differential diagnosis to distinguish between an arthritic and a neuromuscular cause. A fixation can be shown best understood from the lack of passive mobility (examination with rigid laryngoscope in general anesthesia). A Cricoarytenoid arthritis could be such. have developed as a complication of rheumatoid arthritis, according to an obtuse external trauma or prolonged tracheal intubation example. Therapy Surgical intervention in unilateral paralysis, so that the vocal folds back approach Surgery at bilateral paralysis and measures to secure the airway In unilateral paralysis treatment (augmentation, medialisation or reinnervation of the vocal cord) to improve the voice quality targets. Augmentation (enlargement) plasticizer paste, collagen, micronized dermis or autologous fat is injected into the paralyzed vocal cord, so that both vocal cords closer again; characterized the voice quality is improved and prevents aspiration. Medialisation means that an adjustable spacer is introduced next to the affected vocal fold, to bring it more to the center line again. Since the procedure can be performed under local anesthesia, the placement of the spacer can “tune” exactly to the patient’s voice. A reinnervation was previously only rarely successful. With bilateral vocal cord paralysis is necessary to ensure a sufficient passage of breathing air. For this purpose, a permanent or temporary tracheotomy (z. B. at an upper respiratory infection) may be required. If a Arytenoidektomie performed for widening of the glottis, although can better flow through the air, but with negative consequences for the voice quality. Compared to an endoscopic or open Arytenoidektomie the transection of the posterior vocal cord laser (posterior laser cordectomy) is preferable. If it is possible with the laser treatment to ensure a sufficient airway in the back larynx, usually a (long-term) is required tracheotomy, and the voice also is maintained in usable quality. Summary An vocal cord paralysis can be from a lesion somewhere in the Nevenbahnen to the larynx (nucleus ambiguus, supranuclear webs vagus main trunk, the recurrent laryngeal nerve) may be caused. Most paralysis is unilateral and mainly concern the voice, but it can also double-sided paralysis occur and obstruct the airway. Paralysis is diagnosed by a direct laryngoscopy, identification of the cause, however, typically requires imaging (z. B. MRI), and further tests. Patients with bilateral paralysis often first require tracheal intubation. Various surgical procedures are available to improve the voice quality in unilateral paralysis or improve airway patency in long-term bilateral paralysis.

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