What is laryngeal paresis and how to treat it?

Laryngeal paresis is a condition in which the motor activity of the muscles of the larynx is pathologically reduced and the closure of the vocal folds is impaired, which leads to changes and loss of voice, as well as problems with the respiratory function of the larynx. Most often, the disease is associated with disruption of the functioning of the nerves that transmit signals to the muscles of the larynx, which can occur when they are compressed, involved in any pathological process, or damaged due to surgery or injury.

Pathology can occur at any age, in both women and men. Paresis of the left half of the larynx is most often diagnosed. Laryngeal paralysis indicates that the activity of the laryngeal muscles does not return within 12 months. If this pathology occurs, it is necessary to consult a doctor, carry out a diagnosis and find out the causes. Because the sooner treatment is started, the more opportunities there will be to restore the voice and normal functionality of the larynx.

What are the causes of paresis and paralysis of the larynx?

Pathologies of this type can occur with changes in the muscles of the larynx and with various lesions associated with the transmission of nerve impulses. This type of disorder can be provoked by many diseases, for example, it can occur against the background of inflammation of the larynx (laryngitis), infectious diseases (ARVI, influenza, tuberculosis, etc.), it can be diagnosed with vascular disorders (paresis of the larynx after a stroke), tumors of the brain, neck and chest.

Most often, neuropathic paresis of the larynx occurs, the causes of which can be divided into three groups:

• Compression of nerves. Pressure on the nerve trunk may appear due to the appearance of a neoplasm in the neck or chest area, protrusion of the trachea or esophagus, hematoma, hypertrophy of the heart and aortic arch, and may occur with a number of disorders of the contractility of the heart.
• Medical injuries. They occur during surgery on the neck or chest, for example, after surgery on the thyroid gland.
• Neuritis of various etiologies. These can be inflammatory processes affecting nervous tissue, toxic poisoning, consequences of the progression of a number of diseases that negatively affect metabolic processes.

Symptoms and signs of laryngeal paresis

Characteristic symptoms of laryngeal paresis include:

• Hoarseness of voice, rattling, inability to say something loudly, in some cases up to complete loss of voice.
• Breathing difficulty that occurs due to a narrowing of the glottis. In severe cases, asphyxia (breathing problems) can develop, which is a life-threatening condition.

Pathology can occur abruptly or develop gradually. In the second case, tickling, coughing, and a sensation of a foreign body in the throat may first appear. Ligament paralysis is recorded if both ligaments are involved in the process. In severe cases, severe breathing problems may require immediate medical attention.

Types of laryngeal paresis

Doctors distinguish the following types of laryngeal paresis depending on the causes of the pathology:

• Neuropathic laryngeal paresis. The most common group of pathologies. It is diagnosed when the innervation of the muscles is disrupted. If the pathology occurs due to damage to the nerve that transmits impulses to the muscles, this is called peripheral paresis. When disorders are localized in the brain stem, bulbar paresis is diagnosed. If the damage is associated with the cerebral cortex, this is called cortical paresis.
• Myopathic paresis of the larynx. The changes that lead to loss of muscle strength occur in the muscles themselves.
• Functional paresis of the larynx. They appear when the functioning of the central nervous system is disrupted, and no structural disturbances occur with this form of pathology.

Complete and partial, unilateral and bilateral laryngeal paresis can also be diagnosed.

Unilateral laryngeal paresis

This is a more common form of the disease than bilateral. Moreover, left-sided laryngeal paresis is much more common. When one side is affected, neuropathic disorders are usually diagnosed.

A hoarse voice is a characteristic sign of this type of pathology. Voice problems in this case often develop gradually. But at the same time, the airways are not closed, because a healthy vocal cord works normally. Difficulty breathing is not typical for this type of disease.

Bilateral laryngeal paresis

Myopathic disorders are often bilateral. When the muscles on both sides are affected, the voice is often preserved, but its volume decreases.

In this case, both vocal cords are pulled closer to the middle of the larynx, which causes shortness of breath and whistling sounds, and asphyxia develops. Urgent surgery (tracheostomy) may be required in severe cases.

Diagnosis of laryngeal paresis

Doctors perform laryngoscopy to make an accurate diagnosis, during which a specialist looks at the condition of the ligaments, determines how far they are from each other, and examines the laryngeal mucosa. In addition, doctors can prescribe x-ray diagnostics, electromyography, neurography, and conduct a study of vocal function.

If there is a suspicion that paresis is caused by a stroke, neoplasms or other pathologies, additional ultrasound examinations and magnetic resonance imaging of the brain, chest area, etc. may be prescribed.

Treatment of laryngeal paresis

Doctors choose treatment tactics taking into account the causes of vocal cord paresis. Both medical and surgical methods can be used.

Tracheotomy is performed in acute situations with difficulty breathing. If ligament paralysis occurs, surgery to tighten the ligaments may be prescribed. Surgery is also performed to restore normal innervation to the nerve if the disorder is due to nerve damage. However, if surgery can be avoided, doctors suggest conservative treatment.

Depending on the causes of the pathology, specialists can prescribe antibiotics, neuroprotectors, muscle activity stimulants and other medications, which are selected on an individual basis. Physiotherapeutic methods are actively used, for example, electrical stimulation, electrophoresis with drugs. It is imperative to treat diseases that cause laryngeal paresis. Injection laryngoplasty is another promising non-surgical treatment option.

Drug treatment of laryngeal paresis: injection laryngoplasty

Qualified doctors in advanced otolaryngological centers have recently actively used this method to treat vocal cord paresis. It turns out to be effective in many cases, allowing eliminating the problem and restoring your voice without surgery. During the procedure, the doctor injects a special drug into the vocal cord. The patient’s fat tissue is most often used for the procedure. Hyaluronic acid or calcium hydroxide may also be used. These are unique fillers for the vocal cords, the use of which allows to restore the desired volume and shape of the cords and restore voice. The procedure is performed under local anesthesia.

Some clinics use their own unique approaches to this procedure. Thus, the Institute of Plastic Surgery VIRTUS uses its own technique for making a fat graft, which is injected simultaneously with the PRP drug (platelet-rich plasma of the patient), which helps accelerate the action of fat and achieve better results. The procedure can effectively treat paresis and restore normal functionality of the vocal cords. At the same time, it is low-traumatic and easily tolerated. The effect of using this method is noticeable almost immediately.

To learn more about injection laryngoplasty options, contact us.

Paresis of the larynx – prognosis

The causes of disturbances in the motor activity of the vocal cords primarily affect the prognosis of this pathology. The functioning of the vocal cords is usually restored when the factors leading to the development of the disease are eliminated. However, with prolonged paresis, the muscles can atrophy, which leads to a change in voice. Therefore, it is important to start treatment in a timely manner.

Also, the correct selection of treatment and the use of modern effective techniques are of great importance for the prospects for voice restoration. The likelihood of successful treatment will be quite high if you go to clinics that use advanced technologies and apply an individual approach to each patient.

The best clinics for the treatment of laryngeal paresis

You can undergo treatment in medical centers in different countries. The MedTour platform works with the best clinics specializing in the treatment of diseases in the field of otolaryngology. You can choose a medical institution in Turkey, Germany, Italy, Spain, South Korea and other countries. The MedTour coordinator will select the best option for you that best suits your needs and preferences.

In Ukraine, you can undergo treatment for ligament paresis at the VIRTUS clinic. The clinic actively uses a progressive technique of injection laryngoplasty, which allows you to restore your voice quickly and without surgery.

To find the best clinic in the country you are interested in, contact the MedTour coordinating doctor for a free consultation.

The best doctors for the treatment of laryngeal paresis

Vocal cord paresis is usually treated by an otolaryngologist. Consultations with a neurologist and psychiatrist may also be required. MedTour will help you find good specialists who have extensive experience in treating pathologies of this type and use the latest and most effective techniques. During a free consultation, our coordinating doctor will tell you about doctors who specialize in treating this disease and help you choose the best option.

Published: 24.11.2023

Updated: 26.11.2023

Medical author, Medical editor:

Natalia Segen

Medical author, Medical editor:

Olena Kursabaieva