Paralysis

• Paralysis ( plegia ) - Paralysis is the complete loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage as well as motor.

• Paresis- Reduction in the maximum force of muscular contraction and in muscular force on repeated contraction.

Paralysis

• Hemiplegia– Paralysis on one side of body– Lesion in corticospinal tract– Contralateral motor control

• Hemiparesis– Weakness or partial paralysis– Less severe than Hemiplegia

Vocal Paralysis: What is it?

• Vocal fold paralysis and paresis result from abnormal nerve input to the voice box muscles (laryngeal muscles).

• Paralysis is the total interruption of nerve impulse resulting in no movement of the muscle

• Paresis (also possible) is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s).

Vocal Paralysis• What nerves are involved?

• Superior Laryngeal Nerve (SLN): carries signals to the cricothyroid muscle which adjusts vocal cord tension for high/low pitches

• Recurrent Laryngeal Nerve (RLN): signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing vocal folds for vocal fold vibration during voice use, and closing vocal folds during swallowing.

Vocal Paralysis

• Not simply inability to speak

Can also affect: ability to swallow cause shortness of breath noisy breathing

hoarseness unclear “breathy” voice breath use in sound production

Vocal ParalysisHow is it diagnosed?

Laryngeal electromyography (LEMG): measures electrical currents in voice box muscles resulting from nerve input information. Measuring and looking at patterns in electrical currents show whether there is repair of nerve inputs (re-innervation) and the extent of the nerve lesion or problem. It works through the insertion of small needles that can measure electrical currents in the vocal cord muscles. In LEMG testing, patients perform a number of tasks that would normally produce typical activity in the vocal muscles.

Vocal Cord Paralysis

• Causes in the CNS• Causes in the base of skull• Causes in Parapharyngeal space • Causes in the neck.• Causes in the chest.• Neurological causes.

D/D V.C. Paralysis - Causes in CNS

• Infections -Encephalitis, meningitis.• Trauma• Vascular causes - infarction., hemorrhage,

aneurysm.

D/D V.C. Paralysis - Causes in base of skull

• Inflammations - Chronic specific• Trauma• Bone disease e.g., paget’s disease osteopetrosis,

osteogenosis imperfectaTUMOURS• Primary- glomus jugulare.• Secondary- parotid, Nasopharynx.

D/D V.C. Paralysis - Causes in Parapharyngeal Space

• Inflammations - Parapharyngeal abscess• Trauma• Tumour- Parotid, Nasopharynx, Secondaries.

D/D V.C. Paralysis - Causes in the Neck

Trauma:• Surgical thyroid, larynx, esophagus etc.• Physical blunt & penetrating.Inflammation,• Non specific and specific.Tumours. Larynx, esophagus, thyroid, trachea,

lymphomas and secondaries.

D/D V.C. Paralysis - Causes in Chest (left side only)

Tumours• Carcinoma• Retrosternal goiter• Ca esophagus• Mediastinal malignancyTuberculosisAortic aneurysmRt. Ventricular hypertrophy

TYPES OF PARALYSIS

UNILATRAL ABDUCTOR PARALYSISUNILATRAL ADDUCTOR PARALYSISBILATRAL ABDUCTOR PARALYSISBILATRAL ADDUCTOR PARALYSIS

UNILATRAL ABDUCTOR PARALYSIS

1. Paralysis of recurrent laryngeal nerve2. Vocal cord lies in paramedian position3. Initial hoarseness4. No regurgitation5. Vocal cord compensation occurs leading to

improvement of voice6. Teflon paste injection---- Treatment

UNILATRAL ADDUCTOR PARALYSIS

1. Paralysis of both superior and recurrent laryngeal nerves2. Vocal cord lies in Lateral (cadaveric) position3. Weak husky voice 4. There is aspiration of food and fluid5. Vocal cord compensation occurs leading to

improvement of voice6. Teflon paste injection usually not possible.

Medialization of vocal cord or reverse cordopexy ---- Treatment

BILATRAL ABDUCTOR PARALYSIS

1.Paralysis of both recurrent laryngeal nerves2. Thyroid surgery - cause3. Both vocal cord lies in paramedian position4. Severe dyspnoea and stridor.5. Voice is good and there is no regurgitation6. Vocal cord compensation may occurs leading to

improvement 7. Immediate tracheostomy followed by laser, woodman, s

operation or aytenoidectomy or valved tracheostomy--- Treatment

BILATRAL ADDUCTOR PARALYSIS

1. Paralysis of combined both recurrent and superior laryngeal nerves

2. Psychiatric Illness or widespread neurological lesion or neoplastic lesion in the base of skull, upper neck etc.

3. Both vocal cord lies in lateral (cadaveric) position4. Severe regurgitation of food and fluid.5. Voice is breathy6. Vocal cord compensation may occurs leading to

improvement 7. If compensation does not occur than total laryngectomy

and epiglottopexy ---- Treatment