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Neurological affection of the larynx

Neurological affection of the larynx

Sensory dysfunction

The sensory nerve supply to the supraglottis is from yhe vagus via internal laryngeal nerve.Stimulation produces a cough reflex which prevents food and saliva from entering the airway,thus being very important protective reflex.

Loss of this reflex predispose to aspiration.

Uncontroled aspiration lead to sever pneumonia which is life threatening.

Sensory paralysis is caused by lesions affecting the vagus nerve in the skull base or in the upper neck

Laryngeal spasm

It is most commonly seen postoperatively in the patient with with sensitive larynx that has been irritated by secretion or blood.

The cords become adducted and the patient cannot breath

Laryngeal spasm may present in the clinic with repeated chocking episodes and loss of voice gastroesophageal reflex or postural drip may be the cause

Functional dysphonia

 Is a form of  laryngeal spasm which is often induced by anxiety and panic attach It is most commenly present in young female,who present with aphonia. The vocal cords will de seen lying equidistant from the midline and move normally with deep inspiration but on phonation will not meet in the midline.Patient able to cough and when cough ,the cord will meet in the midline.

Treatment is by reassurance with good speech therapy.

Vocal cords paralysis

It can be unilateral or bilateral and can be adductor or abductor paralysis

Abductor paralysis means loss of power of abduction i.e V.C are in adduction

Adductor paralysis means loss of power of adduction i.e V.C are in abduction

Causes

1.malignancy 25%

2.surgical trauma

3.idiopathic

4.inflammatory T.B of the lung

5.non surgical trauma pressure by atrium enlargement or by aneurysm

6.neurological as DM,CVA

7.other as rheumatoid arthritis

The left nerve affected more because it has longer course