Односторонний парез гортани: особенности клинической картины и сложности диагностики

Abstract

The article presents the experience of the phoniatric department of the Saint Petersburg Institute of Ear, Throat, Nose, and Speech in the management of patients with unilateral vocal fold paresis. Variants of the clinical picture of the disease that complicate the compensation of the phonatory, respiratory, and protective functions of the larynx have been studied. The most common clinical picture of unilateral laryngeal paresis is the presence of complaints of hoarseness, diplophonia, inspiratory dyspnea during physical activity, aspiration. However, complaints about the voice may be absent, or they may be presented in the form of an aphonia. Patients may not complain of shortness of breath, or inspiratory stridor appears with minimal physical activity, snoring with episodes of apnea, laryngospasm attacks. The article presents cases of rare manifestations of paresis associated with the phenomena of hypotension and hypotrophy of the laryngeal muscles. These include the weakening of the tension of the medial edge of the vocal fold, thinning of the vocal fold, contouring of the vocal process of the arytenoid cartilage, lower location of the paralyzed vocal fold relative to healthy, rotation of the arytenoid cartilage, rotation of the epiglottis, and others. Compensatory mechanisms of phonation are described. Possible difficulties in diagnosing laryngeal paresis based on video laryngoscopy data, including hypomobility of the vocal fold, as well as options for simulating paresis due to neoplasms and post-traumatic changes in the larynx are considered.