2023-11-28 06:30:42
[Ming Pao Special News]When drinking and eating, they often fall into the wrong position or become confused; when speaking, even if they “open their throats”, they still have a low voice, or even lose their voice. Eating and vocal problems may seem unrelated, but in fact they may be due to the same cause, which is a disease of the vocal cords. Damage to the nerve cords can lead to paralysis of the vocal cords, which cannot close properly. Unilateral vocal cord paralysis can lead to hoarseness, weakness, and leakage of the voice; if both sides are completely paralyzed, it can lead to voice loss and even difficulty breathing. Because the vocal cords cannot completely close, water or food particles may fall into the trachea from the gaps in the vocal cords when eating or drinking, causing coughing or even aspiration pneumonia. (Editor’s note: In addition to vocal cord paralysis, common vocal cord lesions also include infection and inflammation, nodules, polyps, etc.)
Vocal cord paralysis – Damage to the nerve cords causes vocal cord paralysis and the inability to close properly, making the voice sound weak and hoarse. (Design image by Phira Phonruewiangphing, Aldona@iStockphoto)
Four common vocal cord lesions: inflammation, paralysis, nodules, polyps, causes and symptoms of hoarseness and loss of voice
The vocal cords are two pieces of muscle tissue located at the entrance to the trachea. When you speak, they close together and vibrate, creating sound. The rest of the time, stay open and relaxed to allow for easy breathing.
Vocal cord closure is innervated by the central nervous system, vagus nerve and recurrent laryngeal nerve. In addition to vocal cord paralysis, common vocal cord lesions also include infection and inflammation, nodules, polyps, etc.
Vocal cord inflammation
Causes: There are two types of inflammation: acute and chronic inflammation. Acute refers to viral infection of the vocal cords, such as upper respiratory tract infection, resulting in vocal cord edema or damage; chronic refers to long-term incorrect vocalization.In addition, gastroesophageal reflux and gastritis are also causes of chronic laryngitis
Symptoms: Hoarse and low voice, or even loss of voice
Vocal nodules
Cause: Chronic vocal cord inflammation caused by long-term overuse or incorrect phonation. Without proper treatment and improvement of phonation, nodules (cocoons) will form on the vocal cords.
Symptoms: Hoarse and low voice, swelling of throat, vocal fatigue, etc.
polyp
Cause: Long-term excessive vocal use or incorrect phonation, or shouting loudly while the vocal cords are damaged, causing the capillary blood vessels of the vocal cords to rupture and bleed, forming hematomas and, over time, polyps.
Symptoms: Hoarse and low voice
Vocal cord paralysis:Unilateral paralysis, sound sand, and paralysis on both sides are prone to choking.
Causes: Laryngeal trauma, stroke, viral infection, tumor, or complications following laryngeal surgery, etc.
Symptoms: Hoarseness, weakness, wind leakage, and even difficulty breathing
Why are vocal cords paralyzed? Tang Zhihao, Honorary Clinical Assistant Professor of the Department of Otorhinolaryngology-Head and Neck Surgery at the Chinese University of Hong Kong, explained: “The vocal cords are innervated by the vagus nerve and are divided into left and right sides. The vagus nerve branches off the recurrent laryngeal nerve below the larynx, and the recurrent laryngeal nerve on one side bypasses the clavicle and then returns. ; The recurrent laryngeal nerve on the other side bypasses the clavicle, continues down to the chest and lungs, and then returns to the larynx. Once the recurrent laryngeal nerve is damaged, it can lead to paralysis of the vocal cords and the inability to close freely. “The recurrent laryngeal nerve can be damaged by surgery, Damage caused by accidental trauma, infection, cancer, etc.
Tang Zhihao describes the vocal cords as a pair of doors, “This pair of doors opens when we breathe and closes when we make sounds. If only one door can be closed, air will leak when speaking, making the voice sound weak and hoarse; if both doors cannot be closed, , in addition to affecting the voice, in severe cases, because the larynx is uncovered, food debris can easily fall into the wrong place when eating, causing aspiration pneumonia.”
Related reading:[Ear, Nose and Throat Problems]Long-term throat discomfort and out-of-pitched speech? Recognize the problem of voice disorders and the speech therapist teaches you 10 DOs and DON’Ts to protect your vocal cords
Vocal cord function: producing sounds, protecting the trachea and preventing choking due to food and saliva
The function of the vocal cords is not only to produce sounds, but also to protect the trachea to prevent food, drinks or saliva from entering the trachea and causing choking. Tang Zhihao pointed out that the throat has a natural safety mechanism when eating. Food in the throat will trigger a swallowing reflex, and the pharyngeal muscles will automatically tighten. The epiglottis will close the trachea and suspend breathing to prevent food or drinks from entering the trachea. If food accidentally enters the trachea, the body will naturally induce a cough to cough up the food. “However, if the vocal cords cannot be closed normally and there is a problem with the swallowing reflex mechanism, food may easily fall into the wrong place. This is common in stroke patients. Due to uncoordinated throat function, food may easily fall into the wrong place when eating, leading to aspiration pneumonia. Severe cases may result in death from suffocation.”
Related reading: Difficulty Swallowing｜Do you often suffer from “vomiting” or “falling into the wrong place”?Understand the 4 stages of swallowing and handle it early to avoid aspiration pneumonia
Common sequelae of throat and neck surgery
Vocal cord paralysis is a common sequelae of laryngeal and neck surgery. Deng Zhihao explained: “Surgeries on the neck or near the upper chest may cause damage to the recurrent laryngeal nerve, including surgeries on the thyroid, thoracic blood vessels, gastroesophagus, etc. Among them, thyroid surgeries are the most common. The recurrent laryngeal nerve may be stretched or even severed during surgery, causing permanent damage; in addition, the heat energy released by surgical instruments may also damage the recurrent laryngeal nerve.”
The thyroid gland is located in the front part of the neck and throat, close to the trachea and esophagus, and also close to the recurrent laryngeal nerve. It is an easily injured part during thyroid surgery and is also one of the known risks of this surgery. Generally speaking, if the recurrent laryngeal nerve is damaged only due to stretch or compression, most cases can be cured following appropriate treatment. The recovery time depends on the degree of damage to the recurrent laryngeal nerve and the patient’s physical condition, ranging from months to years. “If the nerve line is severed, permanent damage will occur and vocal cord function may not be restored.”
Filler injection to adjust the shape and position of the vocal cords
In terms of diagnosis, doctors usually use endoscopy or computer scans to find the cause. Vocal cord paralysis usually resolves on its own within a few months, but if the condition persists, drug injections or surgical intervention may be needed. Tang Zhihao reminded: “Acute vocal cord paralysis, such as viral infection of the recurrent laryngeal nerve, may cause vocal cord function to deteriorate rapidly within a few hours. However, because the symptoms are obvious, patients usually seek medical treatment in a timely manner; on the contrary, if it is chronic vocal cord paralysis, such as The recurrent laryngeal nerve is compressed by the tumor and affects the function of the vocal cords. Symptoms may gradually appear within a few days or even a week or two. Therefore, if you find that your voice is hoarse or your wind leakage has not improved for two weeks, you should seek medical advice as soon as possible.”
Seek medical attention early – Otolaryngologists often use a throat endoscope to initially check the vocal cords. If there is any doubt, they will further check with a computer scan. (Design image, PonyWang@iStockphoto)
After finding out the cause of vocal cord paralysis, the doctor will decide whether to treat it with drugs or surgery depending on the situation. Taking unilateral vocal cord paralysis as an example, common treatments include injecting hyaluronic acid with a filling effect into the paralyzed vocal cords to adjust the shape and position of the vocal cords. Deng Zhihao explained: “The purpose is to widen the vocal cords, even if only the other side of the vocal cords can move. , can also “close the door”, effectively improving the patient’s speech tone and swallowing function. The benefit of the treatment is immediate effect, but because hyaluronic acid will be absorbed by the body over time, patients need to receive injections every 3 to 4 months. In addition, you can also choose to implant permanent materials in the vocal cords, such as silicone. However, relatively speaking, it takes a long time for patients to adapt and achieve results.”
Deng Zhihao (provided by interviewee)
Postoperative speech therapy to improve voice
In addition to otolaryngology treatment, speech therapy is often used as auxiliary treatment following vocal cord paralysis. Speech therapist Luo Ji-tung, assistant professor of the Department of Otolaryngology-Head and Neck Surgery and deputy director of the Department of Speech Therapy at the Chinese University of Hong Kong, said: “After patients with vocal cord paralysis are diagnosed, they will be referred for speech therapy if necessary. The treatment mode and time required will vary. It is adjusted according to the reasons and goals of the treatment. Generally speaking, the treatment course lasts from 3 to 6 months and includes regarding 8 sessions of 45 minutes to 1 hour of vocal training. The training goals are also divided into two stages: first, let The patient practices to master how to pronounce the voice correctly, and the second stage is to strengthen the closure of the patient’s vocal cords to make the voice lines thicker and reduce air leakage.” (See “Vocal Training”)
Luo Jiadong pointed out: “In addition to vocal cord paralysis caused by damage to the recurrent laryngeal nerve, many people also have functional voice disorders caused by long-term incorrect vocalization. That is, due to long-term overuse or incorrect vocalization, the larynx muscles are tense. , affecting the voice line, these conditions can also be improved through speech therapy. As long as you persist in practicing, your vocal function will be improved, and it is not difficult to practice and can be practiced anytime and anywhere.”
Luo Jiadong (provided by interviewee)
People with damaged vocal cords should train to pronounce correctly, protect the vocal cords, and increase vocal cord closure.
Hoarse voice is a common occupational disease caused by people who use a lot of voice at work, such as teachers, waiters, singers, etc. Vocal cord nodules will form due to excessive friction due to long-term overuse or misuse of the vocal cords. (Casarsa@iStockphoto)
Resonance vocal exercises
Use your nasal cavity to hum the words with the “M” sound, such as cat and mom. Start practicing with the single sound first, and then gradually hum the short sentences. The principle of this exercise is to use the smallest force to trigger the closure of the vocal cords through resonant humming and train the vocal cords to close. Using a resonating cavity to speak can reduce the load on the throat muscles and protect the vocal cords.
Semi-obstructed voice line exercises
Hold the drinking tube and squirt water and make a “woo woo” or “bu bu” sound, which will make the vocal cords more relaxed when making sounds, and the flapping amplitude will be thinner, which can not only enhance the closure of the vocal cords, but also reduce the impact and impact on the vocal cords. pressure.
Text: Ye Kaixin
Editor: Liang Xiaoling
Art: Xie Weihao
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