Causes
Since the nerve runs in direct proximity to the thyroid gland (Glandula thyroidea), surgery on the thyroid gland, for example because of a tumor or struma, is the most common cause of recurrent paresis. However, recurrent nerve palsy can also be caused by In general, all surgical interventions in the cervical and thyroid area, such as surgery on the cervical spine or heart surgery, are considered a risk for recurrent paresis. Rare causes of recurrent nerve palsy can also be a large aneurysm in the aorta, Parkinson’s disease or various forms of neuritis.
In addition to these causes, there are also drugs that can cause symptoms similar to those of recurrent nerve palsy as side effects. Recurrent nerve palsy can also occur in the context of ganglion stellatum blockade, when the local anesthetic spreads in the tissue. The consequences are hoarseness, coughing and even shortness of breath.
- A large thyroid tumor,
- By a tumor from another adjacent area,
- Through a metastasis or
- By a viral infection with involvement of the nerves.
Diagnosis
The diagnosis is usually made by the ear, nose and throat doctor or the phoniatrist, who can check the position of the vocal folds in a laryngoscopy based on classic findings such as hoarseness and shortness of breath. In this way, it can be ascertained whether the complaints are due to vocal cord paralysis or other possible causes.
Therapy
Also in therapy, a distinction must be made between unilateral and bilateral recurrent paresis. With a one-sided recurrent nerve palsy, the full ability to develop the voice can often be restored by specific voice training. In the case of bilateral recurrent nerve palsy, the therapy usually focuses on the elimination of breathing difficulties.
For this reason, a tracheotomy must often be performed and then a breathing piece (tracheostoma) must be placed in this slit to allow the patient to breathe more easily. A speech cannula can be inserted into this tracheostoma so that the patient can communicate again despite complete recurrent paresis. If the vocal cord nerve is only partially damaged, the nerve function can be restored by targeted electrostimulation. If there is no improvement in function after one year, surgery is indicated to avoid the permanent use of a tracheostoma due to infection. In the operations that are then possible, the glottis is surgically widened with a laser so that breathing becomes easier again and the agonizing feeling of breathlessness disappears.