Withчины хриплого, осипшего голоса у детей иadults

Update: October 2018

Human voice is the sound waves that occur when
the passage of air through the glottis of the larynx with closed
vocal cords. The longer and thicker the ligaments, the lower the voice. Than
the smoother the ligaments, the cleaner the tone.

The voice becomes low and hoarse when the ligaments become
uneven and thicker, or appear in the way of the voice wave
additional obstacles that interfere. This state
also called dysphonia. it возможно в нескольких ситуациях.

Withчины изменения или потери голоса у взрослого

Infectious and inflammatory diseases of the larynx and voice
bundles

Воспалительные изменения bundles и, прежде всего, отек при острых
viral inflammations of the larynx (laryngitis) or laryngotracheitis
causes hoarseness. Puffiness interferes with ligaments tightly
to close, changing the color of the voice and reducing its sonority.

  • In addition, there may be a dry cough in the program.
    tracheitis, temperature rise to 37-38, tickling, tickling and
    rawness in larynx.
  • Hoarseness can be replaced by complete loss of voice
    (athos).
  • Such a picture can be observed with influenza, parainfluenza,
    adenovirus infection, respiratory syncytial lesions
    a virus.
  • Bacterial laryngitis caused by pneumococcus is also possible.
    Bordetella, hemophilus bacillus, or fungal laryngitis in the background
    candida larynx.

With хронических ларингитах разного of origin осиплость
voices can stay for life.

Poisoning

  • Chlorine give hoarseness, loss of voice, dry cough,
    spasm of the glottis, pulmonary edema (in everyday life, inhalation of some vapors
    household cleaning products – Domestos, ACE, BF, Prill, Whiteness, Comet and
    etc.)
  • Ammonia, in addition to the hoarse voice, cause sore throat,
    chest pain, cough with mucous sputum, which in severe
    cases go into pulmonary edema.
  • Fluorine provoke laryngitis clinic, lacrimation and
    eye redness (conjunctivitis), cough, mucous discharge from
    nose, bloody diarrhea, convulsions, delirium.

Allergic conditions

Laryngeal edema due to immediate type allergies or
features of the complement system develops in the edema program
Quincke. Wherein осиплость голоса – грозный признак, предшествующий
stenosis of the larynx and difficulty in breathing up to asphyxiation. Besides
sore throat and cough, difficulty breathing, gradually
pale and then turn blue face and fingers, there is a lethargy
or excitement, alternating with loss of consciousness. All stages are very
quickly replace each other, so the state refers to
urgent.

Exchange violations

  • Hypothyroidism or reduced thyroid hormone production
    also changes voice. It develops in the outcome of thyroiditis or after
    gland removal for goiter or tumor, and also becomes
    the result of radiation therapy or iodine deficiency in endemic areas.
    On the background of hypothyroidism in the tissues fluid is retained, the mucous
    larynx and ligaments swell. Wherein отек достаточно плотный и плохо
    eliminated, although with hormone replacement therapy it is possible
    restore voice. The type of patients with hypothyroidism is characteristic: they
    swollen, puffy, pale, inhibited. They have dry skin, brittle
    dull hair and fallen outer edges of the eyebrows. They are few
    interested in external stimuli, suffer from lack
    appetite, shortness of breath, slow heart rate.
  • Dehydration is another cause of hoarseness. With дефиците воды
    may appear dry skin and mucous membranes, thirst, hoarseness,
    which as the progression of joining work
    heart and consciousness disorders.

Acute or chronic burns

  • With контакте с уксусной кислотой связки и larynx могут
    receive chemical burns of varying severity and depth. Cicatricial
    изменения bundles могут испортить голос или даже лишить его
    forever and ever.
  • Nicotine, carbon dioxide and tar produced during smoking,
    constantly irritate the mucous membrane of the larynx, causing
    отечность bundles и хриплость голоса (прокуренный vote).
  • Ethanol burns work slowly but surely. Have
    chronic alcoholics voice is hoarse (drunken
    vote).
  • Reflux esophagitis, in which hydrochloric acid and pepsin from
    желудка забрасываются в пищевод и могут попадать в larynx (см.
    heartburn medication).

Перенапряжение bundles

Have выступающих перед аудиторией преподавателей, лекторов, актеров
or singers on the background of chronic tension of the vocal apparatus,
can “sit down” voice. To prevent this from happening, all singers are involved.
on special systems, they try not to overstrain bundles
and periodically visit a special doctor – foniatra. If
an untrained person will start shouting too loudly and then
he can simply disrupt his voice when faced with a complete
inability to talk for a while.

The most annoying thing that can happen to those who often
enjoys a voice in his profession – this is education
specific growths on ligaments or “nodules”, which sometimes
even have to be removed surgically.

Травмы bundles

They can occur with tracheotomy, when with stenosis of the larynx
or getting a foreign object into the airway
trachea. There is a case when a surgeon who operated in 1922
Lenin, the head physician of the Kremlin hospital VN Rozanov,
“Fortunate enough” to do a tracheotomy on the doorstep of the hospital
a knife to the church chorister, choking from stenosis of the larynx.
Having lost his voice, the surviving “grateful” patient filed for his
a savior to the court who sided with the surgeon, denying the lawsuit.

Today, precisely because of the risk of damage to the ligaments instead of
tracheotomy conicotomy, dissecting a bunch between
thyroid and cricoid cartilage.

  • The second variant of traumatic voice damage is trauma.
    recurrent nerve that innervates the vocal cords. Such
    trouble can happen during thyroid surgery
    gland. Unfortunately, after such an injury, a person for life
    gets a hoarse voice.
  • After general anesthesia, in which tracheal intubation is performed,
    larynx may be scratched. In this case, the voice will be sonorous.
    after the mucosa recovers.

Peripheral paralysis and paresis of the nerves supplying
larynx

The larynx, in addition to the recurrent nerve, is innervated
verkhgortannym. When they are damaged, there are voice disorders in
in the form of hoarseness.

  • Independent vertebral nerve palsy – rare
    pathology. It is accompanied by a numb feeling in the larynx and
    weakening the tension of one or both ligaments, which is accompanied by
    voice changes. From diseases to this condition lead
    syphilis, diphtheria, rabies. The reason can also serve
    injury.
  • Paralysis of one or two recurrent nerves (left and right) –
    a consequence of compression of tumors of the thyroid gland, mediastinum,
    lymph nodes, esophagus. With expansion of the heart, nerves can also
    experience pressure Paralysis can cause intoxication.
    rabies, botulism. More often the left recurrent nerve suffers.
    The clinical picture is characterized by impaired (hoarseness) voices
    up to his complete disappearance and respiratory disorders of different
    severity. At the same time the glottis is narrowed, and ligaments (with one
    or two sides) are practically immobile.

Laryngeal tumors

As they grow, they squeeze blood vessels and nerves, disrupting the structure
ligaments and their mobility

  • Benign tumors (fibroids, polyps, papillomas, angiomas,
    cysts, chondromas, lipomas) grow from connective, adipose tissue,
    vessels, mucous membranes, glands and may be congenital or
    acquired. They are more likely to suffer men. Main complaints
    patients – hoarseness, cough or intermittent
    cough For tumors on the pedicle, episodes are characteristic.
    voice changes. When the tumor prevents the ligaments from closing, the voice
    may disappear altogether. Too large tumors can
    provoke choking.
  • Malignant tumor – cancer of the larynx gives voice disorders
    very early if located in the vocal cords and much
    later, if localized in other parts of the larynx. Wherein
    characteristic constant hoarseness without periods of improvement. As
    As the process progresses, a sore throat is added which can
    go into a chronic pain syndrome, aphonia can develop.
    Also characterized by dry reflex cough. In the later stages
    cancer intoxication and exhaustion develops. For large tumors
    suffocation may develop.

Vascular pathologies

  • Aortic arch aneurysm can cause paralysis of the left recurrent
    the nerve.
  • Aneurysm of the right subclavian artery causes
    paresis of the right recurrent nerve and sagging of the ligament with this
    parties. In addition to constant pressure, the beating of the vessel can destroy
    outer myelin sheath of the nerve, making it difficult to conduct on it
    nerve impulse to the bundle.
  • Hemorrhagic or ischemic stroke of the brain stem.

Brain stem lesions

Bulbar paralysis of the language of the pharyngeal, vagus and
hypoglossal nerves in hemorrhages or toxic lesions
medulla oblongata. This syndrome is characteristic of botulism,
glioma of the brain stem, porphyria, Lyme disease.

The voice becomes dull, hoarse and slurred up to
complete loss of voice. In addition, there is a disorder
swallowing, gagging, pronounced speech blurring. Can
breathing and heart rhythm disorders occur, against which
the sick die.

Hoarseness in the child

In general, children suffer from hoarseness against the background of the same
sets of reasons as adults. However, there are features.

  • Congenital cysts of the larynx or papillomatosis – quite common
    the cause of hoarse voice in children of different ages. Hoarseness
    the baby can be caused by this very reason.
  • Foreign bodies – in children more often than in adults with laryngoscopy
    about hoarse voices foreign bodies of the larynx are detected
    (husks of seeds and pistachios, small toys).
  • Cry – if a child has a labile nervous system and he loves
    shout, then sooner or later a hoarse voice to him is just
    guaranteed. The more overloaded ligaments, the more likely
    the formation of knots on them, spoiling the voice.
  • Functional dysphonia – if anatomical changes in the larynx
    not detected, then talk about functional dysphonia. it
    due to the fact that the child still does not know how to properly use
    his voice and it’s time to lead to the phoniatrist.
  • Boys are 12-15 years old amid hormonal imbalances and
    lengthening of the ligaments also have voice problems. Wheeze is replaced
    shrill notes and the whole voice resembles a rusty sign on
    an American tavern open to all winds. If mutation
    delayed longer than six months, it is worth showing a teenager
    a specialist.

All the above situations are classified as planned, but
there are also urgent cases in which it is important to act
competently and clearly, without losing a minute.

  • Laryngeal stenosis – acute narrowing of its lumen against the background
    allergic edema (angioedema), croup on the background of stenotic
    laryngotracheitis. Angioedema of the larynx develops in
    children even at the first collision with an allergen. This is to blame
    complement system that triggers a reaction cascade with release
    inflammatory mediators. As a result, the larynx mucosa swells,
    narrowing the glottis and increasing the thickness of the ligaments that are worse
    are closed.
  • Infectious stenosing laryngotracheitis most often
    affects children from three months to three years (see laryngitis in a child
    or barking cough). Under the influence of influenza viruses, parainfluenza and
    others develop rapid laryngeal edema below the glottis. Less often
    causes of croup are diphtheria larynx or lesion
    herpes infection. Stenosing laryngotracheitis is described and at
    chicken pox. Have ребенка дыхательные пути и larynx уже, чем у
    adult, so even in a short time
    appear severe respiratory disorders.

The attack, as a rule, develops in children at night. With
This causes a hoarse “barking” cough, hoarseness or his
loss, breathing with a noisy long breath precedes the full
asphyxia. Marked discoloration of the skin (pale with cyanosis
nasolabial triangle and fingers).

  • With первой степени стеноза нехватка воздуха появляется только
    under load and manifests itself as a contraction of the jugular notch and epigastrium into
    breathing time.
  • The second degree is marked by pallor, cyanosis of the tip of the nose
    and lips, palpitations, arousal of a child, involvement in
    breathing auxiliary muscles.
  • The third degree manifests as pronounced respiratory
    deficiency (severe pallor with blue lips and fingers,
    noisy breathing with difficulty breathing).
  • The fourth degree is the actual choking with a superficial
    type of breathing, rare heartbeats, lethargy and lethargy
    or loss of consciousness.

Treatment for hoarseness

The question of how to treat hoarseness is in the department
two doctors – an otolaryngologist (LOR) and a phoniatrist. The first is engaged
diseases of the larynx, the second – the actual voice problems.
For voice restoration, silence is most important. That’s when it
really becomes gold, saving the cost of pills and
inhalers. Voice rest can be assigned to different periods.
of time.

And only in cases of laryngeal stenosis (infectious or
allergic nature) in the first place are doctors emergency
help and anesthesiologists-reanimatologi.

Infectious lesions require etiotropic therapy

  • viral origin antivirals are prescribed
    drugs
  • with bacterial – broad-spectrum antibiotics,
    like penicillins, macrolides
  • with fungal lesions, grieofulvin or other
    antifungal agents.
  • 2-3 generation generations of antihistamines are given at the same time,
    reducing larynx
  • An excellent remedy for hoarseness of this kind – irrigation of the larynx
    a solution of 5% ascorbic acid

Порядок помощи with stenosis of the larynx аллергического
of origin

  • Interrupting Allergen Contact
  • Inhalation of oxygen
  • Sodium chloride 0.9%, epinephrine (adrenaline), prednisone
    intravenously
  • With отсутствии эффекта — интубация трахеи
  • Before that, the introduction of midazolam, atropine, ketamine
  • If intubation fails – conicotomy, artificial
    pulmonary ventilation, hospitalization

Further treatment is carried out in the intensive care unit.
and resuscitation with the transfer to the specialized department for treatment
main cause of stenosis.

  • Allergic states require infusion therapy and
    prescription glucocorticosteroids (prednisone) and
    antihistamines.
  • Tumors, cysts, papillomatosis is operated.
  • Vascular pathologies are operated or treated with vascular
    by surgeons.
  • Curvilfactions in the brain are carried out according to the standards of strokes in
    departments of ITAR and neurological departments of the hospital. Ibid
    are engaged in neuroinfections and bulbar parlyz.
  • Peripheral paralysis of the laryngeal nerves require combating
    the underlying disease that led to them. In the recovery period
    Physiotherapy and phonopedic exercises are conducted.
  • Chlorine poisoning requires rinsing of the nose, eyes and mouth 2%
    a solution of soda, oxygen inhalation, the introduction of analeptics.
  • Ammonia poisoning requires inhalation of warm water vapor
    with the addition of vinegar or citric acid.
  • With поражениях фтором необходимо промыть желудок 2% содой,
    take the drug calcium or a glass of milk with two eggs
    squirrels.

Medicines for hoarseness

The most popular means of hoarseness, in addition to the solution
Askorbinki are tablets for sucking in the mouth.
However, they are contraindicated in children younger than 5 years. Most effective
antiseptics and antihistamines.

Local antiseptics

  • On the basis of iodine: Lugol’s solution for lubrication, spray Yoks,
    Iodinol for rinsing.
  • Chlorine-containing: Miramistin, Eludril, Korsotil for
    rinses.
  • Herbal: Chlorophilipt, calendula tincture, salvin for
    rinses.
  • Absorbable pills: Laripront, Ajisept, Grmmidin,
    Septolete, Suprima-lor, Falimint.
  • Inhalers: Kameton, Ingalipt.

Antihistamine remedies

  • 2nd generation: ketotifen (very effective for spasms of the bronchi and
    larynx).
  • 3rd generation: astemizol, astemizan, hasmanal, akrivastin,
    claritin, loratadine, clarisens, allergodil, ebastine, telfast,
    zyrtec, terfenadine (see allergy pills).

Folk remedies for hoarseness

  • Half cup with warm milk topped up with the same amount
    mineral water “Borjomi”, add two teaspoons of honey. Drink
    temperature solution of 36 degrees sips for 20
    minutes
  • Eggnog: 2 grind yolks with a teaspoon of sugar,
    add a teaspoon of butter. Withнимать по четверти ложки
    between meals.
  • 10 g of pharmaceutical chamomile add to 5 g of lavender, pour a glass
    boiling water, bring to a boil in a steam bath, cool to
    temperature in 60 degrees, do inhalation.

How to cure hoarseness in functional disorders,
will prompt the phoniatrist. At his disposal are a variety of voice
trainings and psychological correction.

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