Dysphonia
Description:
Frustration of a phonation at which the voice remains, but becomes hoarse and weak carries the name a dysphonia.
Dysphonia symptoms:
The variety of forms of functional narusheyoniya of a voice defines distinction of their clinical manifestations.
The general symptoms for a dysphonia, an aphonia, phonasthenias are poyostoyanny or periodic hoarseness, fatigue of a voice.
Each form of a disease has kliniyochesky manifestations, characteristic of it.
At a hypokinetic (paretic) dysphonia voice folds usually slightly hyperemic, at phonation the crack is formed various form (ovalyyony, triangular).
Voice of the deaf, hoarse.
For a giperkineyotichesky (spastic) dysphonia harakyoterno a condition of a spastic hyperkinesia of muscles of a throat with a preyoobladaniye of a tonic spasm.
During phonation the preddveyoriya is noted convulsive rapprochement of voice folds and folds.
Voice folds are not changed, mobile, at phonation are in a condition of sharp tension.
The most severe form of functional frustration of a voice, the spastiyochesky dysphonia is.
The beginning of a spastic dysphonia usually acute, as a rule, obuslovyoleno a mental injury which in certain cases predyoshestvut a long overstrain of a voice.
The disease of a spastic dysphonia has resistant long character, renders negative vliyayony on a mental condition of patients.
Gipotonusny dysphonia - permanent funktsionalyyony disturbance of a voice - are characterized by a diskoordination of all departments of a voice apyoparat.
At a gipotonusny dysphonia is defined:
• hypotone of voice folds,
• incomplete smykaniye of a glottis,
• decrease in intensity of a voice and disturbance of its timbre.
By special psychological obsleyodovaniye L. E. Goncharuk (1986) it is established that permanent functional disturbances of a voice represent not только a throat disease, and are connected with disturbance neuroпсихической spheres.
Dysphonia reasons:
Origins of voice frustration the most various. Most often disturbances of a voice arise against the background of flu, a SARS, quinsy, tracheitis, bronchitis.
Not the last place among the reasons of voice frustration is taken by a voice overstrain, especially when people try to outvoice others in the company, in the noisy room or, despite an indisposition, go to give a lecture. And if similar cases often repeat, a number of disturbances is possible: nodulation, polyps, fibromas, developing of hemorrhages in voice folds. The long and excessive tension of a voice leads to developing of chronic laryngitis which main symptom is the dysphonia.
Frustration of a voice can be connected also with a microclimate of the room in which the person spends much time. In this case the irritating factors are dampness, dust, and also temperature influences – cold or a heat. Voice function is influenced by also production factors. A throat, being a part of respiratory system, is affected by organic and inorganic dust, gases and various impurity which are contained in the inhaled air.
Treatment of the Dysphonia:
Functional disturbances of a voice are not local pathological process in a throat, and are connected with various disturbances, diseases and the raised layobilnost of a nervous system.
In this regard treatment of these bolyyony has to be complex, including:
• psychotherapy,
• respiratory gymnastics,
• speech and vocal fonopediya,
• medicamentous therapy.
The important place at treatment of patients is taken by the physical methods of treatment of functional disturbances of a voice directed mainly to regulation of a deyayotelnost of the central nervous system and local vozdeystyovy to a throat.
Treatment of functional disfoniya has to be directed to elimination of the pathological center of congestive braking in bark of a great brain and recovery of narushenyony reflex mechanisms.
For improvement of processes of an obyomen and carrying out excitement in interneural synapses the stimulating medicamentous therapy nayoznachatsya:
• poliviyotamina,
• ATP,
• strychnine,
• прозерин (intramuscular injections),
• sedatives,
• tranquilizers (Trioxazinum, Tazepamum) inside.
Medicamentous therapy of a dysphonia is carried out against the background of the golosoyovy mode in a complex with respiratory gymnastics and orthophonic treatment.
From physical methods of treatment of a dysphonia for immediate effect appoint galvanization, an electrophoresis of 0,1% of solution of strychnine to the neuromuscular device of a throat.
One electrode with laying of 40x60 mm in size place on область throats, raspolayogat other electrode of 60X80 mm in size in the lower cervical vertebras.
Current is up to 3 - 5 мА, 10-20 min., on a course of 10-15 procedures.
According to M. A. Ratenberg (1973), good results, especially at patients with existence are paresthesias, are observed at local darsonvalization of a throat.
The fungoid electrode is medyolenno moved on the front surface of a neck within 5-10 min.
Appoint also vibration massage of a throat.
For the purpose of stimulation of the neuromuscular device of a throat influence faradic and diadynamic tokayom is shown.
DD-therapy of the neuromuscular device of a throat is carried out by currents - a rhythm a syncope.
Electrodes of 80X90 mm establish at plates of a thyroid cartilage between the lower and average third of a grudinoklyuchichno-mastoidal muscle.
Begin treatment with two-half-period wave current.
Current before emergence expressed (but unpainful) feelings of vibration, 10 min., on a course to 15.
Good rezulyyotata are noted at a diadinamoelektroforeza of a prozerin.
Uluchyosheniye broken as a result of a disease of a peripheral kroyovoobrashcheniye and a trophicity of fabrics, along with normalization of funkyotion of the autonomic nervous system provides medical effect of SMT.
Important factor of medical action of SMT at funktsioyonalny disturbances of a voice is their influence on the chuvstviyotelny sphere of a nervous system.
Influence by these currents causes rhythmic the arranged impulsation flow with ekstero-, intero-and proprioretseptor in the central nervous system.
Influence of SMT carry out by the doubled electrode (30X40 mm everyone), have them on the side surfaces of a throat ahead of grudinoklyuchichno-mastoidal muscles on the urovena of the lower and average third (area of a motor point of a phrenic nerve), place other electrode in areas of nizhyony cervical vertebrae.
The mode 1, sort of work II, frequency is 75 - 100 Hz, duration of half-cycles 2-3 with, depth of modulations is 50-100%, 10 min., on a course 10-12.
In the presence of a pain syndrome influence of SMT directly on область is shown to a throat, at considerable disturbances of neurohumoral regulation and a trophicity - on area of cervical sympathetic nodes.
For the purpose of recovery of the broken reflex mekhanizyom it is necessary to include reflex therapy in a complex of medical actions - influence by physical factors (an electrophoresis of 10% of solution of Calcii chloridum) for "vorotniyokovy" area, 15-20 procedures.
V. A. Trinos and соавт. (1984) suggest to carry out at the specified pathology electrostimulation of muscles of a throat under zayoshchity mutings (that the patient did not hear the sobstvenyony voice).
In process of improvement of phonation by voice skladyoka muting is removed.
The complex which includes step-by-step differenyotsirovanny use of a fonopediya, the psychotherapy, a psikhoprofiyolaktika and methods of physical therapy promoting a noryomalization of function of a nervous system is developed for treatment of permanent functional disturbances of a voice.
It is appointed:
• sedative therapy,
• hydrotherapy,
• a galvanic collar on Shcherbaka,
• breathing exercises which purpose is elaboration of the correct speech breath.
It is necessary to emphasize importance of exact differential diagnosis of nature of defeat and the reasons which caused a disease as the irrational terayopiya at these patients promotes fixing of a pathological soyostoyaniye.
At a hyperkinetic dysphonia treatment is directed generally to elimination of the excess muscle tension of a goryotana during phonation caused by dysfunction of the central nervous system.
At treatment of a hyperkinetic dysphonia appoint:
• psychotropic prepayorata,
• neuroleptics (Tisercinum, сонапакс),
• tranquilizers (Elenium, Seduxenum, Tazepamum),
• antidepressants (триптиозол, нипотен),
• spasmolytic drugs (Nospanum, Nicospanum, to midoka).
Along with medicamentous therapy the fizicheyosky methods of treatment of a hyperkinetic dysphonia promoting recovery of a normal funkyotion of a nervous system are applied.
Carry out:
• electrophoresis of 1% of solution of ephedrine,
• an electrophoresis of 10% - Calcii chloridum,
• an electrophoresis of 2% - an Euphyllinum on "voyorotnikovy" area,
• a galvanic collar on Shcherbaka.
In a complex of medical actions of treatment of a hyperkinetic dysphonia are shown:
• a balyyoneoterapiya (iodine-bromine bathing temperature of 35-36 °C 12-14 min., on a course of 10-12 bathtubs, pearl bathtubs of a temperayotura of 34-36 °C, 10-15 min., on a course of 12-15 bathtubs),
• electrophoresis, medical physical culture,
• electrophoresis, massage of "collar" area.
With poyolozhitelny effect of treatment of a hyperkinetic dysphonia at these patients use an electrosleep by a step technique with a frequency of 25-150 Hz, on a course 15 - 20 procedures, acupuncture.
For treatment of a hyperkinetic dysphonia the remedial respiratory gymnastics providing the set of exercises directed to elaboration of steady, coordinate fonatsionny breath is recommended.
The leading place in rehabilitation of patients with a hyperkinetic dysphonia is given to logopedic work.
The stimulating therapy at a hyperkinetic dysphonia is not shown.
At a spastic dysphonia the technique of impact of PEMP on a reflex and segmented zone is more effective.
The obtained data allow to schiyotat that use of PEMP in a complex with a voice and dykhayotelny training is shown at various forms of funktsioyonalny diseases of a throat.
Achievement of the maximum effect requires the differentiated definition of parametyor and zones of influence by magnetic field in each case [Vasilenko Yu. With, the Nikolaev V. P., Demchenko E. V., 1986].
At treatment of patients with functional diseases of a throat widely it is necessary to use the methods of a physical terayopiya exerting the normalizing impact on neuroпсихический the status of an organism.
Appoint a balneoterapiya (uglekisyoly, iodine-bromine, pearl bathtubs), an electrophoresis of calcium, bromine, magnesium to "collar" area, massage of a "vorotniyokovy" zone, the general electrophoresis of calcium across Vermel, the general UF-radiation, medical physical culture, etc.
Thus, at funkyotsionalny disturbances of a voice enter a complex of medical actions:
• psychotherapy,
• medikayomentozny means,
• the orthophonic treatment and methods of fiziyochesky therapy directed generally to regulation of a deyayotelnost of the central nervous system
local impact on a throat (afferent perceiving аппарат).
Such complex pathogenetic therapy, napravlenyony on various, connected among themselves links of patologicheyosky process, provides the potentiated effect of primeyonyaemy medical factors and allows to receive more blagoyopriyatny results.
