Hoarseness: possible causes and treatment in adults. Voice disturbance is a symptom not only of diseases of the larynx. Why does the voice become hoarse with age?

Our expert is a laryngologist surgeon, leading specialist, head of the scientific and clinical department of diseases of the larynx of the Federal State Budgetary Institution NCCO FMBA of Russia, Candidate of Medical Sciences Ibragim Nazhmudinov.

Where is the wheezing coming from?

Hoarseness can appear not only with a cold or overexertion of the voice, but also against the background of allergies, ligament injuries, intoxication of the body, paralysis and paresis of the laryngeal nerve. In children, hoarseness can occur as a result of a congenital laryngeal cyst, a foreign body, or hormonal changes in the body during adolescence.

Hoarseness may have more serious causes. Modern clinical statistics show that laryngeal oncology accounts for 20-25% of the total picture of cancer in the world. It's not only benign tumors, such as polyps, fibromas, nodules, cysts, papillomas, but also malignant ones, such as laryngeal cancer.

Therefore, if hoarseness appears against the background of complete health or does not go away for a long time after acute laryngitis, you need to contact a specialist.

Let's go to the doctor

Often dangerous diseases of the larynx are mistaken for a cold, bronchitis or asthma, because the symptoms of these diseases are similar. Therefore, with persistent long-term hoarseness, patients often think that they have not recovered enough from a cold and try to undergo intensive treatment. But if hoarseness persists for more than two weeks, this is a reason to be wary.

To dispel fears, a visit to a therapist, alas, is not enough. Only an examination by an ENT specialist using special diagnostic equipment, ranging from a laryngeal speculum, which is available in any clinic, and ending with methods such as laryngoscopy with a rigid endoscope, fibrolaryngoscopy, stroboscopy, will reveal the cause of the disease.

Don't delay your visit to the doctor. The fact is that many oncological diseases the larynx at the initial stage proceeds without bright severe symptoms and pain. The person does not notice that there is a slight hoarseness in the voice, and believes that this is the result of fatigue or excessive smoking. But without serious reasons such a picture cannot exist.

Unfortunately, doctors often see patients with stage 3-4 cancer who have ignored their hoarseness for a long time and seek help only when they notice the feeling of a lump in the throat, and this is already a sign of an advanced disease that will require complex surgical treatment.

Take care of the bundles!

The risk group for laryngeal diseases primarily includes people in vocal professions - teachers, actors, call center employees, educators, lawyers, as well as employees employed in hazardous work, smokers.

To prevent the development of dangerous diseases, you need to follow a number of simple recommendations.

Treat your cold promptly. Untreated acute laryngitis, which occurs against the background of colds or infectious-inflammatory processes, often becomes chronic and can lead to the growth of benign and sometimes malignant tumors.

Do not allow prolonged overstrain of the vocal cords; from time to time you need to give your voice the opportunity to rest. Therefore, if you have to talk a lot at work, try not to strain your voice at least at home.

Avoid foods and drinks that are too hot, spicy or sour. Such food leads to irritation and sometimes burns of the laryngeal mucosa.

Use household aerosols carefully. Spray them as far away from you as possible.

Don't smoke, don't abuse alcohol.

If possible, try to avoid being in smoky rooms. When working with hazardous substances, use respirators.

Be careful about your health. Don't neglect going to the doctor. Even such a natural process as teenage voice breakdown, which is also accompanied by long-term hoarseness, requires observation by an ENT specialist.

For quotation: Karpova O.Yu. Voice disturbance is a symptom not only of diseases of the larynx // Breast Cancer. 1999. No. 9. P. 11

The vocal apparatus is complex system, in which the functions of its component parts are interconnected and controlled by the central nervous system. It consists of a primary sound generator - the larynx, an energy department - the lungs, resonators - the nasal cavity and nasopharynx, paranasal sinuses, pharynx, trachea, bronchi and articulatory department - neck muscles, tongue, soft palate, teeth, lower jaw. Violation of the normal morpho-functional structure of each of these departments has a negative impact on the process of voice formation and vocal guidance, leading to the development of functional and organic dysphonia.

G The vocal apparatus is a complex system in which the functions of its component parts are interconnected and controlled by the central nervous system. It consists of a primary sound generator - the larynx, an energy department - the lungs, resonators - the nasal cavity and nasopharynx, paranasal sinuses, pharynx, trachea, bronchi and articulatory department - neck muscles, tongue, soft palate, teeth, lower jaw. Violation of the normal morpho-functional structure of each of these departments has a negative impact on the process of voice formation and vocal guidance, leading to the development of functional and organic dysphonia.
Many chronic diseases of organs and systems that are not part of the vocal apparatus can cause inferiority of its function even in the absence of any changes in the larynx. These include diseases of the lungs, cardiovascular, nervous and endocrine systems. Thus, chronic diseases of the thoracic and abdominal organs negatively affect the voice due to impaired ability of the diaphragm to move normally. When even small areas of inflammation appear in the lungs, the mobility of the diaphragm decreases, as a result of which the timbre of the voice changes, rapid fatigue appears, and pain in the larynx occurs, even with a slight vocal load. The symptom of a high diaphragm and pronounced changes in the acoustic properties of the voice in pulmonary tuberculosis, even with a small primary focus, are described.
Voice disorders are often only a symptom of a disease. Therefore, if no changes in the vocal apparatus are detected in the patient, then he must be subjected to a thorough and comprehensive examination. For example, hoarseness may be the first symptom of diseases such as apical lung cancer and thyroid cancer, myasthenia gravis and a number of other organ diseases chest.
Voice function disorders are grouped under the name "dysphonia". They are conventionally divided into functional and organic. If, during examination of the larynx, the vocal folds and other elements have a normal configuration, the usual color of the mucous membrane, and voice disorders come to the fore, then such diseases are classified as functional dysphonia. Organic dysphonias are caused by inflammatory diseases of the larynx (acute and chronic laryngitis, marginal and vasomotor chorditis, contact ulcers), neoplasms of the vocal folds (nodules, polyps, angiomas, fibromas, papillomas, intabulation granulomas, cancer) and paralysis of the larynx (peripheral and central origin).
The larynx is a hormonally dependent organ. The vocal apparatus is under the influence of the endocrine glands not only during the period of growth and development, but also throughout a person’s life.
Voice disorders in girls during puberty accompanied by dryness, soreness, tingling, and sometimes sore throat and hoarseness. Such disorders are most often associated with acute respiratory diseases, and therefore incorrect treatment. In women, voice disorders may occur a few days before or immediately during menstruation, with the voice becoming dull and low-pitched. Therefore, during this period, women in vocal professions should limit their vocal load. At use of contraceptives Due to the androgenic effect of the progesterone component - testogen, signs of voice virilization may appear. To avoid such complications, the use of these drugs should be limited to a period of up to 3 months. If even the slightest changes in voice timbre are detected, even without any narrowing of the vocal range, it is necessary to stop taking these drugs. In later stages, voice changes become irreversible.
In recent years, for some infectious and other diseases, after severe injuries and burns, accompanied by loss of protein, they began to use anabolic steroid - nerabol, retabolil, etc. The use of these drugs can lead to voice disorders in women: voice fatigue quickly occurs, disappears high tones out of range, the voice becomes lower. Women may also develop hair growth on the face and legs. The changes that occur regress very slowly after discontinuation of the drug.
A close connection has been established between voice disorders and thyroid dysfunction. In this case, rapid fatigue and weakness of the voice, hoarseness, and narrowing of the range due to the loss of high sounds are observed. The voice becomes muffled due to a sharp decrease in the tone of the vocal muscles. In most patients suffering from hypothyroidism, gelatinous swelling of the vocal folds is determined. These patients also exhibit dry and pale skin, puffiness of the face, and pasty extremities. Treatment is hormone replacement therapy. With diffuse toxic goiter Voice disorders are manifested by rapid periodic changes in pitch and timbre, rapid and severe fatigue of the voice, and a feeling of “tightening” in the larynx. This is probably a consequence of an increase in the level of cholinesterase in the blood, which inhibits the conduction of nerve impulses through acetylcholine. Treatment is usually surgical.
Voice disorders are significantly associated with dysfunction of the adrenal cortex. If its function is insufficient, weakness and rapid exhaustion of the voice are observed, especially pronounced in the evening hours and accompanied by a feeling of “tightening” in the larynx, up to complete suspension colloquial speech. In Addison's disease, the administration of deoxycorticosterone can significantly improve the voice. With hyperfunction of the adrenal cortex, which is observed mainly with its tumors, virilization syndrome occurs in women - a voice similar to a man appears, and its range narrows.
Thus, if dysphonia appears in patients with hormonal disorders, it is useless to use inhalations and other physiotherapeutic procedures in this regard; the underlying disease must be treated, and as hormonal disorders normalize, the voice will improve.
In the pathogenesis of functional diseases of the larynx, an important role is played by concomitant vertebral pathology: cervical osteochondrosis, craniovertebral block, spondylodystrophy of the cervical spine, detected during X-ray and neurological examinations. Thus, with cervical myofascial syndrome, along with pharyngeal parasthesias and dysphagia, patients complain of hoarseness, a rough voice, rapid voice fatigue, and a feeling of stiffness in the larynx. And all this against the background of sharp pain in the neck, behind the angle of the lower jaw, in the area of ​​the floor of the mouth. With this disease, painful muscle thickening is detected along the anterior and posterior surfaces of the sternocleidomastoid, chewing and pterygopalatine muscles. Treatment of patients with vertebral pathology includes manual therapy, novocaine blockades and different kinds physiotherapeutic and drug treatment. At professional treatment With this pathology, voice disorders quickly disappear.

Inflammatory diseases of the larynx

The problem of voice restoration in patients with inflammatory diseases of the larynx is one of the most complex and pressing in laryngology. This is explained by the prevalence of the disease, which reaches 61.2 cases per 10,000 population (Yu.S. Vasilenko, 1995).
There are acute and chronic inflammatory diseases of the larynx. The most common acute types are acute catarrhal laryngitis and subglottic laryngitis in children.
Acute catarrhal laryngitis It is quite rare to occur as an independent disease. It is usually a symptom of ARVI and such infectious diseases, like measles, scarlet fever, whooping cough. The cause of acute laryngitis is an infection, the pathogens of which saprophyte in the larynx and are easily activated under the influence of a number of exogenous and endogenous factors. Exogenous factors include general or local hypothermia, alcohol abuse, excessive vocal stress, exposure to fumes, dust, gases and other occupational hazards. TO endogenous factors include dysfunction of the autonomic nervous system, metabolic disorders, decreased immunity and diseases such as rheumatism, tuberculosis and others, in which there is increased sensitivity of the laryngeal mucosa even to mild irritants.
Patients complain of hoarseness up to aphonia, a feeling of dryness, sore throat, and dry cough. The general condition remains good, the temperature rarely rises to low-grade levels. Laryngoscopy reveals hyperemia and swelling of the mucous membrane of the larynx, drying of lumps of mucus on its surface. Treatment includes: 1) voice mode - the patient must remain silent or speak in a silent whisper, since with a formed whisper the load on the vocal apparatus is 2 - 3 times greater than with spoken speech; 2) a diet excluding cold, hot, spicy and salty foods, alcoholic beverages; 3) alkaline oil inhalations; 4) antihistamines.
Usually, with proper treatment, the voice is restored in 7 to 10 days. Particular attention should be paid to people with a voice profession. They can begin work (regardless of the duration of treatment) only after liquidation inflammatory phenomena in the larynx and full recovery voice function.
In various acute infectious diseases, certain changes in the larynx may be detected. In some cases, these are ordinary catarrhal laryngitis (scarlet fever, whooping cough), in other cases the changes are pathognomonic. These include: enanthema with measles, pustules with smallpox, fibrinous deposits of a dirty gray color with diphtheria, perichondritis with typhus, ulcers with typhoid fever and others. The course of the inflammatory process in the larynx largely depends on the condition of the patient and the severity of the underlying disease. Treatment is primarily general. The local treatment has no peculiarities; those measures are used that correspond to this form of laryngeal disease of a non-acute infectious nature. Particular care must be taken to monitor patients who develop edema, perichondritis, necrosis in the larynx, so as not to miss the time for emergency intervention (intubation or tracheotomy).
In children with acute inflammatory diseases of the larynx, subglottic laryngitis (or false croup). With this disease, a narrowing of the larynx occurs in the subglottic region due to inflammatory edema. The development of subglottic laryngitis is facilitated by the narrowness of the lumen of the larynx and the pronounced loose submucosal layer in the subglottic region in children of the first years of life. Usually these children suffer from allergic diseases.
The clinical picture is usually the same. The attack begins suddenly at night. A paroxysmal barking cough, acrocyanosis, inspiratory shortness of breath, retraction of the pliable areas of the chest and epigastric region appear. The attack lasts from several minutes to half an hour, then the child sweats heavily, falls asleep, and in the morning he wakes up in a normal state. Since attacks can recur, parents need to be taught how to provide first aid to their child. You need to pick up the child and try to calm him down. The air in the room should be humidified, for which you can bring the child into the bathroom and let him out of the shower hot water; It is recommended to take a hot foot bath. Give the child a warm drink from a spoon. In case of laryngospasm, you should induce a gag reflex by pressing with a spoon on the root of the tongue. Since there is swelling in the subglottic area, antihistamines are prescribed in the form of microenemas, rectal suppositories or injections. If the attack drags on and the listed measures turn out to be ineffective (and this sometimes happens when the attack develops against the background of a cold), it is required medical assistance: prednisolone is administered intravenously at the rate of 1 - 2 mg per 1 kg of body weight. After this, the child's condition usually improves quickly.
Special attention should be paid to acute stenosing laryngotracheobronchitis in children. This disease always occurs against the background of a viral infection. Gradually to normal clinical picture hoarseness develops, then a dry cough, and then a cough with sputum; Signs of laryngeal stenosis gradually increase: inspiratory shortness of breath and retraction of the pliable parts of the chest, acrocyanosis, the child can only be in a semi-sitting position. The disease develops over several days against a background of high fever. In these cases, urgent hospitalization of the child in a specialized ENT department is indicated.
Chronic laryngitis usually occurs under the influence of the same reasons as acute inflammation, if they were not eliminated in a timely manner and continued their harmful effects for a long time. These reasons include the following factors: constant breathing through the mouth; chronic sinusitis (especially purulent); chronic diseases of the lower respiratory tract (bronchitis, bronchiectasis, tuberculosis); occupational hazards (dust, vapors, gases); sudden temperature fluctuations, excessive dryness or humidity; improper use of the voice when singing and speaking; smoking and alcohol abuse. Chronic diseases of cardio-vascular system, leading to stagnation of blood and lymph in the neck, also lead to the occurrence of chronic laryngitis.
However, recognizing the role of individual factors in the development of chronic laryngitis, it was found that each of the harmful substances leads to laryngeal disease much less often than their combination.
There are three main forms of chronic laryngitis: catarrhal, hypertrophic and atrophic.
At chronic catarrhal laryngitis patients complain of slight hoarseness, rapid voice fatigue, sore throat, frequent coughing with the release of mucous sputum. During an exacerbation, these phenomena intensify. Laryngoscopy reveals moderate hyperemia and swelling of the laryngeal mucosa, and phonation reveals incomplete closure of the vocal folds. During an exacerbation, treatment is the same as for acute catarrhal laryngitis. The prognosis is favorable if the causes that led to the occurrence are excluded. of this disease.
Chronic hyperplastic laryngitis characterized by the proliferation of both the epithelial and submucosal layers. There are diffuse and limited forms of hyperplastic laryngitis. In the diffuse form, there is a uniform thickening of the mucous membrane of the larynx, most pronounced in the area of ​​the vocal folds. Sometimes the vocal folds are covered by hyperplastic vestibular folds. The limited form manifests itself in the form of singing nodules, leukoplakia, pachyderma and hyperkeratosis. One of persistent symptoms All forms of hyperplastic laryngitis are characterized by hoarseness, the severity of which depends on the stage, form and duration of the disease. The diagnosis is made on the basis of characteristic laryngoscopic signs.
Patients with hyperplastic laryngitis often have bacterial, inhalant or food allergies. Thus, with edematous hyperplasia of the vocal folds (Reinke-Haek edema), increased sensitivity to inhalation allergens (nicotine) predominates; with diffuse forms of hyperplastic laryngitis, great importance is attached to bacterial allergies, and food allergies can in some cases lead to hypertrophy in the area of ​​the interarytenoid space.
In the diffuse form of hyperplastic laryngitis, conservative treatment is usually carried out: infusion of anti-inflammatory and hormonal drugs into the larynx, extinguishing the laryngeal mucosa with silver nitrate. For limited forms of hyperplastic laryngitis, surgical treatment is indicated. It is advisable to perform operations using direct subanesthetic microlaryngoscopy. Hyperplastic epithelium, leukoplakia, pachyderma, polypous changes are subject to removal. mucous membrane of the larynx. Histological examination of distant formations reveals initial signs of laryngeal cancer in 1 - 3% of cases. Limited hyperplastic laryngitis in the form of foci of keratosis is a precancerous condition. Therefore, these patients should be under mandatory medical supervision. Since almost all of these patients are smokers, it is very important at this stage to convince them to quit smoking, thus, if possible, preventing the transition of hyperplastic laryngitis to laryngeal cancer.
Chronic atrophic laryngitis may occur in people working chemical production who had diphtheria of the larynx, were in a zone of increased radiation, in patients diabetes mellitus and renal failure. Usually the atrophic process in the larynx accompanies the same process in the nose and pharynx.
Patients complain of dryness and sore throat, hoarseness, cough with crusts coming out, sometimes streaked with blood, and in some cases there is difficulty breathing associated with partial closure of the lumen of the larynx with dried crusts. Laryngoscopy reveals dry and thinned mucous membrane of the larynx, covered with crusts, mainly in the area of ​​the vocal folds and in the interarytenoid space.
Treatment is mainly symptomatic: alkaline oil inhalations, lubricating the laryngeal mucosa with Lugol's solution, infusion into the larynx vegetable oils, except sea buckthorn, vitamins A, E, K, B1, iron preparations, biostimulants (aloe, ATP, vitreous), proserin electrophoresis and diadynamic currents to the larynx area. The disease is difficult to treat, but it is quite possible to alleviate the condition of patients.
In the development of chronic inflammatory changes in the larynx, the release of the contents of the stomach and esophagus into the lower parts of the pharynx has been established. In this case, diffuse catarrhal, infiltrative inflammatory changes in the mucous membrane of the larynx, as well as local trophic and hyperplastic changes in the area of ​​its posterior third, were noted. The indicated organic changes in the laryngeal mucosa in this group of patients with secondary laryngitis are facilitated by a violation of the immune resistance system, identified when studying the state of general humoral and local immunity.
Currently, the participation of the immune system in the formation chronic inflammation mucous membrane of the larynx is generally accepted. There is evidence of the effective use of the herbal medicine "Erakond" in the treatment of these diseases, which regulates reparative processes and has a pronounced anti-inflammatory and immunomodulatory effect. The drug is used by infusion into the larynx.

Motor disorders of the larynx

Movement disorders in the muscular system of the larynx occur either in the form sharp increase their function, or, conversely, weakening and complete oppression of it. Increased reflex excitability of the neuromuscular apparatus of the larynx is more common in childhood in the form of diseases such as spasmophilia, rickets, whooping cough and others. It is expressed in seizures of convulsive closure of the glottis, which can be repeated many times. Laryngospasm can appear as a result of reflex irritation of the larynx by a foreign body, from the use of cauterizing agents, or inhalation of irritating gases. In other cases, laryngospasm may be of central origin, as, for example, in hysteria, epilepsy, tetanus. Treatment should be aimed at the underlying disease. Paresis and paralysis of the larynx can be myopathic and neurogenic . Myopathic paresis And paralysis arise as a result of inflammatory changes in the internal muscles of the larynx. These phenomena can be observed in acute and chronic laryngitis, some infectious diseases (diphtheria, influenza, typhoid, tuberculosis), and high vocal load. In myopathic paralysis, the process mainly involves the constrictors of the larynx; The laryngoscopic picture depends on which muscle or muscle group is affected. Thus, against the background of influenza, paresis of the vocal muscles often develops, and the glottis becomes fusiform. As a result of incomplete closure of the vocal folds, the voice in these patients is weakened and has a hissing character.
Due to increased air consumption, shortness of breath develops during a long and intense conversation. If treatment is not started promptly, the voice may remain hoarse for a long time. Neurogenic paralysis of the larynx can be central or peripheral. And the central ones, in turn, are divided into organic and functional. Organic central paralysis of the larynx occurs with brain lesions (tumors, hemorrhages, syringomyelia, acute polio, tick-borne encephalitis, syphilis). In this case, there are no isolated paralysis of the larynx; they are usually combined with damage to the IX, XI and XII cranial nerves, which is revealed by neurological examination. In case of signs of laryngeal stenosis, tracheotomy and treatment of the underlying disease are indicated.
Functional central palsies larynx occur in neuropsychiatric disorders, due to disruption of the interaction between the process of excitation and inhibition in the cerebral cortex. A striking example is hysteria. One of the manifestations of movement disorders during hysteria may be difficulty breathing associated with paradoxical closure of the vocal folds during inspiration. As a rule, these changes occur in young women with a labile nervous system who have previously suffered from colds. Usually the diagnosis was made: bronchospasm, laryngospasm, uncontrolled bronchial asthma and treatment with bronchodilators and hormones was carried out unsuccessfully. The duration of the disease can range from several hours to 10 years or more.
Differential diagnosis between true laryngeal stenoses and respiratory disorders during hysteria, which require a diametrically opposed approach to treatment, causes certain difficulties in some cases. It is typical that during the day, in the presence of strangers, these patients experience noisy stridor breathing, but when the patients are distracted during a conversation, breathing becomes freer. It is typical that during sleep patients breathe completely calmly. During laryngoscopy, periods when the vocal folds during inspiration are located almost at the midline (clearance 1-2 mm when the norm is 14-16 mm) alternate with the divergence of the vocal folds in full, which never happens with organic stenoses of the larynx. When examining the function of external respiration, despite the apparent difficulty in breathing, hyperventilation is detected in patients, which is so characteristic of hysteria.
Hasty diagnosis, when immediate symptoms are taken into account without taking into account its dynamics, can lead to an unjustified decision to perform a tracheotomy. With this type of stenosis, tracheotomy is not advisable. Moreover, it can only aggravate the manifestation of hysteria. Decannulation in the future, taking into account psychogenic cause illness will be extremely difficult. These patients will never die from suffocation, and their treatment should be carried out only in a psychoneurological hospital (hypnosis, narco-hypnosis, etc.).
Peripheral paralysis arise as a result of damage to the laryngeal nerves, primarily the lower laryngeal or recurrent. Due to the peculiarities of the passage of the return laryngeal nerve in the chest cavity and on the neck, disruption of its conductivity is possible when various organs are affected. Since the left recurrent laryngeal nerve enters the chest cavity, numerous pathological processes in this area can lead to its compression (aneurysm of the aortic arch, dilated cardiomyopathy, cancer of the apex of the left lung, tumors and cysts of the mediastinum, tuberculous infiltrates, enlarged lymph nodes, etc. ). Various processes in the neck area can also lead to compression or injury to the nerve (cancer of the esophagus, trachea, thyroid gland, neck injury, subclavian artery aneurysm, thyroid surgery). If the patient has a limited mobility of the left half of the larynx, first of all you need to do a tomography of the lungs and mediastinum, and then X-ray examination esophagus and trachea, ultrasound of the thyroid gland. With unilateral paralysis of the larynx, patients complain of severe hoarseness, sometimes aphonia, shortness of breath when speaking, and difficulty coughing up sputum. During laryngoscopy, the vocal fold usually occupies an intermediate position; during phonation, a gap of about 2 - 3 mm remains between the vocal folds. Because of this, pronounced voice disturbances are observed. Treatment is aimed either at bringing the paralyzed vocal fold closer to the midline (introduction of Teflon into the vocal fold, suturing the vocal fold at the midline, reinnervation of the laryngeal constrictor muscles), or at compensatory movement of the healthy vocal fold beyond the midline during phonation to close with the paralyzed vocal fold (voice and breathing exercises, acupuncture, stimulating physiotherapeutic procedures). If unilateral laryngeal paralysis occurred after surgery on the thyroid gland, usually as a result of removal of a nodular goiter, and the voice disappeared immediately after the operation, treatment aimed at restoring voice function can begin within 1-2 weeks. Using reflexology in combination with forced voice exercises, we were usually able to achieve a significant improvement in voice function within 2 weeks, and after discharge the patients could begin to work. In cases where the start of treatment was delayed for 3-6 months or more, atrophy of the paralyzed vocal fold often developed. In these cases, the prognosis for voice restoration is unfavorable. With bilateral paralysis of the larynx, observed, as a rule, with neck injuries and operations on the thyroid gland, patients complain of severe difficulty breathing, with a virtually unchanged voice. There is often an idea that if the voice is not changed, then the disease is not related to the larynx. And in these patients, difficulty breathing is often associated with heart or lung disease and inadequate treatment is carried out, so tracheotomy has to be done for urgent reasons. The treatment of these patients is only surgical and consists of various plastic surgeries aimed at a fixed expansion of the lumen of the glottis. The voice deteriorates after these operations, but it becomes possible to get rid of the constant wearing of a tracheotomy tube.

Neoplasms of the larynx

Among diseases of the larynx, a significant place occupied by benign tumors. They are more often diagnosed in people of voice-speech professions, who usually quickly notice even minor changes in the voice and turn to a laryngologist. Benign neoplasms of the larynx often develop against the background of chronic laryngitis. These include fibromas, angiomas, angiofibromas, cysts, papillomas. All these tumors, with the exception of papilloma, grow slowly, sometimes over several years, and are characterized by a smooth surface, the presence of a stalk, and the absence of infiltrating growth and metastases. Subjective sensations of patients with benign neoplasms are different. The nature and degree of disorders are determined by the location, size and degree of mobility of the tumor. Voice disorders often worsen when inflammation occurs in the larynx. If the neoplasm has a wide The basis of hoarseness is permanent. If the tumor is pedunculated and descends into the subglottic space, then the vocal folds close tightly and hoarseness does not occur. In cases where the tumor is pinched between the vocal folds, there is a sudden interruption of the voice when speaking. Difficulty breathing occurs rarely, only with rapidly growing laryngeal papillomas. The diagnosis is made based on laryngoscopy data. Treatment for benign tumors of the larynx is surgical. After this, all patients, especially people with a voice-speech profession, should undergo phonopedic therapy.
From malignant neoplasms The most common cancer is the larynx. Risk factors are smoking, alcohol abuse, vocal overload, occupational hazards (dust, soot, aniline dyes, radioactive substances). Precancerous conditions include all types of dyskeratoses (hyperplasia, leukoplakia, keratosis, pachyderma), degenerative proliferative processes (contact ulcers and granulomas), and all benign tumors. Based on location, cancer of the upper (vestibule), middle (vocal folds) and lower (subglottic) parts of the larynx is distinguished. More often the cancerous tumor affects the upper part, less often the middle part, and even less often the lower part. With cancer of the laryngeal vestibule, the earliest symptom is painful or silent dysphagia. Since the voice does not change with this localization of cancer, it is not uncommon to experience diagnostic errors(they treat pharyngitis, tonsillitis, pharyngeal neuroses, but without effect). Therefore, with such complaints, examination of the larynx should be mandatory. When the vocal fold is affected by a cancerous tumor, the main complaint is hoarseness, which should force the patient to see a doctor. But there is an opinion that a smoker’s hoarse voice is a normal condition, and patients are in no hurry to consult a doctor about this.
With cancer of the subglottic region, the main complaint is difficulty breathing, and this, as a rule, manifests itself already at the 2nd - 3rd stage of the disease.
To diagnose laryngeal cancer, laryngoscopy, microlaryngoscopy, fibrolaryngoscopy, stroboscopy and tomography of the larynx are used. Treatment for laryngeal cancer is combined: surgery and radiation. In cases where the tumor has grown into surrounding tissues, tracheotomy and chemotherapy are performed.

Functional dysphonia

In recent years, the number of people with functional diseases of the larynx has sharply increased, which, according to many researchers, is associated with an increase in the load on the nervous system and human psyche. Diseases of the larynx that impede speech communication, reduce performance and create a threat of professional unsuitability. Specialized care for these diseases helps restore voice function and return people to labor activity. A decrease in the sonority of the voice, the appearance of hoarseness or absence of voice is usually considered a sign of a disease of the larynx. However, indirect laryngoscopy in some patients with an altered voice does not reveal organic changes in the larynx. Such disorders are considered functional. Dysphonias are divided into hypotonic, hypertonic and spastic. Functional aphonias are divided into paretic and spastic, and phonasthenias are divided into acute and chronic. Voice and speech formation is carried out thanks to the coordinated activity of the respiratory, vocal and articulatory apparatuses, the interaction of which is ensured and controlled by the cerebral cortex. Functional dysphonia occurs when this coordination is disrupted in any area and is manifested by a variety of subjective symptoms, which are divided into two main groups: general neurological and local disorders. General neurological symptoms include the patient’s peculiar behavior: anxious and gloomy experiences, depressed state, fear of an unfavorable outcome of treatment, increased irritability, mood instability, short temper, sometimes apathy, sleep disturbance. Local manifestations are characterized by changes in voice, sensory and secretory disorders. Functional voice disorders are observed in people weakened by various somatic and infectious diseases, suffering from chronic diseases of the upper respiratory tract, and also using improper phonation and breathing techniques. Let's consider separate forms functional voice disorders.

Hypotonic dysphonia- reduction muscle tone vocal folds. The main causes of this disease are vocal stress during or after ARVI, tonsillitis, bronchitis, tracheitis; vegetative-vascular dystonia, hormonal dysfunctions, stressful situations. Patients complain of rapid voice fatigue, hoarseness, and decreased voice strength. The mucous membrane of the larynx and trachea is without inflammatory changes, the vocal folds are mobile, their tone is reduced, and during phonation there is a non-closure of about 1 mm. Laryngostroboscopy reveals sluggish, weakened vibrations of the vocal folds. Maximum time phonation is shortened. Typically, treatment includes the use of drugs aimed at increasing the tone of the muscles of the vocal folds: tinctures of eleutherococcus, aralia, ginseng root; anticholine esterase drugs - prozerin, galantomine; proserine electrophoresis and sinusoidal modulated currents to the larynx area, acupuncture. Proper breathing, speech and vocal phonopedia are required.

Hypertonic dysphonia- increased tone of the vocal muscles. It develops with a forced, forceful manner of speaking and singing, especially in a noisy environment. There is constant overstrain of the abdominal muscles, jerking movement of the diaphragm, tension in the muscles of the face and neck, accompanied by swelling of the veins of the neck. The main complaints of patients: hoarseness, pain in the larynx, pharynx and neck, constant desire to cough up mucus and phlegm, rapid voice fatigue, periodic laryngospasms. The patient's voice is sharp, shrill, with a metallic tint, and sounds tense. Noteworthy is the tight closure of the vocal folds during phonation. The following types of treatment are usually used: intranasal novocaine blockades, electrophoresis with aminophylline on the larynx area, low-frequency magnetic field on the paravertebral area. When treating these patients, we successfully used intradermal novocaine blockades in the Zakharyin-Ged zone in the larynx area. Gradually connected breathing exercises and phonopedic exercises.

Spasmodic dysphonia- neurodynamic phonation disorder, expressed in excessively intense activity and incoordination of the internal and external muscles of the larynx, as well as respiratory muscles. The occurrence of spasmodic dysphonia is most often associated with mental trauma and stress overload, but in some cases it can occur in people who have previously suffered acute infectious diseases, such as influenza. The voice of patients with spasmodic dysphonia is monotonous, low, with various overtones, the phonation is tense and compressed, often accompanied by grimaces, tension in the muscles of the neck and face. Many patients prefer to speak in a whisper. During singing, crying, laughing and after drinking alcoholic beverages, the voice becomes normal. Treatment of patients with spasmodic dysphonia presents significant difficulties. The leading role in treatment is played by the prescriptions of a neuropsychiatrist, combined with a strict voice regimen. Physiotherapeutic procedures include aminophylline electrophoresis on the larynx area. The use of acupuncture can be effective. The development of physiological phonation breathing and the formation of a new mechanism of voice formation are of great importance. If ineffective conservative treatment in severe cases, they resort to cutting or crushing the recurrent laryngeal nerve on one side. In functional aphonia, voice disorders are based on hysterical disorders. The disease occurs suddenly in people with a labile nervous system under the influence of stressful situations. Patients complain of a feeling of a “lump” in the throat, “sticking” of mucus, but the main thing is aphonia. They strive to emphasize the severity of their illness and express disbelief in the possibility of recovery and restoration of their voice. Hysterical subjects often experience relapses of aphonia. Functional aphonia can also develop in persons who have suffered acute inflammatory diseases of the larynx or exacerbation of chronic laryngitis. During the period when they communicate in a whisper, the incorrect mechanism of voice formation occurs. Functional aphonia is characterized by the absence of a sonorous voice, while loud cough and laughter are sonorous. The laryngoscopic picture can be variable. Some doctors are of the opinion that if a person has lost his voice, then best treatment- silence. In the case of inflammatory changes in the larynx, this is justified, but a short time, and for functional aphonia, treatment should begin as early as possible. According to our data, the most effective method of treating functional aphonia is acupuncture, thanks to which it is usually possible to restore the voice in 1 to 3 sessions, without additional drug treatment. Methods used to treat organic diseases of the larynx are not suitable for the treatment of patients with functional diseases of the larynx. And the treatment of this group of patients, as a rule, is carried out by specially trained otolaryngologists and phoniatrists. At the Ear, Nose and Throat Clinic named after M.M. THEM. Sechenov has been dealing with the problem of treating patients with functional diseases of the larynx since 1985. Along with the use of various treatment methods, acupuncture has been proven to be highly effective in treating patients with this pathology. Simplicity of the method, cost-effectiveness, absence of toxic and negative side effects on the body, the possibility of use both in inpatient and outpatient settings gives us the opportunity to recommend this method of treatment for functional diseases of the larynx, which allows us to quickly relieve the patient from long-term suffering associated with the absence or severe voice impairment. In addition, reflexology helps to normalize the activity of the nervous system, and breathing and voice exercises help strengthen the neuromuscular apparatus of the larynx, eliminate defects in phonation breathing and lead to coordination of the activity of individual parts of the vocal apparatus. The effectiveness of acupuncture in the treatment of various, especially functional diseases has been proven by centuries of practice. Currently, many doctors have undergone special training and are proficient in reflexology methods. These are mainly therapists and neurologists. There are only a few specialist otolaryngologists. In our opinion, acupuncture for ENT patients should be performed by an otolaryngologist who is well versed in his specialty. Only in this case can he adequately decide whether acupuncture alone is indicated, or whether it must be combined with traditional methods of treatment, and dynamic monitoring of the patient will help to adjust the treatment.

Our voice depends on various organs. After all, even in order to make the simplest sound, the vocal cords, lips, tongue, teeth, soft palate, throat, larynx, nose must be involved - and this is not the whole list. And when there is a malfunction in the functioning of at least one of these parts of the body, it can be recognized by the voice. Its purity, volume and clarity often help determine the disorder.

Let's look at some symptoms of voice diseases.

Symptoms of diseases by voice

Do you start speaking and it seems that your voice creaks like an ungreased cart? Of course, a deep voice in men - and women too - sounds very sexy (think Marlene Dietrich). But most of us find a rattling and squeaky voice extremely unpleasant and annoying... both for its owner and for the listeners.

About 7.5 million Americans experience dysphonia. This change may be due to the natural aging process and may not pose any health threat.

With age, lung tissue loses elasticity, respiratory and other muscles weaken and lose tone, in particular due to hormonal changes. Many men's voices become higher as they age because their estrogen levels increase, while in older women, as the amount of estrogen in the body decreases, their voices become lower. But all these and other voice changes can tell a lot about what is happening in our body.

Rarely occurring hoarseness - laryngitis - is a harmless phenomenon, usually associated with a cold, allergies or swelling of the nasopharynx. But this condition can also be a symptom of more serious respiratory infections or vocal cord strain. Although screaming and squealing are the main culprits in the appearance of laryngitis, in order to become hoarse, it is not at all necessary to squeal. Frequent coughing and whispering also cause similar voice changes. And if you live with a person who is hard of hearing, you may become hoarse from constant conversations in a raised tone.

Sometimes hoarseness just means you're getting older. If hoarseness does not go away within two to two and a half weeks, you should take this phenomenon seriously. This may be a symptom of one of two types of reflux: either gastroesophageal or reflux laryngitis. In the case of gastroesophageal reflux, the stomach throws gastric juice into the esophagus, and with reflux laryngitis, gastric juice rises to the throat.

Morning hoarseness, especially when accompanied by heartburn and dizziness, can be a symptom of both types of reflux. Other symptoms include a bitter taste in the mouth, a burning sensation, or a sensation as if something is stuck in the throat. If reflux is not treated, then consequences in the form of infections of the throat, nose and ear, Barrett's esophagus ulcer, fraught with esophageal cancer, will not keep you waiting.

A deep, hoarse voice, especially in women, is usually a symptom of many years of smoking, and when talking on the phone with such a lady, she can be mistaken for a gentleman. In both men and women, smoking causes thickening of the vocal cords, hence the “smoker's voice.” This symptom often occurs with Reinke's edema, a swelling of the vocal cords that is rare in non-smokers. Unfortunately, this symptom is rarely recognized in men because they tend to have deep voices. Although Reinke's edema is a clear symptom that smoking has already caused serious harm to human health. Chronic hoarseness can also be a hallmark of long-term alcohol abuse.

During his reign, former US President Bill Clinton often lost his voice, and this happens to him to this day. The causes of this disease have been called many: from allergies to asthma and overstrain of the vocal cords. Screaming is bad for the voice, but good for the heart. Hoarseness is a clear symptom of vocal cord cancer, and smoking is its main provoking factor. Those who smoke should not only give up this harmful habit as soon as possible, but also undergo periodic medical examinations in order to recognize a precancerous condition or cancer in time.

If you live in an industrial city, a hoarse voice may indicate that environment too many irritants and toxins.

Hoarseness also develops as an allergic reaction to certain medications - blood thinners, blood thinners, blood pressure, antihistamines, steroids, asthma medications, antidepressants, diuretics and high doses of vitamin C.

• There is no need to clear your throat frequently;
• Do not shout or speak in a whisper unless absolutely necessary;
• Avoid drinks containing caffeine, alcohol, and dairy products;
• Drink plenty of water.

Hoarseness can occur with iron deficiency anemia, as well as with serious autoimmune disorders, including myasthenia gravis, rheumatoid arthritis, Sjogren's syndrome and sarcoidosis (benign lymphogranulomatosis). Morning hoarseness - common occurrence with hypothyroidism. Chronic hoarseness can be a symptom of a disease such as a benign or malignant tumor of the vocal cords, throat, mouth or neck. Although all of these lesions are more common in smokers, they can also occur in non-smokers.

If your voice sometimes hoarses, it becomes difficult to breathe - you cannot “breathe”, you cough, shortness of breath appears - you may decide that you have asthma. But all of these symptoms most likely indicate that you have vocal cord dysfunction.

Doctors often confuse this voice disorder with asthma, especially when the patient is brought in by ambulance with symptoms very much like asthma, with a blue face and a feeling of tightness in the chest. The name says it all - the dysfunction is that the vocal cords cannot open and close properly to allow normal air flow when speaking. This attack may be caused by nasal problems or reflux, or may be a reaction to heavily polluted air.

There is a widespread myth in China that if a pregnant woman eats chicken or rabbit, her baby will have a hoarse voice.

Frequent coughing is a symptom of what disease?

Do you constantly feel like clearing your throat? You may develop this bad habit after a long period of coughing or laryngitis. In addition, the desire to “clear the throat” often occurs in a person experiencing anxiety, with a nervous tic or movement disorders. As with hoarseness, this symptom may mean you have chronic nasopharyngeal swelling or reflux.

Sometimes a constant desire to cough occurs when the throat is dry (this is how the body sometimes reacts to medications that cause hoarseness), as well as after radiation therapy. But most importantly, this symptom should cause concern, since it is characteristic of throat cancer. The vocal cords vibrate at speeds ranging from 8C to 400 times per second.

Diseases of the thyroid gland may cause pain in the cervical spine and suffocation. The functional activity of the thyroid gland depends on the presence of iodine in the body. If there is a shortage of this component, you will be able to feel it yourself. With pathological changes in the thyroid gland, you can feel like something is choking, and your neck is tightened.

Why does there be a feeling of pressure in the throat?

At pathological processes The size of the thyroid gland begins to increase, pressure appears in the throat, and you feel constant discomfort. Often this can be:

1. inflammation of the thyroid gland (thyroiditis);
2. excess production of hormones (hyperthyroidism);
3. thyroid cancer.

There are a lot of signs of thyroiditis. It all depends on the form of the disease. Thyroiditis occurs:

• acute purulent;
• acute non-purulent;
• subacute;
• chronic fibrous;
• chronic autoimmune.

Diseases that cause discomfort

Acute purulent thyroiditis develops during an acute or chronic infectious disease. It could be a sore throat, pneumonia, etc. Pain begins in the neck area in front, which radiates slightly to the back of the head and jaw. Are increasing The lymph nodes and pain increases during swallowing and head movements. Body temperature begins to rise.

Subacute thyroiditis can appear after viral diseases such as mumps, acute respiratory viral infections, and coxsackie. Most often, carriers of this type of thyroiditis are women over 30 years of age. Pain also appears in the neck and ears, migraine, body temperature rises and the patient’s activity decreases, sweating and weight loss are observed. When the illness lasts for a long time, drowsiness, swelling on the face, dry skin, and a lethargic state appear.

Chronic fibrous thyroiditis mainly affects people who have had Graves' disease or endemic goiter. The patient's thyroid gland becomes enlarged and thickened, and its functions are impaired.

With autoimmune chronic thyroiditis, there are no symptoms in the first few years. Most often, this disease occurs in women over 40 years of age. With an enlarged thyroid gland, compression of the neck begins, and the necessary hormones in the blood decrease.

With hyperthyroidism, all processes in the body are accelerated due to the oversaturation of hormones in the blood. This causes frequent changes in mood, overexcitability, trembling hands, and disturbed sleep.

Heart failure appears due to the large difference between the upper and lower pressure. The vision begins to double, the eyelids swell. The eyes may become watery and there may be a stinging sensation. A person may lose vision.

The digestive process is disrupted, appetite can either increase or decrease. The muscles begin to get tired quickly. Men may experience infertility, and women may experience menstrual irregularities. The patient begins to experience shortness of breath, and due to a decrease in lung capacity, metabolism accelerates.

No matter how much the patient eats, the weight will drop sharply. Appears constant thirst and, as a consequence, polyuria (frequent urination). During such an illness, the skin, nails, and hair quickly wear out, and the person begins to turn gray early.

The symptoms of such a disease may not be detected in older people, since most of them are present as a pattern.

Oncological diseases of the thyroid gland

Thyroid cancer is a malignant tumor that affects the most important organ endocrine system person. This pathology is often found in girls. The tumor can appear at any age. Most often, this disease occurs in people who suffer from iodine deficiency. It may appear in a few years.

A tumor can arise from radiation exposure. The reason may be radioactive rain that began after the test nuclear weapons. With frequent x-ray irradiation Tumors may develop in the head and neck area.

In old age, people experience malfunctions in their genes, resulting in the appearance of a tumor. The reason may be harmful work in workshops related to metal, or bad heredity. But the easiest way to get thyroid cancer is through tobacco and alcohol.

Typical tumors after chronic diseases. It can be:

• breast tumors;
• rectal diseases and colon cancer;
• multinodular goiter;
• diseases of the female genital organs;
• endocrine neoplasia.

When a patient develops a tumor, a nodule on one side of the neck may enlarge. At first, this nodule does not feel any pain. Over time, it begins to grow and thicken, and the lymph node enlarges.

In late stages of thyroid cancer, pain begins in the neck area, which is partially transmitted to the ear, pressure is felt in the thyroid gland, a feeling of suffocation and a lump in the throat, the voice becomes hoarse, the patient finds it difficult to breathe, and the veins swell. Such signs indicate that the tumor has begun to compress all the organs surrounding it.

There are several types of cancer:

• papillary;
• medullary;
• follicular;
• anaplastic.

During papillary cancer, tumors begin to emerge from many projections that resemble papillae. They respond well to treatment and are considered benign

Medullary cancer is detected quite rarely. It can grow into muscle and trachea. Basically, the disease is transmitted through genes. Iodine therapy does not help treat the tumor. Only surgery will help get rid of it. Operative method Not only the thyroid gland is removed, but also the lymph nodes.

Follicular cancer appears more often in older women. Cancer cells spread to the lungs and bones in the area of ​​the diseased thyroid gland. The tumor can be cured using iodine treatments.

Anaplastic cancer is considered the rarest form of the disease. Cancer cells spread very quickly throughout the body. This type of tumor is practically incurable.

Any of these thyroid diseases can cause suffocation. To ascertain the cause, you need to consult a doctor. He will examine your throat, prescribe all the necessary diagnostics, medications to cure the disease, or send you for surgery. You should not self-medicate or delay it. This will worsen your condition, and treatment will be even longer and more difficult.

Diet for thyroid diseases: healthy foods

Most common diseases

The thyroid gland is an endocrine gland that is responsible for metabolic processes, growth and development of tissues and organs, as well as other important functions of the body. The work of this organ is directly related to hormones such as triiodothyronine, thyroxine and calcitonin. Insufficient and excessive activity of the thyroid gland is equally dangerous and results in serious complications.

Among the main causes of thyroid diseases is an insufficient amount of iodine in food and water. In addition to iodine deficiency, chronic stress and genetic disorders can lead to thyroid pathologies ( hereditary factor), a number of chronic and infectious diseases, taking certain medications, unfavorable environmental conditions, including radiation.

These reasons lead to the fact that the function of the thyroid gland decreases (hypothyroidism occurs) or increases (hyperthyroidism), or changes occur in the structure of the organ (goiter, nodules in the thyroid gland, hyperplasia are formed). All these diseases are characterized by the following symptoms:

• constant physical weakness;
• fast fatiguability;
• irritability.

Specific manifestations are observed depending on whether the function of the thyroid gland is increased or decreased. For example, if the metabolism accelerates with hyperthyroidism, then the patient may notice:

• sudden weight loss;
• rapid pulse;
• tremor of the limbs;
• increased sweating;
• insomnia.

Thyrotoxicosis occurs due to a sharp increase in the activity of the thyroid gland, intoxication of the body occurs due to increased production of hormones. A characteristic manifestation of this disease is the so-called bulging eyes, as well as the development of goiter and photophobia.

Hypothyroidism leads to severe weight gain, tissue swelling, increased blood pressure, dry skin and hair, and bradycardia.

A goiter of the thyroid gland can have a nodular structure (nodular goiter) or be formed due to excessive proliferation of organ tissue - then it is called diffuse. The presence of both nodes and overgrown tissues indicates a mixed type of goiter. Since such a formation compresses neighboring organs and tissues, this disease can be suspected based on the following signs:

• hoarse voice;
• sensation of a foreign body, a lump in the throat, pressure in the neck;
• dyspnea;
• difficulty swallowing.

The larger the size of the goiter, the more pronounced the symptoms will be. An advanced disease can cause pain, which indicates the development of inflammatory processes and possible internal hemorrhage. Inflammation is indicated by enlarged lymph nodes in the neck.

The growth of cervical lymph nodes may indicate the presence of a malignant thyroid tumor with metastases. Autoimmune diseases of the thyroid gland cause the formation of antibodies and leukocytes, which, acting together, stimulate its function or disrupt the integrity of tissues. Among such diseases, the most common (about 1% of thyroid diseases) are autoimmune thyroiditis and diffuse toxic goiter.

With autoimmune thyroiditis, patients experience the following symptoms:

• bradycardia appears;
• the timbre of the voice changes, it becomes low and hoarse;
• speech becomes slurred and clarity disappears;
• facial features become coarser;
• shortness of breath appears even after little physical activity;
• memory deteriorates;
• weight increases.

The problem is that in many cases there are no clear signs of the disease. Serious diseases of the thyroid gland, including a malignant tumor, can be detected using ultrasound examination or special analyzes blood for hormones.

General symptoms of thyroid diseases

It is worth contacting an endocrinologist for examination if the following symptoms occur:

• severe weight loss or weight gain for no apparent reason;
• increased irritability;
• fast fatiguability;
• skin and hair become dry, hair becomes brittle and falls out;
• muscle pain;
• dyspnea;
• sensation of a foreign object in the throat (lump);
• changes in hormonal levels;
• passivity or, conversely, hyperactivity in the child;
• disruptions of the menstrual cycle in women.

The above symptoms indicate possible availability problems with the thyroid gland, so it is necessary to undergo examination and begin treatment as quickly as possible to avoid serious complications.

Features of diseases in men, women and children

The same thyroid diseases in men and women, as well as in at different ages manifest themselves with similar symptoms, but there are also some distinctive features. Thyroid pathologies are more common in women than in men, and “ female version» diseases are characterized by more severe symptoms and the most serious consequences for health.

Problems in the functioning of the endocrine system, including the thyroid gland, are often associated with hormonal imbalances: adolescence, pregnancy, menopause. During these periods, girls and women need to be very careful about their health and, if there is the slightest suspicion of an endocrine disease, consult a doctor for advice.

During pregnancy, thyroid disease in the absence of adequate therapy threatens to develop congenital pathologies The child has. There are frequent cases of infertility in women suffering from thyroid diseases. Severe premenstrual syndrome and an irregular monthly cycle are clear signs of hormonal imbalances, which may be caused by thyroid disease.

In men, problems with the thyroid gland are less common and are manifested by decreased libido and erectile dysfunction.

In childhood, dysfunction of the thyroid gland can be suspected if the child suffers from excessive thinness and hyperactivity or, conversely, passivity and obesity with proper nutrition.

Diet: menu for the week

Therapy for thyroid diseases involves mandatory intake of hormonal medications in the dosage prescribed by the doctor and a special diet. An important condition for proper nutrition is a complete cessation of smoking and alcohol, sweet carbonated drinks, pickles, smoked, canned foods, coffee, sweets and spicy seasonings. You should limit the consumption of bread, pastries, sausages, strong tea, and white rice.

The diet for hypo- and hyperfunction of the thyroid gland is different. If in the first case it is necessary to focus on reducing the calorie content of food to combat obesity, then in the second, on the contrary, it is necessary to increase the patient’s weight and strengthen his health.

Diet for hypothyroidism

Therapeutic meals are served five times a day, the daily calorie content of food should not exceed 2100 kcal. Particular preference should be given to low-fat fermented milk products, vegetables, fruits and cereals.

For breakfast, you can eat buckwheat with meat (boiled or steamed), drink weak tea or herbal decoction. For a second breakfast, low-fat cottage cheese and fruit or berry compote without sugar are suitable. For lunch you can eat vegetable soup, meat or fish with a vegetable side dish and drink compote. For an afternoon snack, meatballs made from fish, meat or poultry, and unsweetened tea are suitable. For dinner, it is recommended to prepare a light vegetable salad, an omelette from egg whites and compote. If you feel hungry before going to bed, you can drink jelly.

Example of a menu for a week for hypothyroidism (dishes to choose from):

Diet for hyperthyroidism and thyrotoxicosis

Nutrition for these diseases should help reduce the activity of the thyroid gland and reduce the production of hormones. To do this, you should consume foods rich in calcium and phosphorus in large quantities (cheeses, beans, sardines, parsley, dill, cabbage, basil, etc.), and avoid those that contain iodine or stimulate the central nervous system. Food should preferably be plant-based; you need to take fiber in the form of dietary supplements or with food (cereals, legumes, pumpkin, apples, tomatoes, potatoes, avocados).

For breakfast, a vegetable salad with apples, seasoned with sour cream, a piece of cheese, an omelette, oatmeal, and tea are perfect. You can have a snack on toast with cheese, drink tomato juice. For lunch you can eat borscht, for the main course - boiled chicken with brown rice, wash down with unsweetened compote. Biscuits and rosehip decoction are good for snacking. For dinner, you can prepare vegetable puree with meatballs, casserole and tea. You are allowed to drink kefir at night.

Healthy foods

Seaweed, fish (especially red fish), cod liver and seafood, as well as healthy foods containing large amounts of protein: lean meat, eggs, legumes, will help replenish iodine deficiency in hypothyroidism. It is necessary to consume fresh fruits and vegetables and cereals in sufficient quantities. It is important to remember that excessive drinking of water can lead to the formation of edema, which already occurs with a slow metabolism. Clean water You should drink no more than 1.5 liters per day, but not at night.

With hyperthyroidism, you need to pay more attention to foods rich in vitamins, phosphorus and calcium, and additionally take vitamin and mineral complexes.

Pain in the thyroid gland occurs with to varying degrees intensity, has aching or sharp character, intensifies when swallowing food.

Causes of pain syndrome

Pain in the thyroid area most often provokes the development of thyroiditis - this is an inflammatory disease caused by bacterial, viral infections, and autoimmune processes. The cause may also be pathological proliferation of glandular tissue and hyperfunction of the thyroid gland - thyrotoxicosis. In this case, an increase in the volume of the organ leads to compression of the larynx, trachea, and nerve endings, resulting in pain and a feeling of a lump in the throat.

Why does the thyroid gland hurt?

• Hashimoto's chronic thyroiditis;
• De Quervain's granulomatous thyroiditis;
• strumit;
• Riedel's chronic thyroiditis;
• thyrotoxicosis;
• thyroid cancer.

The intensity of pain in the thyroid gland depends on the type and severity of the disease. In some cases, discomfort occurs only during eating or talking and does not cause any special problems. During an acute inflammatory process, a person feels severe malaise, severe pain in the lower neck, the skin over the organ is hot to the touch and hyperemic. Upon palpation, the unpleasant sensations intensify.

Fibrous-invasive goiter or Riedel's thyroiditis is characterized by the replacement of parenchymal tissue of the thyroid gland with connective cells. The disease mainly affects women aged 30–60 years. The cause of the development of the pathology is not fully understood, but there is a hypothesis that subacute thyroiditis can develop into Riedel's disease.

Signs of the disease:

• feeling of a lump in the throat;
• limitation of tongue mobility in women;
• thickening of the Adam's apple in men;
• hoarseness of voice;
• dry cough;
• labored breathing;
• hardening of the lower part of the anterior neck.

Pain occurs when swallowing food. An enlarged thyroid gland puts pressure on the trachea, esophagus and nerve endings. It is difficult for a person to talk, and attacks of suffocation may occur. Such symptoms are diagnosed in the later stages of the disease.

Hashimoto's thyroiditis

Hashimoto's goiter develops with an autoimmune lesion of the thyroid gland. The immune system begins to perceive the endocrine organ as a foreign body and actively produce antibodies. T-lymphocytes destroy thyroid follicles and provoke the development of hyperplasia, a chronic inflammatory process. Subsequently, the affected cells die, and the gland cannot sufficiently synthesize hormones, and hypothyroidism is diagnosed.

Symptoms of autoimmune thyroiditis:

• weakness, malaise;
• mood changes, depression;
• drowsiness;
• hair loss;
• deterioration of memory and concentration;
• swelling of the face.

The disease progresses slowly, with symptoms increasing over 2–4 years. Pain in the thyroid gland is moderate and occurs with significant enlargement of the organ caused by an acute inflammatory process. The thyroid gland grows, becomes dense, nodular to the touch.

Subacute Quervain-Crile thyroiditis has a viral etiology and is characterized by the formation of granulomas in the thyroid gland. The pathology develops after an infection, has a chronic course, and autoimmune reactions may occur. Women over 30 years of age are most often affected.

Symptoms of subacute thyroiditis:

• increased body temperature;
• chills, malaise;
• pain in the thyroid gland area, aggravated by palpation and neck movement;
• irritability;
• weight loss

How does the thyroid gland hurt with de Quervain's thyroiditis? The pain is localized in the front of the neck, can radiate to the ear or lower jaw, discomfort increases when turning the head. Patients have difficulty chewing and swallowing solid food. Upon examination, the doctor notes pronounced thickening of the thyroid gland.

Strumit

This is acute purulent thyroiditis. The inflammatory process develops against the background of a bacterial infection; the causative agents of the pathology can be streptococci, Staphylococcus aureus, Escherichia coli. Microorganisms penetrate into the thyroid tissue from chronic lesions (caries, tonsillitis, otitis media) along with the blood or lymph flow. The thyroid gland thickens, ulcers form in its follicles, and hormone synthesis is disrupted.

Clinical signs of strumite:

• high body temperature (up to 40°C);
• tachycardia;
• chills;
• headache;
• aches in joints and muscles;
• enlargement of regional lymph nodes;
• The thyroid gland hurts, unpleasant sensations radiate to the neck, back of the head, ear, lower jaw, tongue.

How does the thyroid gland hurt with the symptoms of strumitis? The skin over the thyroid gland turns red and becomes hot. With palpation, the pain intensifies; coughing, eating, talking, and sudden head movements can affect the intensity of the pain syndrome. At the initial stages, the thyroid gland has a dense consistency, later suppuration occurs, and the tissues become more elastic.

After the abscess ruptures, necrotic masses leak into nearby organs (esophagus, trachea, mediastinum), in some cases sepsis develops, which poses a threat to the patient’s life.

Can the thyroid gland hurt due to malignant tumors? In most cases, thyroid cancer is asymptomatic; a characteristic sign is the formation of a rapidly growing node and inflammation of the cervical lymph nodes. Pain appears in the later stages and can be caused by damage to nearby organs and nerve endings.

Symptoms of thyroid cancer:

• hoarseness of voice;
• difficulty swallowing food;
• dry cough not associated with colds;
• respiratory depression;
• pain in the thyroid gland, radiating to the ear;
• dilation of veins in the chest area;
• the formation of a lump on the front side of the neck, the lump quickly increases in size;
• general intoxication of the body, sudden weight loss.

Similar symptoms can be caused by metastasis to the peritracheal area, to the area of ​​the neurovascular bundle, and soft tissues of the neck in papillary and anaplastic thyroid cancer.

Diffuse toxic goiter

This autoimmune disease, characterized by pathological proliferation of thyroid tissue and its excessive secretion. Increased level thyroid hormones leads to intoxication of the body and the development of thyrotoxicosis.

The functioning of the cardiovascular, digestive, reproductive, and nervous systems is disrupted. Protruding eyes and puffiness of the face are observed. The patient loses a lot of weight, eats poorly, suffers from insomnia and migraines.

A lump in the throat due to the thyroid gland is symptoms of diffuse proliferation of endocrine organ tissue. In this case, the surrounding structures are compressed, paresis of the recurrent nerve occurs, and the voice disappears or becomes shallow. The patient cannot swallow dry, solid food. Pain occurs when nerve endings are damaged.

Inflammatory diseases and some forms of thyroid goiter can cause pain. The degree of severity depends on the stage of the pathology and the presence of complications. To establish a diagnosis and prescribe treatment, you must visit an endocrinologist. The doctor will conduct an examination, refer you for laboratory tests and instrumental studies. Based on the results obtained, the doctor will select adequate therapy.

How safe is surgery to remove thyroid cancer?

Hormonal functions thyroid gland and their disorders

Symptoms of hyperthyroidism

What does a cough with thyroid problems mean?

How to recognize and treat thyroid cysts

What to do if nodules form in the thyroid gland

Postoperative rehabilitation of patients after removal of the thyroid gland

Surgical intervention is indicated for patients who have been diagnosed with malignant changes in the structure of the thyroid gland. The thyroidectomy procedure is performed by an experienced surgeon after determining a number of indications for surgery: if dysfunction of this organ is diagnosed; when there is a severe form endocrine pathology thyroid glands How recovery proceeds after removal of the thyroid gland will be discussed below.

Features of rehabilitation after thyroidectomy

The postoperative period in men and women is accompanied by the following sensations:

• swelling and sore throat;
• the seam swells;
• The back of my neck hurts and feels tight.

The above symptoms, as a rule, are transitory in nature and after two to three weeks they completely disappear. Special treatment for such manifestations in postoperative period not required.

Patients often experience complications associated with voice disorders. A similar phenomenon is caused by the appearance of laryngitis, provoked by the irritating effect of the incubation tube used during surgery to administer anesthesia. Complications associated with voice disorders can manifest themselves in hoarseness and the appearance of hoarseness. These symptoms are caused by damage to the recurrent nerve. Fortunately, complications with voice dysfunction are extremely rare.

If a patient has a large part of a damaged organ removed, then rehabilitation and postoperative treatment may be accompanied by a state of weakness caused by insufficient calcium levels in the patient’s body. In such a situation, proper nutrition comes to the aid of the patient - it is this that helps prevent the occurrence of hypocalcemia in men and women during the recovery period. Nutrition is supplemented with medicinal biological active additives, which saturate the patient’s body with useful minerals and trace elements.

Heavy postoperative complication is local bleeding - according to statistics, the phenomenon is observed in only 0.2% of patients. Bleeding may be accompanied by significant swelling of the postoperative suture, as well as its suppuration. Fortunately, such consequences for surgical practice are quite rare.

Tests and therapy during rehabilitation

To improve the general health of the patient, after removal of the thyroid gland, he is prescribed treatment with the drug levothyroxine (injection). Such measures during the recovery period are necessary in order to suppress the secretion of thyroid-stimulating hormone produced by the pituitary gland in women. Such procedures help prevent relapse of TSH-dependent neoplasm and block the development of secondary hypothyroidism.

In the postoperative period are required additional tests. So, a month after the procedure on the thyroid gland, it is necessary to perform scintigraphy - this is required in order to detect potential metastasis of the tumor to other organs (for example, the lungs).

Such tests help identify complications after thyroid surgery: according to statistics, 15% of diagnosed patients have metastases in the lung tissue.

If the above method cannot be applied, the condition of the internal organs of the operated patient is assessed using radiography.

To prevent the consequences of removal of the thyroid gland, during the recovery period in women, the level of the hormone thyroglobulin in the blood serum is determined. Such tests help to identify the presence or absence of tissue of malignant origin in patients’ bodies.

If the swelling in the neck does not go away for a long time or the postoperative suture does not heal, the patient is tested for the presence of residual tissue of the removed organ. Radioactive iodine therapy comes to the rescue. A week after the administration of this substance, the condition of the body is assessed using the scintigraphy method. The doctor examines all organs of women and men for the presence (absence) of metastases. If malignant cells are detected, the patient is indicated for repeated radioactive iodine therapy.

If necessary, similar treatment is carried out again a year after the operation. During such therapy, various complications can arise - from complete disappearance of the voice to acute leukemia. Another possible complication is pulmonary fibrosis.

Additional examinations

To ensure that the patient’s treatment is effective and life after thyroid surgery is full, doctors use a combined treatment technique to prevent relapses:

• treatment with levothyroxine;
• use of radioactive iodine.

If there are no serious complications, re-examination of patients who have undergone surgery is carried out at intervals of one to three times a year. The patient undergoes the necessary tests and also informs the endocrinologist about the presence (absence) of the following symptoms:

• swelling in the throat;
• voice disorder;
• the presence of pain in the bones;
• migraine.

If the doctor, during the examination (in particular, palpation of the cervical region), discovers enlarged lymph nodes or other lumps, he prescribes additional tests to detect relapses of the malignant disease.

Three months after surgery, all patients with a removed thyroid gland undergo scintigraphy with concomitant administration of radioactive iodine. If specific symptoms no relapse of the disease was detected, there is no need for additional laboratory and medical tests, the patient’s life returns to normal.

Also, to determine hormonal levels and clarify whether pregnancy is possible after removal of the thyroid gland, the doctor prescribes tests to determine the content of thyroid-stimulating hormone produced by the pituitary gland in the patient’s blood serum.

The life of any patient who has undergone thyroidectomy is associated with replacement hormonal therapy. This treatment involves the use of the hormone thyroxine. For the first three months after surgery, this substance is administered to the patient in small quantities (no more than 50 μb per day, twenty minutes before meals). If the thyroid gland is not completely removed, then this amount of hormone is quite enough for its adequate functioning.

Over time, thyroxine replacement treatment is limited to a dose of 25 mcg per day. If the therapy gives positive results, the treatment is canceled. A month later, the patient undergoes a comprehensive examination, which includes verification of the level of free thyroxine and pituitary thyroid-stimulating hormone in the patient’s blood.

After the period postoperative recovery is over - the patient's swelling has subsided, voice disturbances have disappeared, hormonal balance has been restored - his life can proceed as usual.

Conclusion

So, surgical removal of the thyroid gland is necessary:

• for the treatment of malignant neoplasms on a diseased organ;
• when the nodes on the thyroid gland become very big sizes and cause excessive swelling in the neck, creating a clear cosmetic defect;
• surgery can be a way to treat hormonal dysfunction - thyrotoxicosis (the thyroid gland can be partially removed).

The patient’s life after thyroidectomy (subject to correct rehabilitation) proceeds as usual, women can become pregnant, give birth to children, play sports and carry out other usual daily activities.