Electrostimulation as an Effective Tool in Therapy of Vocal Cords

Summary

Background:
Electrostimulation has been an important factor in the treatment of paresis. We therefore decided its application in the therapy of patients with iatrogenic and idiopathic paresis of vocal cords, although this indication had been so far only occasional. Vocal cord paresis (recurrent nerve paresis) results in phonation problems, but also to respiratory problems and it is therefore necessary to begin the treatment early.

Cohort and methods:
The case study concerned two patients. The first one, a retired male patient, 64 years of age, a business representative, was subjected to endarterectomy, laryngostroboscopy with resulting dysphonia of 2nd to 3rd degree, and paresis of pl. voc. sin. of the iatrogenic type which resulted from surgery. The second patient, a women aged 29 years, a cleaning lady, was subjected to total thyroidectomy and fiberoptic laryngoscopy with resulting paresis of the left vocal cord in paramedial position with dysphonia of 2nd to 3rd degree. Both patients suffer from considerable phonation limitations. At the beginning of therapy both patients were subjected to detailed examinations at the ORL outpatient department. They were subsequently sent to a rehabilitation physician outpatient department. After his indications and exclusion of possible contraindications they were sent to a rehabilitation ward for treatment. Electrostimulation of pharyngeal muscles with cathode applied on thyroid cartilage and anode applied to the patient’s contralateral back of the neck. The applied impulse was 300-500ms and 2-3 ms pause, supra-threshold selected individually according to tolerance of the patient. The treatment was applied 10 times and three to five times weekly. The patient were also subjected to voice and breathing exercise under the guidance of a physical therapist. The therapy was followed by the control examination of a rehabilitation physician with a possibility to continue the treatment including possible individual corrections according to needs of the patient. The authors compared the entry and final examination by laryngoscopy, phonation and respiration abilities, subjective feeling of the patient during the therapy and afterwards and the physician’s opinion.

Results:
The patients viewed Electrostimulation favorably, the physician evaluated voice as improved with better resonance. Laryngoscopy demonstrated improvement of vocal cords mobility with better resonance. Dysphonia was improved by one degree in the first patient and by 0.5 degree in the second patient.

Conclusion:
The completed treatment was evaluated favorably with expected favorable result not only from the patient’s point of view, but also as viewed by the physician and physical therapist. Laryngoscopy also confirmed changes to the better. Electrostimulation is substantiated and occupies an important position in the treatment of vocal cord paresis as well. It also fulfills an important psychological constituent in general therapy of the patient. The authors recommend to explore the problems is a larger group of patients.

Keywords:
electrostimulation, vocal cords, paresis