A text-book of diseases of the nose and throat / by D. Braden Kyle.

  • Kyle, D. Braden (David Braden), 1863-1916
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of diseases of the nose and throat / by D. Braden Kyle. Source: Wellcome Collection.

    619/680 (page 591)
    The appeai-ance of the cords (hirinij; phonatioii renders the diagnosis easy, for instead of closely approximating, there is seen an elliptical opening extending the wliole length of the glottis, produced by the cords bellying up before the current of air instead of being tightly tensed, as they normally would be by sound thyro- arytenoids. Bilateral Paralysis of Adductors (I^ateral Crico-Ary- tenoids).—Hysterical aphonia is usually treated under this head- ing, but that condition being rather a paresis than paralysis of the cords, is considered elsewhere under Hysterical Aphonia. Bosworth asserts that, while he has never seen an instance of this disease, a genuine myopathic paralysis involving the lateral crico-arytenoid muscles may be due to lead-poisoning, exposure to cold, to diph- theria, or to any of the exanthemata, and would give rise to com- plete loss of voice with phonatory waste. The laryngeal image (Fig. 166, 6) so closely resembles that of double recurrent nerve paralysis that differentiation is practically impossible. Unilateral Adductor Paralysis (I^ateral Crico-Aryte- noid).—This condition is not only extremely rare, but also pecul- iarly difficult to diagnosticate. Myopathic paralysis, due to the same causes as mentioned above, has occasioned the condition which is characterized by impairment or absence of plionation. During phonation the affected cord lies tightly drawn in complete abduction, Avhile its fellow tries by extra effort, passing over the central line, to effect approximation, the sound arytenoid cartilage passing in front of that of the affected side. Prognosis.—The prognosis for all the preceding conditions depends on the character of the underlying cause and the length of time it has been operative. If consequent upon one of the acute infectious diseases or exposure, the outlook for spontaneous or speedy recovery under proper treatment is good. The inability to procure absolute rest for the affected muscles makes the prog- i-ess proportionately graver, especially in involvement of the thyro- arytenoids. Treatment.—Removal of the cause should be the first reme- dial effort. Rest that is as nearly complete as possible should be insisted upon by forbidding loud or prolonged use of the voice, limiting necessary conversation to an easily produced whisper, Faradism or, failing this, galvanism should be applied daily to the affected muscles for five to ten minutes. Use both electrodes within the larynx, or place one on the outside of that organ, while the other is introduced through the mouth. Strychnin ])ushed to full tolerance is an admirable adjuvant. The general health should receive proper hygienic and tonic treat- ment by the ordering of cold sjionges, followed by friction, massage, outdoor exercise, and liberal diet, together with coca wine, kola, and the otiier vegetable and mineral tonics.