Paresis of the soft palate treatment. Paresis of the soft palate, after adenotomy and tonsillectomy for the treatment of paresis Articulation exercises for rhinolalia

Paresis refers to a number of serious neurological disorders, which is a partial paralysis - an incomplete loss of the ability to move any organ. Can affect any part of the body. Paresis of the stomach is called gastroparesis, and all limbs - tetraplegia.

The disease is caused by a disruption in the course of the nerve pathways. The degree of severity is assessed in the system:

• 0 points means complete plegia (immobility);
• 1 point corresponds to a condition in which there is contractile activity in the muscles, but it is so low that it is almost imperceptible;
• 2 points are given if there are movements in the horizontal plane, there are movements in the joints, but they are constrained;
• 3 points are equal to a situation in which the limbs are raised, that is, they work not only horizontally;
• 4 points correspond to the full range of motion with reduced muscle strength;
• 5 points is the norm of a healthy person.

Depending on the type of paresis, it can be divided into:

• Sluggish, with pathological relaxation of the muscles with a decrease in their tone - hypotension;
• Spastic, with excessive tension and increased activity - hypertonicity.

Gastroparesis is a disorder of the nervous activity of the stomach, which does not allow the organ to be freed from food under normal conditions. Paresis of the stomach is associated with damage to the vagus nerve, which is responsible for the regulation digestive system. Its damage causes a violation of the normal functioning of the muscles. Because of this, an obstacle is created in the movement of food through the gastrointestinal tract - the gastrointestinal tract.

Conceived, it is impossible to determine the cause of gastroparesis. However, the factors are:

• Diabetes mellitus in an uncontrolled state;
• Surgical interventions on the stomach with a mechanical lesion of the vagus nerve;
• Negative medicinal effects of certain antidepressants and stimulants;
• Parkinson's disease;
• Multiple sclerosis;
• Amyloidosis;
• Scleroderma.

The main symptoms of paresis of the stomach consist of:

• Feelings of heartburn or the presence of GERD - gastroesophageal reflux disease;
• Nausea and vomiting;
• Feelings of rapid satiety;
• Bloating
• poor appetite and weight loss;
• Uncontrolled blood glucose levels.

Paresis is fraught with adverse consequences for the body. So, incapable of the normal release of food, the stomach becomes rigid. The food that accumulates in its cavity stagnates and wanders. This causes an increase in the number of bacteria, and as a result, infectious processes.

Food that stagnates in the body for a long time, hardens, becomes a beozar, almost a stone. An obstruction in the digestive tract can cause more congestion. Paresis of the stomach is a chronic long-term process. For its treatment, drugs - "Metoclopramide" and "Erythromycin" can be used.

If gastroparesis reaches critical proportions, an operation is prescribed, which consists in the introduction of a special tube surgically. It is inserted through the abdomen into small intestine so that nutrients can reach the intestines, bypassing the stomach and not stagnating there. So, food is absorbed faster.

Another option is intravenous or parenteral nutrition. Substances enter immediately into the bloodstream using a catheter. Electrical stimulation is used for treatment. Its meaning is to connect the electrodes, which cause the contraction of the walls of the stomach, due to which the food moves into the intestines.

Paresis of the soft palate and tongue

Paresis of the tongue and soft palate causes swallowing and speech disorders. The soft palate is a mobile muscular aponeurosis that separates the nasopharynx from the oropharynx due to the contraction of its muscles. The nerves that approach the tongue and palate are called the vagus, trigeminal, glossopharyngeal, and hypoglossal nerves. Their defeat causes paresis.

Causes of violation of the innervation of these organs:

• Inflammatory and infectious processes, such as poliomyelitis or diphtheria;
• congenital defects;
• Decreased blood filling of the brain in the vertebrobasilar system according to the ischemic type;
• Injuries that occur due to domestic injuries, technical errors during intubation or aspiration, as well as probing or endoscopy;
• SARS;
• Tumor neoplasms.

Symptomatically, this dangerous disease manifests itself:

• Disorder of the act of swallowing and breathing;
• Violation of the speech act;
• Problems with ventilation of the auditory tube;
• Dysphagia - food begins to flow into the nasopharynx, as the septum that holds it back no longer fulfills its function;
• Violation of phonation, that is, a change in voice. He becomes nasal;
• Problems with pharyngeal and palatal reflexes;
• Decreased sensitivity in the mucous membrane, soft palate, tongue;
• Violation of the act of chewing.

Diaphragm paresis

Diaphragm paresis is also called Cofferat's syndrome. It is manifested by a limitation in functioning caused by damage to the phrenic nerve. This disease occurs mainly during childbirth. And often in children who have spent a long time in conditions of asphyxia.

These babies require very careful handling. Obstetric benefits may not be favorable for them. However, without them, the child will not survive. So, the most common cause of paresis of the diaphragm during childbirth is the tipping of the upper limb of the fetus. This condition is a consequence of the difficulty in removing the shoulders and head of the baby.

In addition to obstetric causes, the nature of paresis may be congenital. A prime example is myotonic dystrophy. Symptoms:

• Bulging chest on the affected side.
• Dyspnea;
• Rapid and irregular breathing;
• Recurrent bouts of cyanosis;

80% of cases are associated with damage to the right side of the chest. About 10% are bilateral process. Paresis is detected by X-ray. On it, the dome of the diaphragm appears as a sedentary formation. Diaphragmatic paresis in a newborn baby contributes to the occurrence of pneumonia.

This disease should be treated by providing active pulmonary ventilation. Up to replenishment of the full volume of respiratory movements. Therapy is carried out using transcutaneous stimulation of the phrenic nerve. The prognosis of treatment will depend on the extent and severity of the process.

Most sick babies recover within 10 to 12 months. Symptoms of the disease in these cases go away earlier, but treatment should not be stopped until the signs of the disease on the x-ray disappear. Bilateral process, by right, is considered the most dangerous. Mortality in these cases reaches 50%.

After suffering a stroke

Stroke is often complicated by paresis. Pathology occurs on the side that is controlled by the affected part of the brain. Each of the hemispheres is responsible for controlling the opposite part of the body. So, paresis on the right occurs with an ischemic accident of the left hemisphere. It occurs more often, in 60% of cases.

Pathology on the right is characterized by a more favorable prognosis than that on the left. Paresis after a stroke is of two types:

• spastic;
• Peripheral.

Symptoms following a stroke are associated with:

• speech disorders;
• Fading of linguistic and verbal memory. Patients forget words and speech patterns, cannot read and write;
• Immobility of the limbs on the side of the lesion, while the arm is compressed and pressed against the body, the leg is extended at the knee;
• Changes in the mimic muscles of the face. On the affected side, the corner of the mouth and the lower eyelid descend;
• Depressed mental state, isolation.

Soft sky(lat. - palatum molle) is a muscular-aponeurotic formation that can change its position, separating the nasopharynx from the oropharynx when the muscles that form it contract.

In humans, five pairs of muscles control the shape and position of the soft palate: the muscle that strains the soft palate (m. tensor veli palatini), the muscle that lifts the soft palate (m. levator veli palatini), the tongue muscle (m. uvulae), palatoglossus (m. palatoglossus) and palatopharyngeus muscles (m. palatopharyngeus).

The soft palate is innervated by three nerves: vagus - innervates the muscles of the soft palate, trigeminal and, partially, glossopharyngeal - innervates the mucous membrane of the soft palate. Only the muscle that strains the soft palate receives double innervation - from the vagus nerve and the third branch of the trigeminal nerve.

Paresis of the soft palate clinically characterized by a violation of the processes of swallowing, breathing, speech formation, ventilation of the auditory tube. Paralysis of the muscles of the soft palate leads to leakage of liquid food into the cavity of the nasopharynx and nose, dysphagia. Speech acquires a nasal nasal tone, as sounds resonate in the nasopharynx, there is an excessive use of the nasal cavity as a resonator (hypernasality), manifested in excessive nasalization of vowel sounds.

With a unilateral lesion, the soft palate hangs down on the side of the lesion, its immobility or lagging behind on the same side when pronouncing the sound “a” is determined. The tongue deviates to the healthy side. The pharyngeal and palatine reflexes decrease on the side of the lesion, anesthesia of the mucous membrane of the soft palate and pharynx develops.

Bilateral symmetrical paresis of a mild degree is manifested by the periodic appearance of a slight difficulty in swallowing dry food, there is also a slight nasal tone of the voice.

note: violation of phonation with paresis of the soft palate usually occurs earlier and is more pronounced than a violation of swallowing.

For diagnostics initial stage paresis of the soft palate, a number of simple tests are offered:

1 - with paresis of the soft palate, inflation of the cheeks fails;
2 - the patient is invited to pronounce the vowels "a - y" with a strong accent on them, first with open nostrils, and then with closed ones; the slightest difference in sound indicates insufficient shut-off of the mouth and nose by the palatine curtain.

The nature of the paresis of the soft palate can be inflammatory and infectious in nature (damage to the nuclei and fibers of the cranial nerves in poliomyelitis, diphtheria, etc.); congenital, due to a malformation; ischemic- in violation of cerebral circulation in the vertebrobasilar system; traumatic, resulting from domestic trauma, trauma during intubation, suction of mucus, probing and endoscopy, and trauma during adeno- and tonsillectomy; also distinguish idiopathic paresis of the soft palate as isolated clinical syndrome that occurs acutely after SARS, often unilateral.

, (Moscow)

Paresis of the soft palate, after adenotomy and tonsillectomy to the treatment of paresis.

The most common operations in otorhinolaryngology are adenotomy and tonsillectomy. According to the literature, the proportion of tonsillectomy among other otorhinolaryngological interventions is 20-75%, and adenotomy 6.5-40.9%. Despite this, in the extensively studied literature, we find relatively few works that comprehensively cover the topic we have touched on.

Transient and persistent paresis of the cranial nerves - at the level of nuclei, fibers, nerve endings- including those innervating the soft palate, are classified in the literature as rare complications.

Paresis of the soft palate is clinically characterized by a violation of its important functions with the development of dysphagia, accompanied by the flow of liquid food into the cavity of the nasopharynx and nose. Speech acquires a nasal nasal tone, because the sound resonates in the nasopharynx, which is not covered by the palatine curtain. A unilateral lesion is manifested by the drooping of the soft palate on the side of the lesion, its immobility or lagging behind on this side during phonation. The tongue deviates to the healthy side. The pharyngeal and palatine reflexes decrease or drop out on the side of the lesion. The defeat of sensitive fibers leads to anesthesia of the mucous membrane of the soft palate, pharynx.

In the genesis of paresis of the soft palate after adenotomy and tonsillectomy, a number of factors are important: impregnation with an anesthetic or direct nerve injury with a needle during anesthesia; blockade or damage to the nerve with a needle with deep injections, gross manipulations; paresis, passing within a few hours, is due to blockade of the nerve, long-term or persistent - mechanical damage. The possibility of such damage is associated with the anatomical proximity of the tonsils to the parapharyngeal space, in the posterior sections of which the glossopharyngeal, vagus, accessory, hypoglossal cranial nerves and the border sympathetic trunk pass, and in the retropharyngeal space - the facial one. Possible direct injury to the nerve with an instrument or compression of the nerve by a hematoma, wound discharge and edematous tissues, followed by involvement of the nerves in the cicatricial process. Damage (injury) to the anatomical structures adjacent to the nasal part of the pharynx can lead to paresis of the soft palate, since the muscles and their tendons involved in its movement are injured. Paresis of the soft palate can also be caused by damage to the cranial nerves innervating the soft palate at the level of their nuclei by type bulbar syndrome as a result of infection penetration into the medulla oblongata from the nasopharynx by the hematogenous route or through the perineural spaces, or decompensation of an organic pathology of the brain such as tonsillogenic vasculitis.

We have treated 9 children with paresis of the soft palate after operations on the lymphoid-pharyngeal ring (after adenotomy - 7, after tonsillectomy - 2). In the treatment complex, agents were used to improve or restore metabolic processes and regenerate nervous tissue:

Biogenic simulators: aloe extract, FIBS, gumizol, apilac

Vasodilators: a nicotinic acid, dibazol

Means that improve vascular microcirculation: trental, cavinton, stugeron

Means that improve the conductivity of the nervous tissue: prozerin, galantamine

Antihistamines and hyposensitizing drugs

Means that normalize the functional state nervous system- glycine, novo-passit.

These groups of drugs are used in combination with physiotherapy (endonasal electrophoresis with dalargin, galvanization with novocaine on the submandibular region, bioelectrical stimulation of paralyzed muscles, neck massage).

In 6 children it was possible to restore the function of the soft palate, the treatment of three children continues.

Jackson Syndrome. On the side of the focus, peripheral paralysis of half of the tongue is observed ( XII couples a CN), on the opposite - pyramidal symptoms (insufficiency, paresis or plegia). One of common causes Jackson syndrome is a violation of blood circulation in the paramedian arteries of the trunk.
Eisenlohr syndrome. Paralysis of the lips, soft palate, tongue, dysarthria, weakness and numbness of the extremities. Occurs with damage to the medulla oblongata.

bulbar syndrome. Bulbar paralysis occurs when the nuclei of the CN of the bulbar group (IX, X, XII), as well as their roots and trunks, both inside and outside the cranial cavity, are damaged. The patient has dysarthria and nasal tone of speech, swallowing disorder (dysphagia), caused by peripheral paralysis or paresis of the muscles of the tongue, soft palate, pharynx, epiglottis, larynx.

Sick choke when taking solid food, liquid food pours out through the nose. Sometimes swallowing movements are generally impossible. Saliva flows from the corners of the mouth. When examining the patient, atrophy of the muscles of the tongue is detected, the soft palate hangs down, motionless during phonation, pharyngeal and palatine reflexes fall out. There is a disorder of breathing, cardiovascular activity. In severe, acutely developing cases, according to the figurative expression of L.M. Popova, the patient is literally "drowning in his own saliva". His tongue is flattened in the oral cavity, the palatine curtain hangs, the tongue touches the root of the tongue.

Pseudobulbar syndrome(pseudobulbar paralysis). It develops with bilateral damage to the supranuclear pathways. It is characterized by difficulty in taking solid and liquid food. In severe cases, the patient is unable to swallow a drop of liquid. Pseudobulbar paralysis is based on an increased reflex from the mucous membrane of the oral cavity, pharynx, soft palate, etc.

Soft palate and tongue movements practically unlimited, reflexes from the soft palate, pharynx are extremely elevated. The doctor is practically deprived of the opportunity to explore these reflexes. In a patient with pseudobulbar palsy, reflexes from the extremities, mandibular reflexes are increased, reflexes of oral automatism, violent laughter and crying are detected.

bulbar dysarthria syndrome. It develops with unilateral or bilateral lesions of V, VII, IX, XII pairs of CN. It is manifested by selective sluggish paralysis of the muscles of the speech apparatus (tongue, lips, soft palate, pharynx, larynx, muscles that lift the lower jaw, respiratory muscles). The patient has atrophy (unilateral or bilateral) of the muscles of the tongue, its atony. Reduced or absent pharyngeal, palatine reflexes (on one or both sides). Decreased mandibular reflex.

soft palate movements, tongue, pharynx are limited. The voice is weak, muffled, exhausted. Vowels and consonants are deafened. Speech is vile. The articulation of vowels is blurred. Selective disorders of articulation are possible in accordance with the characteristics of the distribution of flaccid paresis.

Paresis of the larynx is one of the types of damage to this organ associated with pathological change his neuromuscular work. The causes may be associated with a variety of disorders in the body, and treatment must necessarily include the search for and elimination of the influence of etiological factors. Paresis of the larynx (partial paralysis) now accounts for about a third of all cases of chronic diseases of the vocal apparatus, while the pathology carries a high risk of stenosis respiratory tract.

Paresis of the larynx and their types

The larynx is the part of the respiratory tract located between the trachea and the pharynx. The larynx is responsible for the implementation of voice formation, and is also a direct participant in the act of breathing. This organ contains the vocal cords, which, when vibrated, allow a person to make sounds (the function of phonation). For the degree of narrowing and expansion of the glottis, as well as for all movements of the ligaments, the internal muscles of the larynx are responsible, the work of which is controlled by the brain through the branches of the vagus nerve.

Paresis of the larynx can occur with any violation of the activity of the components of the body. This disease is a decrease in muscle activity, that is, a decrease in the strength or range of motion muscle tissue. Usually paresis of the larynx implies temporary disturbances in this part of the body (no more than 12 months in duration), which cover one half of the larynx, or both halves of it.

Pathology can develop at any age, since its causes can be quite diverse - from inflammatory processes to organic damage respiratory system. All paresis of the larynx is classified according to several criteria. Depending on the cause, these types of diseases are distinguished:

1. neuropathic paresis - associated with disruption of the nervous apparatus in any of its sections;
2. myopathic paresis - due to the pathology of the muscles of the larynx;
3. functional paresis - the disease develops against the background of an imbalance of inhibition and excitation in the body.

Among neuropathic paresis stand out:

• Peripheral (caused by pathology of the vagus nerve).
• Central (consist in violation of conductivity nerve impulses due to brain disease). If we are talking about diseases of the brain stem, where the nucleus of the vagus nerve is located, the paresis is called bulbar, about damage to the cerebral cortex - cortical.

According to the degree of coverage by pathological processes, paresis can be unilateral, bilateral.

Causes of pathology

This disease is due to many reasons. Most often it is associated with the failure surgical intervention, in particular, on thyroid gland. So, now up to 3-9% of operations on the thyroid gland are complicated by paresis of the larynx. In addition, traumatic damage to the nervous structures during interventions on the neck, chest, cranium, as well as injuries and injuries at home, at work, etc., can cause the development of pathology. Other causes of partial paralysis of the larynx:

• metastases, primary tumors of the neck, mediastinum, chest, trachea, larynx, esophagus;
• increase thyroid gland against the background of hyperthyroidism and other diseases;
• benign tumors of the larynx, large vocal cords;
• the presence of an inflammatory infiltrate in infectious pathologies of the larynx;
• the presence of a hematoma after injury;
• some birth defects hearts;
• aortic aneurysms, atherosclerosis of the coronary vessels;
• stroke;
• pleurisy;
• ankylosis of the arytenoid cartilage;
• neuritis against the background of intoxication, poisoning, infectious diseases (ARVI, influenza, tuberculosis, typhoid, etc.).

The greatest susceptibility to the development of paresis are people working in hazardous industries, smokers, people whose professional activities involve high loads on the vocal cords. Functional paresis of the larynx can be caused by severe stress, sometimes accompanied by mental illness, neurasthenia.

Symptoms of the disease

The severity of the clinic of the disease will depend on the degree of coverage of the larynx and vocal cords by pathological processes (unilateral, bilateral paresis), as well as on the duration of the course of the disease. The most striking symptoms appear with unilateral paralysis with disruption of the vocal cord:

• hoarseness of voice;
• hoarseness after a short conversation;
• decrease in sonority of the voice up to speech in a whisper;
• rapid fatigue of the voice;
• choking on liquid food;
• dyspnea;
• pain in the throat;
• impaired mobility of the tongue, soft palate;
• feeling of a coma in the throat, the presence of a foreign body;
• coughing or coughing attacks;
• with psychogenic paresis, the symptoms are often accompanied by headache, sleep disturbances, anxiety;
• by 1-2 weeks of illness, improvements often occur due to the compensatory inclusion of "reserve reserves" by the body, but after a while a sharp deterioration in the person's condition may occur against the background of atrophy of the muscles of the larynx.

Sometimes paresis does not manifest itself outwardly, and only a doctor can detect it during a routine examination. Bilateral paralysis is most often expressed by symptoms of laryngeal stenosis, aphonia, and the development of respiratory failure. Sometimes stenosis progresses so rapidly that in the first hours of the disease it reaches 2-3 degrees and requires emergency surgical treatment.

Possible Complications

The most serious complications arise against the background of difficulties in the flow of air into the trachea and lungs due to the narrowness of the glottis. They can lead to hypoxia of the body, chronic respiratory failure, disruption internal organs, but with central bilateral paresis, in a day they can cause asphyxia and death of a person. The onset of the stage of stenosis is characterized by the following clinic:

• shortening the intervals between exhalation and inhalation (shallow breathing);
• decrease in respiratory movements;
• inspiratory dyspnea;
• noisy breathing;
• slow heart rate;
• weakness, apathy, giving way to anxiety;
• blue nasolabial triangle.

With unilateral paresis, which proceed without treatment for a long time, the patient may develop various pathologies of the lungs, bronchi, as well as persistent voice changes up to its complete loss.

Diagnosis of paresis of the larynx

The task of the otolaryngologist in case of suspicion of the development of this disease is to find its exact cause, for which various examinations can be carried out and consultations of other specialists (psychiatrist, neurologist, gastroenterologist, surgeon, endocrinologist, etc.) can be prescribed. Particular attention is paid to the collection of anamnesis and clarification of the facts of surgical interventions in the past.

Among the instrumental and laboratory methods surveys are most often planned:

1. laryngoscopy and microlaryngoscopy;
2. radiography, CT, MRI of the larynx, brain, neck, chest;
3. EEG, electromyography;
4. phonography, stroboscopy;
5. Ultrasound of the thyroid gland, heart;
6. fibrogastroscopy;
7. complete blood count, blood biochemistry.

In the absence of organic changes in the body, a diagnosis of "functional paresis of the larynx" is made. In addition, it is necessary to differentiate the pathology with laryngeal edema, diphtheria, arthritis of the arytenoid cricoid joint, pulmonary embolism, myocardial infarction.

Conservative and surgical treatment

Therapeutic measures should begin with the elimination of etiological factors: for example, if there is compression of the branches of the vagus nerve, they are decompressed, with the development of neuritis against the background of poisoning, detoxification treatment is prescribed, etc.

Almost always, in order for the full treatment of paresis to be carried out, the patient should be hospitalized. In the hospital, the patient may be recommended the following types of therapy:

• decongestants;
• antihistamines, desensitizing agents;
• antibiotics, anti-inflammatory, antiviral agents;
• vitamins;
• biogenic stimulants;
• drugs to improve nerve conduction and neuroprotectors;
• psychotropic drugs;
• nootropics, vascular agents;
• hormonal drugs;
• muscle relaxants;
• acupuncture;
• electrophoresis;
• therapeutic blockade;
• electrical nerve stimulation;
• endolaryngeal muscle stimulation;
• diadynamic currents;
• massage.

Often paralysis of the larynx has to be treated surgically. This may be necessary in the presence of tumors, scars, as well as ineffectiveness. conservative therapy. Among the methods of surgical treatment:

• surgery of the thyroid gland or other organs in which the cause of paresis lies;
• placement of implants (for example, Teflon paste);
• reinnervation of the larynx;
• thyroplasty (displacement of the vocal cords);
• tracheostomy, tracheotomy as emergency measures.

Efficiency surgical treatment depends on the prescription of the disease, as well as on the individual characteristics of the organism and the specifics of the course of the disease. After the therapy or operation, it is imperative to recommend to the patient long-term phonopedic classes, breathing exercises to form the correct voice leading and normalize the separation function of the larynx. On average, the rehabilitation of patients after paralysis of the upper respiratory tract is 3-5 months.

Among the methods of treatment of paresis folk remedies the following are practiced:

• Brew 1 spoonful of snakehead grass with a glass of water, add a spoonful of honey. Drink 3 tablespoons of infusion three times a day on an empty stomach.
• 2 teaspoons of root marin are poured into 300 ml of water, boiled in a water bath for 10 minutes, insisted for 1 hour. Take 100 ml three times a day on an empty stomach.
• If the paralysis came after infectious disease, you can apply the treatment with garden purslane. Prepare an infusion from a spoonful of herbs and 300 ml of boiling water, drink 3 tablespoons of the remedy four times a day after a meal

Gymnastics with paresis of the larynx

Breathing exercises and phonopedia are of great importance for recovery. They should be used at all stages of the treatment of the disease. Training is aimed at maximizing the motor activity of the vocal cords and muscles of the larynx. Breathing exercises may include the following exercises:

• blowing and drawing in air at a slow pace;
• the use of a harmonica;
• puffing out the cheeks, releasing air through the crack;
• exercises for the formation of an elongated breath, etc.

It will be useful to supplement gymnastics with exercises for training neck muscles. Voice classes are carried out under the control of a phoniatrist. They consist in correcting the pronunciation of each sound, syllables, words and are carried out for a long time.

Forecast and prevention

The prognosis will depend on the cause that caused the disease. If etiological factors completely eliminated, then timely treatment and classes in phonopedia, the voice and respiratory, dividing functions of the larynx are restored. With functional paresis, the patient can recover even without treatment on his own. With a long-term illness, atrophy of the muscles of the larynx and loss of voice function are observed.

To prevent the occurrence of the disease, you need:

• properly treat any infectious pathologies;
• prevent poisoning;
• normalize the load on the vocal cords;
• avoid work in hazardous industries;
• do not overcool;
• monitor the health of the thyroid gland, chest organs;
• if it is necessary to perform operations in the larynx, choose only reliable institutions and qualified specialists to perform interventions.

Simple and effective exercises that allow you to quickly restore your voice when you are tired or if you are hoarse. Shows Alexey Kolyada - author and presenter of the training "Opening voice".