
swarakkuzhal pakshaaghaatham

mrugangalile larrinchial pakshaaghaatham ennathu laarinksinte onno rando aritinoid tharunaasthikalude chalanangale niyanthrikkunna njarambukalum peshikalum pravartthanam nirthunna oru avasthayaanu, koodaathe aaspareshan samayat thurakkunnathinum vizhungumbol adaykkunnathinum pakaram arittinoyidukal alppam nishpakshamaaya sthaanathu nischalamaayi thudarunnu. prathyekichum, aritinoid tarunaasthi thattikkondupokaan kaaranamakunna peshi, cricoaritinoids dorsalis peshi, pravartthanam avasaanippikkunnu. ithu vyaayaamasamayathum thermoregulatory panting samayathum aparyapthamaaya vaayusanjaarathilekkum vizhungumbol vaayumaargathinte apoornnamaaya samrakshanathilekkum nayikkunnu. 
larrinchial pakshaaghaathatthinte ettavum saadhaaranamaaya roopangalilonnu geriatric meediyam muthal valia inam naaykkalil, prathyekichu labrador retriever, mattu chila enangalilum vikasikkunnu. ithu parambaraagathamaayi idiopathic larrinchial pakshaaghaatham ("aii. ell. pii": idiopathic ennaal "anjjaathamaaya kaaranam") ennariyappettirunnu, ithu swarakkuzhalile njarambukale badhikkunna oru avasthayude (aavarthichulla svarakkuzhalukalude ubhaykakshi mono neuropathy) falamaanennu vishwasikkappedunnu. ennirunnaalum 2005-2013 kaalayalavil mishiganilum tennessyilum rund grouppukal nadatthiya aii. ell. pii. yekkurichulla anweshanathil eee avastha swarapedikayude njarambukalude pravarthanarahithathayil maathram parimithappedutthukayo prathyekamaayi falamo aayirunnilla ennu kandethi. pakaram, shareerathile mattu njarambukaleyum baadhicha vaardhakyathinte pathukke purogamikkunna polyneuropathy ettavum drishyamaaya lakshanamaayirunnu ithu. kooduthal gaveshanangalethudarnnu ippol pothuvaayi shariyenn vishwasikkappedunna eee kandethal, itharathilulla swarakkuzhaline "ideopathic swarakkuzhalile pakshaaghaatham" ("aii. ell. pii") ennathil ninnu "geriatric instaats larrinchal pakshaaghaatham polyneuropathy" ("goalp") ennu punarnaamakaranam cheyyaan nirddeshikkunnathilekku nayichu.
larrinchial pakshaaghaatham baadhicha mrugangal vyaayamathodum choodinodum ulla sahishnutha kuraykkukayum aaspireshan pneumoniaykkulla saadhyatha vardhippikkukayum cheiyunnu. shaareerika chalanatthile eathenkilum budhimuttu moolam shwasikkaanulla budhimuttu allengil vaikaarika budhimuttu moolamundaakunna shaareerika budhimuttum uthkandayum ozhike vedanayundaakkunnathaayi eee avastha saadhaaranayaayi kanakkakkappedunnilla. goalppilethupole, swarapedika pakshaaghaatham oru pothuvaaya purogamana polyneuropathy bandhappettirikkunnavel, nadiviewham kramena adhapathikkukayum kaikaalukal (prathyekichu pinkaalukal) kaikaaryam cheiyunnathil budhimuttu vardhippikkukayum vizhungukayum shwasikkukayum cheyyum, oduvil mikka kesukalilum dayaavadhavum sambhavikkum. valia inathilum geriatric naaykkalil, prathyekichu labrador retrieveril, larrinchial pakshaaghaatham valare saadhaaranamaanu, ithu poochakalil apoorvvamaayi maathrame kaanappedunnulloo, koodaathe ithu roaring, rorer syndrome, allengil vaidyashaasthraparamaayi larrinchial hemiplegia allengil aavarthichulla larrinchial neuropathy (rln) ennu vilikkunna kuthirakalilum sambhavikkam. onno rando aritinoid tharunaasthikalude pravarthanakshamathaye aashrayich larrinchial pakshaaghaatham ekapaksheeyamo ubhaykakshi allengil orupakshamo aakam.
kaaranagal.
mikka kesukalilum, larrinchial pakshaaghaathatthinte kaaranam anjjaathamo ideopathic aanu. ennirunnaalum, eee takaraar general neuropathy, generalised neuro muscular rogangal, muscular rogangal, servical (kazhuthu) mekhalayile neoplasia allengil craniel mediastinam allengil aaghaatham ennivaykku dvitheeyamaayi uyarnnekkaam. eee kaivashappedutthiya roopam pradhaanamaayum madhyavayaskan pazhayathumaya valia inam allengil labrador retriever, golden retriever, cyberian haski, newfoundland, sent thudangiya bheeman inam naaykkalilaanu kaanappedunnath. bernard. saadhaaranayaayi eee naaykkal oru saadhaarana swarakkuzhalumaayi janikkunnu, ennaal kaalakramena swarakkuzhaline niyanthrikkunna njarambukaludeyum peshikaludeyum pravartthanam nashtappedunnu.
chila enangalil (udha.jii. rund muthal aarr maasam vare praayamulla naaykkalil prathyakshappedunna bovier dess flandress, dalmatians, cyberian haskikal, buldogukal). rogabadhitharaaya naaykkuttikalkku vizhungaanum shwasikkaanum budhimuttundaakam, avaa idaykkide shwaasammuttiyekkaam, avayude puramtholi palappozhum asaadhaaranamaayi thonnam. daalmeshyanmaaril ithu 'larrinchial paralysis-polyneuropathy complexes' enna mattoru avasthayude bhagamaanu.'baadhicha naaykkuttikale prajananathinaayi upayogikkaruthu.
chokku collarukal eee thakaraarin oru pradhana apakada gadakamaayi kanakkakkappedunnilla. ennirunnaalum, ell. pii. roganirnayam nadatthiya sesham saadhaaranayaayi naayayude kazhuthinu chuttumulla collaro mattenthenkilum upayogikkukayo pakaram oru harnessilake maarukayo cheiyunnathu nirthaanaanu shupaarsha cheiyunnathu.
adayaalangal.
shabdamaattam (naayayude puramtholi parukkan shabdamaakunnu), vaaya adaykkal allengil chuma (palappozhum bhakshanathinidayilo paaneeyatthinidayilo athinusheshamo), vyayaama asahishnutha, prachodanaathmaka stridor (prachodanatthil shabdamundaakkunna shwaasam), shwasikkaan budhimuttu, kadinamaaya kesukalil sayanosis allengil syncope (bodham nashtappedal) enniva swarakkuzhalile pakshaaghaathatthinte lakshanangalil ulppedunnu. shwaasakoshathile aaspireshan allengil edema ulppedeyulla dvitheeya prashnangalum sambhavikkam, ennirunnaalum palappozhum prashnam uyarnna shwasana prashnamaayi thudarunnu. panting vazhi svayam thanuppikkanulla parimithamaaya kazhivu kaaranam baadhicha naaykkalkku choodu strock choodu ksheenam undakanum saadhyathayund, ennaal eee thakaraarine thanne choodu strock ennu thettidharikkaam. 
eppol venamenkilum lakshanagal undakam, pakshe thudakkathil udamakal avarude naayayude puramtholi vyathyasthamayi thonnunnuvennum avarude naayaykk munbatheppole oodaan kazhiyillennum allengil otappetta kesukalil choodulla kaalaavasthayil naayaykk prashnamundennum, kaaranam baadhikkaatha vashathinu nashtappedutthaan kazhiyumenno maathrame shradhikkaavoo. ennirunnaalum mikka ekapaksheeyamaaya kesukalum oduvil swarakkuzhalinte iruvashangalum ulppeduthunnathilekku purogamikkum, ithu kooduthal gurutharamaaya prasnamaanu, rogalakshanangal kooduthal thavana prathyakshappedunnu. 
choodullathum eerppamullathumaaya kaalaavasthayilum vyayaama samayathum sammarddamo aaveshamo ulla samayathum ponnathadiyulla valarthumrgangalilum lakshanagal saadhaaranayaayi moshamaan. nishithamo avasaanakhattamo aaya lakshanagal saadhaaranayaayi avyakthavum adiyanthira chikitsa aavasyamullathumaanu.
roganirnayam.
eee avastha saadhaaranayaayi laitt sedation keezhil swarapedikayude nerittulla parishodhanayiloode nirnnayikkappedunnu, ithu haanikaramallaathatho maarakamaayatho aaya tumours parisodhikkaanum anuvadikkunnu. hridayam, shwaasakosham, mediastinal rogangal allengil ell. pii. yill palappozhum kaanapedunna lakshanangalude mattu kaaranagal enniva thallikkalayaan thorassic radiographukal, sidi-scans allengil ecocardiography polulla parisodhanakal chilappol aavasyamaanu. elpi hypothyroidisathinte lakshanamo sankeernathayo aayirikkaamennathinaal chila mrugadoktarmaar thyroid profile pravarthippikkaanum shupaarsha cheythekkaam.
chikitsa.
pravartthanam parimithappeduthunnathilum aarogyakaramaya sareerabhaaram nilanirthunnathiloodeyum uyarnna anthareeksha thaapanilakalumayi sanbarkkam ozhivaakkunnathiloodeyum neriya kesukal niyanthrikkappedunnu. uthkandayum panthum kuraykkaanum athinaal shwasanam mechappeduthaanum neriya mayakka marunnu upayogikkaam. swarakkuzhalinte veekkavum veekkavum kuraykkunnathinu corticosteroidukal kadinamaaya kesukalil nalkaam. 
shwasikkaan budhimuttu, hyperthermia, aaspireshan pneumonia thudangiya gurutharamaaya lakshanagal mayakka marunum ooksijan therapy upayogichu sthirappeduthanam, koodaathe steroid allengil antibiotic marunnukal aavashyamaayi vannekkaam. chilappol ooksijan vitharanam cheyyaan tracheotamy aavasyamaanu. rogi sthiratha kaivarichukazhinjaal, sasthrakriya chikitsa prayojanakaramaakum, prathyekichu rund aritinoid tharunaasthikalilum (ubhaykakshi pakshaaghaatham) pakshaaghaatham sambhavikkumbol. shasthrakriyayil (aritinoid lateralisation, allengil oru "larrinchial tyback") aritinoid tharunaasthikalilonnu paramavadhi thattikkondupoya (thuranna) sthaanathu thunnicherkkunnu. ithu aparyapthamaaya vaayusanchaaravumaayi bandhapetta adayaalangal kuraykkunnu (vyayaama asahishnutha allengil amita choodu polullava) ennaal aaspireshan, thathfalamaayundaakunna pneumonia ennivayude apakadasaadhyatha vardhippikkum. iruvarkkum pakaram aritinoid tharunaasthikalil onnu maathram bandhippikkunnath aaspireshan saadhyatha kuraykkaan sahayikkunnu. athinusheshavum naaya ippozhum parukkan shabdamundaakkum, ell. pii. yude neriya kesukal ullavareppole thanne kaikaaryam cheyyendathundu. 
larrinchial pakshaakhaathamulla pala naaykkalum annanaalathinte chalanathmakatha kurachathaayi sameepakaala padanangal kandethiyittundu. punarujjeevanamo chharddiyo ulla mrugangale annanaalathino mattu dahananaala sambandhamaaya vaikalyangalko poornnamaayum vilayiruthanam. mega esophagus allengil idaykkide chharddi allengil punarujjeevanathinu kaaranamakunna mattu avasthakalulla naaykkalkku larrinchial tye-backinu sesham aaspireshan pneumonia varaanulla saadhyatha kooduthalaanu. eee naaykkalkku avarude klinikkal adayaalangal shamippikkunnathinulla oru badal shasthrakriyayaan permanant tracheostomy.
shasthrakriyayude sankeernathakal.
shasthrakriyayudeyum anaesthesiayudeyum sankeernathakalkku purame, keerinte azhukku, veekkam allengil chuvapp, bhakshanathino paaneeyatthino idayil mookkolipp allengil chuma, allengil bhakshanathinteyo draavakathinteyo aakamksha moolam pneumonia enniva undakam. <aii. dii. 1> kesukalil abhikaamyamallaatha sankeernathakal undaakumenn kanakkaakkappedunnu. medical therapy paraajayappedukayum oresamayam undaakunna rogangalo (hridayam allengil shwaasakosha prasnangal polullava) allengil chilavo kaaranam sasthrakriya nadatthaan kazhiyaathe varikayum cheythaal, rogam kaaranam mrugathinte jeevithanilavaram asweekaaryamaanennu kanakkakkiyaal dayaavadham aavashyamaayi vannekkaam.
paraamarshangal.
staanli bije, "thudangiyava."ideopathic larrinchial pakshaakhaathamulla naaykkalile annanaalathile pravartthanarogam oru niyantritha cohort patanam. vettinari sarjari 39 (2), pg. <aii. dii. 1>, februvari 2010.

