Subtotal arytenoidectomy for the treatment of laryngeal stridor in multiple system atrophy: phonatory and swallowing results

Stomeo, Francesco; Rispoli, Vittorio; Sensi, Mariachiara; Pastore, Antonio Luigi; Mozzillo, Nicola; Pelucchi, Stefano

doi:10.1016/j.bjorl.2015.03.016

Cited by 8 publications

(9 citation statements)

References 9 publications

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“…Laryngoscopy during wakefulness in patients with MSA with stridor, performed to exclude secondary causes or functional vocal cord abnormalities related to other neurologic conditions, can reveal bilateral or unilateral impairment of vocal cord abduction of varying severity or normal vocal cord motility. 27,29,32,33,35,36,39–44 Conversely, impairment of vocal cord motility during wakefulness was also observed in patients with MSA without stridor during sleep. 27…”

Section: Resultsmentioning

confidence: 94%

“…Studies with drug-induced sleep endoscopy (DISE) demonstrated impaired abduction or paradoxical adduction of the vocal cords in patients with MSA with stridor who had normal vocal cord motility on awake laryngoscopy. 32,33,35–37,41–44…”

Section: Resultsmentioning

confidence: 99%

“…During drug-induced sleep, the main patterns were persistent tonic activity or paradoxical activation of laryngeal adductor muscles during inspiration. 35–38,44–46…”

Section: Resultsmentioning

confidence: 99%

“…Statements are based on core literature consisting of Class IV level studies 27,29,32–37,39–44 and expert opinion.Laryngoscopy can exclude mechanical lesions (e.g., masses and scars) or functional vocal cord abnormalities related to different neurologic conditions (central or peripheral disorders).Laryngoscopy may reveal vocal cord motility impairment in patients with MSA with stridor.If awake laryngoscopy is normal, DISE might be considered if the suspicion of sleep-related stridor needs confirmation.…”

Section: Resultsmentioning

confidence: 99%

“…Statements are based on core literature consisting of Class IV level studies 35–38,44–46 and expert opinion.There is no evidence that other investigations are useful.EMG of the laryngeal muscles may show denervation or abnormal hyperactivity.…”

Section: Resultsmentioning

confidence: 99%

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Stridor in multiple system atrophy

et al. 2019

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Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor is an additional feature for MSA diagnosis, showing a high diagnostic positive predictive value, and its early occurrence might contribute to shorten survival. A consensus definition of stridor in MSA is lacking, and disagreement persists about its diagnosis, prognosis, and treatment. An International Consensus Conference among experts with methodological support was convened in Bologna in 2017 to define stridor in MSA and to reach consensus statements for the diagnosis, prognosis, and treatment. Stridor was defined as a strained, high-pitched, harsh respiratory sound, mainly inspiratory, occurring only during sleep or during both sleep and wakefulness, and caused by laryngeal dysfunction leading to narrowing of the rima glottidis. According to the consensus, stridor may be recognized clinically by the physician if present at the time of examination, with the help of a witness, or by listening to an audio recording. Laryngoscopy is suggested to exclude mechanical lesions or functional vocal cord abnormalities related to different neurologic conditions. If the suspicion of stridor needs confirmation, drug-induced sleep endoscopy or video polysomnography may be useful. The impact of stridor on survival and quality of life remains uncertain. Continuous positive airway pressure and tracheostomy are both suggested as symptomatic treatment of stridor, but whether they improve survival is uncertain. Several research gaps emerged involving diagnosis, prognosis, and treatment. Unmet needs for research were identified.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

“…During drug-induced sleep, the main patterns were persistent tonic activity or paradoxical activation of laryngeal adductor muscles during inspiration. 35–38,44–46…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Stridor in multiple system atrophy

et al. 2019

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Laryngeal Movement Disorders in Multiple System Atrophy: A Diagnostic Biomarker?

et al. 2020

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A BS TRACT: Background: Multiple system atrophy (MSA) is a rare neurodegenerative disorder, and its parkinsonian variant can be difficult to delineate from Parkinson's disease (PD). Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life, systematic assessments of laryngeal dysfunction in large cohorts are missing. Objectives: The objective of this study was to systematically assess laryngeal dysfunction in MSA and PD and identify laryngeal symptoms that allow for differentiating MSA from PD. Methods: Patients with probable or possible MSA underwent flexible endoscopic evaluation of swallowing performing a systematic task protocol. Findings were compared with an age-matched PD cohort. Results: A total of 57 patients with MSA (64 [59-71] years; 35 women) were included, and task assessments during endoscopic examination compared with 57 patients with PD (67 [60-73]; 28 women). Patients with MSA had a shorter disease duration (4 [3-5] years vs 7 [5-10]; P < 0.0001) and higher disease severity (Hoehn & Yahr stage 4 [3-4] vs 3 [2-4]; P < 0.0001). Of the patients with MSA, 43.9% showed clinically overt laryngeal dysfunction with inspiratory stridor. During endoscopic task assessment, however, 93% of patients with MSA demonstrated laryngeal dysfunction in contrast with only 1.8% of patients with PD (P < 0.0001). Irregular arytenoid cartilages movements were present in 91.2% of patients with MSA, but in no patients with PD (P < 0.0001). Further findings included vocal fold motion impairment (75.4%), paradoxical vocal fold motion (33.3%), and vocal fold fixation (19.3%). One patient with PD showed vocal fold motion impairment. Conclusion: Laryngeal movement disorders are highly prevalent in patients with MSA when assessed by a specific task protocol despite the lack of overt clinical symptoms. Our data suggest that irregular arytenoid cartilage movements could be used as a clinical marker to delineate MSA from PD with a specificity of 1.0 and sensitivity 0.9.

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Abductor Paresis in Shy-Drager Disease

Isozaki

2021

Movement Disorder Emergencies

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Subtotal arytenoidectomy for the treatment of laryngeal stridor in multiple system atrophy: phonatory and swallowing results

Cited by 8 publications

References 9 publications

Stridor in multiple system atrophy

Stridor in multiple system atrophy

Laryngeal Movement Disorders in Multiple System Atrophy: A Diagnostic Biomarker?

Abductor Paresis in Shy-Drager Disease

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