Dysphagia in Parkinson’s Disease Improves with Vocal Augmentation

Howell, Rebecca J.; Webster, H. L.; Kissela, E.; Gustin, Renée L.; Kaval, Farah; Klaben, Bernice K.; Khosla, Sid

doi:10.1007/s00455-019-09982-z

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…Behavioral therapy such as Lee Silverman Voice Therapy (LSVT LOUD) and vocal fold injection augmentation have both been utilized as treatments for dysphonia in PD and are more recently being re-explored as potential interventions for dysphagia in PD. [36][37][38][39][40][41] Furthermore, even though we did not find a relationship with BI and cough airflow measures in this analysis, other recent studies have demonstrated immediate improvement in cough airflow parameters such as peak expiratory flow and CVA after vocal fold injection augmentation in non-PD patients with glottic insufficiency. 42,43 These promising results suggest a potential role for prospective trials of injection augmentation in patients with PD and vocal fold…”

Section: Discussioncontrasting

confidence: 88%

“…Even if vocal fold atrophy only plays a minor role in airway protection for patients with PD, it represents a potential therapeutic target with well‐established interventions. Behavioral therapy such as Lee Silverman Voice Therapy (LSVT LOUD) and vocal fold injection augmentation have both been utilized as treatments for dysphonia in PD and are more recently being re‐explored as potential interventions for dysphagia in PD …”

Section: Discussionmentioning

confidence: 99%

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Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

et al. 2019

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Objectives When swallowing function is compromised in patients with Parkinson's disease (PD), cough plays a crucial role in clearing the airway and preventing pulmonary complications. The aim of this study was to determine the influence of vocal fold atrophy severity as measured by the bowing index (BI) on airway protection in PD. Methods Thirty participants with PD completed measures of voluntary and reflex cough. Flexible laryngoscopy with endoscopic evaluation of swallowing allowed for measurement of BI using ImageJ software. Swallowing safety was scored on the Penetration‐Aspiration Scale (PAS). Regression and receiver operating characteristic (ROC) analyses were performed to test our study aim. Results Twenty‐four of 30 participants had some degree of vocal fold atrophy (BI >0). When controlling for age, disease duration did not significantly influence BI. BI was not predictive of any sensorimotor parameters of cough including measures of cough airflow, reflex cough threshold, or urge to cough. BI discriminated participants with near‐normal (PAS 1–3) swallowing safety from participants with impaired (PAS 4–8) swallowing safety (P = .01, sensitivity: 87.0%, specificity: 71.4%, cutoff value BI >4.6). Conclusion Vocal fold atrophy is a potential factor contributing to poor swallowing safety in PD. BI was not associated with cough function in this PD cohort, contrary to prior studies that have shown improved cough measures after vocal fold augmentation. Vocal fold atrophy in PD remains an important area of study as a targetable intervention for patients with airway protective dysfunction. Future studies should include measures of glottic closure during vocal fold adduction. Level of Evidence Level 3 Laryngoscope, 130:303–308, 2020

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

et al. 2019

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“…Statements are based on core literature consisting of Class IV level studies [102,103,105] and expert opinion:…”

Section: B4) Medical Treatmentsmentioning

confidence: 99%

“…Injection laryngoplasty is a surgical technique aimed at augmenting and medializing the vocal fold to decrease the glottic insufficiency caused by a variety of medical conditions. One retrospective Class IV study investigated the efficacy of vocal fold augmentation through injection laryngoplasty in adjunct to speech and language therapy on a small sample of patients with PD (n = 14) with glottal insufficiency and vocal bowing [105]. The procedure was found to be safe in all patients.…”

Section: Medical Treatmentsmentioning

confidence: 99%

Consensus on the treatment of dysphagia in Parkinson's disease

Schindler

Pizzorni

Cereda

et al. 2021

Journal of the Neurological Sciences

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Background: Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. Objective: To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. Methods: A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by email consensus. Results: The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. Conclusions: The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.

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“…Expiratory muscle strength training (EMST) to increase the ability to voluntarily cough to eject foreign material from the airway was also effective in decreasing penetration/aspiration in these patients [46,51]. Considering the function of the vocal cords in the swallowing process, it was suggested that the use of vocal augmentation may be beneficial for these patients with glottal insufficiency [52].…”

Section: Parkinson’s Diseasementioning

confidence: 99%

Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders

Kwon¹,

Lee

2019

JMD

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Oro-pharyngeal dysphagia is a common symptom in patients with Parkinson’s disease (PD) and related disorders, even in their early stage of diseases. Dysphagia in these patients has been underdiagnosed, probably due to poor the self-awareness of the conditions and the underuse of validated tools and objective instruments for assessment. The early detection and intervention of dysphagia are closely related to improving the quality of life and decreasing the mortality rate in these patients. The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. The management of dysphagia and future research directions related to these disorders are also discussed.

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Dysphagia in Parkinson’s Disease Improves with Vocal Augmentation

Cited by 14 publications

References 23 publications

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

Consensus on the treatment of dysphagia in Parkinson's disease

Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders

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