Percutaneous Laryngeal Collagen Augmentation for Treatment of Parkinsonian Hypophonia

Abstract

Percutaneous laryngeal collagen augmentation is an effective treatment for parkinsonian hypophonia in a majority of patients. Patients with advanced neurologic disease with aphonia, difficulty with speech initiation, dysphagia, or ambulatory difficulty are less likely to respond to this procedure and should be so informed.

Studying vocal fold vibrations in Parkinson’s disease with a nonlinear model

“…Increasing vocal fold thickness ͑and therefore also reducing glottal rest area͒ by injection of collagen has resulted in subjective improvement in the quality of speech among patients with Parkinson's disease. [48][49][50] Extending our analysis to another physiological parameter, vocal fold thickness, provides an opportunity for evaluation of another important determinant of properties of phonation. It has been clinically found that in comparison with R treatment, the LSVT is more effective at increasing sound pressure level and reducing the breathy voice.…”

Percutaneous injection laryngoplasty in the management of acute vocal fold paralysis

“…Because of the small needle caliber, injection can be performed without the need for local cutaneous anesthetic, let alone intravenous sedation. Percutaneous injection laryngoplasty using collagen affords a safe route to medialization even in the most debilitated patient population, such as in patients with Parkinsonian hypophonia 7, 8. The Point‐Touch technique is now used in the treatment of a variety of laryngeal disorders, including vocal fold paralysis, spasmodic dysphonia, and vocal fold granuloma 6, 9, 10…”

Clinical Evaluation of Parkinson's‐Related Dysphonia

“…Idiopathic Parkinson's disease (IPD) is a progressive neuromuscular disorder that affects nearly 2 million Americans 1 . In addition to the hallmark symptoms of tremor, rigidity, and bradykinesia, 2 IPD has significant and progressive manifestations in the phonatory system that frequently result in debilitating communicative deficits.…”

“…Of the nearly 2 million Americans with IPD, 70% to 90% of patients exhibit some form of Parkinson's‐related dysphonia (PRD) 2–5 . Nearly one third of these patients cite dysphonia as their most debilitating deficit 1,3 …”

“…PRD is characterized by a harsh and breathy voice. Numerous studies have attempted to quantify the dysphonia with objective acoustic and aerodynamic measures 1,2,5 . Although findings are inconsistent across studies, patients with IPD generally demonstrated reduced pitch and loudness ranges, elevated subglottal phonation threshold pressures (PTP), and vocal tremor 1,5 .…”