Surgical Management of Airway Dysfunction in Parkinson's Disease Compared with Parkinson-Plus Syndromes

Sinclair, Catherine F.; Gurey, Lowell E.; Brin, Mitchell F.; Stewart, Celia; Blitzer, Andrew

doi:10.1177/000348941312200502

Cited by 7 publications

(6 citation statements)

References 20 publications

(18 reference statements)

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“…Vocal fold palsy due to the affection of the vagal nerve and its branches as well as pronounced vocal fold atrophies, which occur e.g. in M. Parkinson or ALS [ 271 ], can cause GI that causes an impairment of laryngeal protective functions [ 272 ]. Aspiration and reduced cough strength with subsequent impaired laryngeal and bronchial clearing are likely consequences [ 273 ].…”

Section: Therapymentioning

confidence: 99%

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Dziewas

Allescher

Aroyo

et al. 2021

Neurol. Res. Pract.

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Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

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Section: Therapymentioning

confidence: 99%

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Dziewas

Allescher

Aroyo

et al. 2021

Neurol. Res. Pract.

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“… 42 While a smaller ETT may be considered to avoid vocal cord damage, it may be more difficult to actually ventilate the patient due to a larger air leak because of a wider gap between the cords and tube. 42 Also, the medication used to treat Parkinson’s, levodopa, wears off relatively quickly, and if usage is stopped before surgery, Parkinsonism symptoms, such as rigidity, may be exaggerated. 7 This could manifest as greater difficulties with BMV and direct laryngoscopy.…”

Section: Physiopathological Changes Indirectly Affecting Airway Managmentioning

confidence: 99%

Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

Johnson¹,

Botros²,

Groban³

et al. 2015

CIA

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There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the difficulty associated with ventilating the patient, the patient’s risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic broncho-scope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population.

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“…The laryngeal dysfunction resulting from hypokinetic dysarthria in PD is manifested by glottal incompetence due to bowing of the vocal folds, in some cases with accompanying atrophy [ 5 ]. The perceptual and physiological consequences of this impairment are reduced speech volume and vocal sound intensity, respectively.…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria

Watts

2016

BMC Ear Nose Throat Disord

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BackgroundReduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD). Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Intensive treatment programs requiring high-intensity voice and speech exercises with clinician-guided prompting and feedback have been established as effective for improving vocal function. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments.MethodsA retrospective cohort design was utilized. Data from 78 patient files across a three year period were analyzed. All patients received a structured, intensive program of voice therapy focusing on speaking intent and loudness. The dependent variable for all analyses was vocal intensity in decibels (dBSPL). Vocal intensity during sustained vowel production, reading, and novel conversational speech was compared at pre-treatment, post-treatment, six month follow-up, and twelve month follow-up periods.ResultsStatistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Significant treatment effects were found in all three speaking conditions. Effect sizes for all outcome measures were large, suggesting a strong degree of practical significance.ConclusionsSignificant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. These findings are supported by outcome studies reporting treatment outcomes within a few months post-treatment, in addition to prior studies that have reported long-term outcome results. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment approaches which focus on high-intensity, clinician guided motor learning for voice and speech production in PD. Theories regarding the underlying neurophysiological response to treatment will be discussed.

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Surgical Management of Airway Dysfunction in Parkinson's Disease Compared with Parkinson-Plus Syndromes

Cited by 7 publications

References 20 publications

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria

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