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

Yiu, Yin; Curtis, James A.; Perry, Sarah; Troche, Michelle S.

doi:10.1002/lary.28158

Cited by 14 publications

(29 citation statements)

References 43 publications

(85 reference statements)

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“…However, the incidence of vocal fold bowing in this study is higher than what would be expected of healthy individuals matched for age and sex 20 . Similarly, a high incidence of vocal fold bowing has been identified in Parkinson's disease, with a prevalence ranging from 70% to 94% 9–11,21 . Recent work by our group found 80% of people with PD exhibited some degree of bowing, with 20% demonstrating severe vocal fold bowing 11 .…”

Section: Discussioncontrasting

confidence: 58%

“…Similarly, a high incidence of vocal fold bowing has been identified in Parkinson's disease, with a prevalence ranging from 70% to 94% 9–11,21 . Recent work by our group found 80% of people with PD exhibited some degree of bowing, with 20% demonstrating severe vocal fold bowing 11 . Interestingly, no relationship was found in this study between bowing index (BI) and age, sex, or disease duration alone when controlling for other variables.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, the average BI in the present study was considered “severe” (13.63 ± 6.41) based on a prior study in an older, healthy cohort 18 . This is descriptively higher than what has been identified in young adults (3.6 ± 2.6), individuals with age‐related vocal fold atrophy (6.8 ± 5.4), and individuals with PD (7.57 ± 5.06) 11,18 …”

Section: Discussionmentioning

confidence: 99%

“…First, methodological differences in BI were present between these two studies. In the present study, we captured maximal BI during rest breathing, often during tidal exhalation, whereas in the PD study BI was captured when the vocal folds were fully abducted 11 . Additionally, previous research examining swallowing safety in PSP has identified aspiration to predominately occur before the swallow 8 .…”

Section: Discussionmentioning

confidence: 99%

“…In Parkinson's disease (PD), vocal fold atrophy is a common laryngeal abnormality 9,10 and recent work by our group has identified that changes in this laryngeal structure were associated with impaired swallowing safety and aspiration in people with PD. This suggests that vocal fold atrophy may be a clinically significant finding related to airway protection in other Parkinsonian syndromes as well 11 …”

Section: Introductionmentioning

confidence: 99%

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The Role of Vocal Fold Bowing on Cough and Swallowing Dysfunction in Progressive Supranuclear Palsy

et al. 2020

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Objectives: Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in PSP, and 2) the influence of vocal fold bowing on cough and swallowing in PSP.Study Design: Prospective Cohort Study. Methods: Twenty-three participants with PSP completed instrumental assessments of cough and swallowing. Vocal fold bowing (BI) and swallowing safety (PAS) was assessed using flexible laryngoscopy. Measures of cough effectiveness were obtained using spirometry. Statistical analyses were used to determine the frequency of mild-moderate (BI > 0) and severe (BI > 12.2) bowing, and to assess the influence of BI on PAS and cough effectiveness in PSP.Results: Fifty-two percent (n = 12) of participants exhibited severe bowing while 48% (n = 11) exhibited mild-to-moderate bowing. Voluntary cough peak expiratory flow rate (P = .01), as well as reflex (P = .02) and voluntary (P = .005) cough volume acceleration were lower for participants with severe BI when compared to mild-to-moderate BI. However, BI did not influence PAS (P > .05).Conclusions: Findings from this study suggest that vocal fold bowing is highly prevalent in PSP and associated with reduced reflex and voluntary cough effectiveness. These findings provide insight into the pathophysiology of compromised airway protection in this patient population. Future studies should examine vocal fold atrophy as a treatment target for behavioral and medical intervention in PSP.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Role of Vocal Fold Bowing on Cough and Swallowing Dysfunction in Progressive Supranuclear Palsy

et al. 2020

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Changes in Cough Airflow and Acoustics After Injection Laryngoplasty

et al. 2022

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Objective/Hypothesis We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. Study Type/Design Prospective interventional study. Methods Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed‐rank test was used to compare the differences between pre‐ and post‐injection laryngoplasty in airflow and acoustic measures. A Spearman rank‐order correlation was used to evaluate the association between airflow and acoustic cough measures. Results Twenty‐five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: −0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2, SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: −0.31, p = 0.04) and peak power density (coefficient: −0.35, p = 0.02). Conclusions Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. Level of Evidence 3 Laryngoscope, 133:S1–S14, 2023

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Quantification of Vocal Fold Atrophy in Age‐Related and Parkinson's Disease‐Related Vocal Atrophy

et al. 2022

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Objective Vocal fold atrophy (VFA) is associated with aging and Parkinson's disease (PD). Clinical diagnosis of VFA depends on several visual‐perceptual laryngostroboscopy findings that are inherently subjective. The purpose of this study was to use quantitative measurements to; (1) examine the relationships between VFA and dysphonia severity and (2) evaluate differences in VFA in patients with age‐related VFA versus PD. Methods Thirty‐six patients >60 years of age with VFA were included in this retrospective cohort study. Demographic information, medical history, Consensus Auditory‐Perceptual Evaluation of Voice (CAPE‐V), Voice Handicap Index‐10 (VHI‐10), and still images from the stroboscopic exam were obtained. Image J™ was used to measure VFA, including bowing index (BI), normalized glottal gap area, and normalized mucosal wave amplitude. Pearson's correlation was used to evaluate the relationship between VFA, CAPE‐V, and VHI‐10. t‐Tests and multivariate linear regression were used to compare VFA measures by dysphonia severity (CAPE‐V <30 vs. >30) and diagnosis (age‐related vocal atrophy [ARVA] and PD). Results BI was positively correlated with CAPE‐V. Patients with CAPE‐V >30 had a significantly larger BI compared to those with CAPE‐V <30. Patients with PD had significantly larger BI than those with ARVA. Diagnosis of PD also predicted a larger BI after controlling for age and CAPE‐V. Conclusion Quantitative measures supported an association between bowing severity and dysphonia severity in patients with PD and ARVA. A PD diagnosis significantly predicted more severe BI. These findings demonstrate the potential utility of BI. Quantitative VFA measures might also provide insight into the mechanisms of ARVA and dysphonia. Level of Evidence 3 Laryngoscope, 133:1462–1469, 2023

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

Cited by 14 publications

References 43 publications

The Role of Vocal Fold Bowing on Cough and Swallowing Dysfunction in Progressive Supranuclear Palsy

The Role of Vocal Fold Bowing on Cough and Swallowing Dysfunction in Progressive Supranuclear Palsy

Changes in Cough Airflow and Acoustics After Injection Laryngoplasty

Quantification of Vocal Fold Atrophy in Age‐Related and Parkinson's Disease‐Related Vocal Atrophy

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