Can Parkinson’s disease or stroke affect the vocal cords? Here’s what you need to know

Parkinson’s disease is a neurodegenerative disorder that affects the older age group and is a movement disorder caused by the degeneration of extrapyramidal areas of the brain, specifically the substantia nigra. The major symptoms of the disease are rest tremor, stiffness, bradykinesia (slowness of movement) and lack of coordination during movement.

What vocal cord complications can arise from vocal cord disease?

In an interview with HT Lifestyle, Dr. Smita Nagaonkar, consultant and section coordinator of ENT at Sir HN Reliance Foundation Hospital, Mumbai, shared that Parkinson’s disease also exhibits laryngeal dysfunction, where speech is often affected and phonology is impaired. Loss may be its initial symptom. The disease. According to him, vocal cord complications of PD may include –

1. Dysphonia: Difficulty producing sounds, often resulting in a strained or hoarse voice. Patients with Parkinson’s disease have a distinctive voice that is soft, monotone, breathy, and harsh. Patients often have difficulty initiating speech, speak in fewer words, have inappropriate silences, have varying speed of speaking, and may have vocal tremor.

2. Decrease in volume: Speech may become quiet due to lack of control over the vocal cord muscles.

3. Monotonous Speech: Patients may speak with limited variation in pitch, tone, or inflection.

4. Vibration of voice: Uncontrollable trembling or shaking of the voice, affecting clarity.

5. Shortness of breath: Weakness in the vocal cord muscles can cause speech to have a breathy or whisper-like quality.

6. Difficulty in Articulation: Impaired coordination of the vocal muscles may result in slurred or unclear speech.

7. Dysphagia PD may be caused by disturbances in the oral, pharyngeal, and esophageal stages of swallowing. Impaired laryngeal function and motion significantly contribute to retention and impaired laryngeal regeneration and laryngeal vestibule closure after swallowing.

Bringing in her expertise, Dr. Shama Kovale, Consultant, ENT, Kokilaben Dhirubhai Ambani Hospital, Mumbai, said, “First of all, I would like to say that these cannot be called complications, but they are related to the larynx or larynx. It is possible Folds in a person with Parkinson’s. The voice quality of a patient suffering from Parkinson’s disease will be very low and monotonous. We need to evaluate the larynx with stroboscopy, which tells us about laryngeal movements or any other problems with the larynx. Incomplete glottic closure may occur which means the vocal folds are not closing completely. Hypoadduction of the vocal folds and bowing of the vocal folds again cause incomplete closure. This may be due to muscle bradykinesia which in simple terms is slow muscle responding. Patients suffering from Parkinson’s disease may also have problems with swallowing. The aim of treatment in these patients is to take medications for Parkinson’s disease. We can start them on therapy, a permanent procedure like injection laryngoplasty or sometimes Type I thyroplasty.

How can stroke affect vocal cord function?

Talking about the ways in which stroke can affect vocal cord function, Dr. Smita Nagaonkar said, “Stroke can present with changes in voice. It can affect one of the vocal cords, causing it to stop moving and resulting in a change in voice. It can also affect the quality and strength of the voice. Sometimes, this can cause a loss of sensation in the voice box, causing patients to experience a cough while eating or at rest, which is caused by the blocking of their own saliva.

He stressed that the effects of stroke on the vocal cords can vary depending on the location and severity of the stroke and he highlighted 20 possible points regarding the effects of stroke on the vocal cords –

• Dysphonia: Stroke can cause dysphonia, which is a condition characterized by difficulty producing speech sounds due to weakness, paralysis, or decreased mobility of the vocal cords.
• harshness: Damage to the nerves that control the vocal cords due to stroke can cause hoarseness or a harsh, hoarse voice quality.
• Weakness: Stroke can cause vocal cord weakness, which leads to reduced vocal intensity and difficulty projecting the voice.
• Paralysis: In severe cases, stroke can cause paralysis of the vocal cords, resulting in the inability to produce speech sounds.
• Breathy voice: Breathy voice quality may be impaired due to paralysis or weakness of the vocal cords due to complete closure of the vocal cords during speech.
• Tense voice: Some stroke survivors may experience a strained or effortful voice due to compensatory muscle tension in an attempt to overcome vocal cord weakness or paralysis.
• Pitch Change: Stroke can affect the control of vocal fold tension, causing changes in pitch, such as sounding higher or lower than normal.
• Developed vocal range: Vocal cord dysfunction as a result of stroke can limit the ability to produce sound across a wide vocal range.
• Difficulty with phonological functions: stroke Survivors may have difficulty with tasks requiring precise vocal control, such as singing or speaking loudly.
• Difficulty swallowing: Stroke-related dysphagia (difficulty swallowing) can also affect vocal cord function, as the same nerves control both swallowing and voice production.
• aspiration: Vocal cord weakness or paralysis may increase the risk of aspiration (entry of food or fluid into the airway), which can impair vocal function and increase the risk of respiratory complications.
• Decrease in vocal stamina: In stroke survivors, vocal fatigue may occur more rapidly due to impaired vocal cord function, leading to reduced vocal endurance.
• The voice breaks: Weakness or instability of the vocal cords can cause stutters or interruptions in the voice during speech.
• Disadvantages of vocal fold adduction: Damage to the nerves that control vocal fold adduction (closure) can cause difficulty with voice initiation and continuation.
• Voice Trembling: Stroke-related neurological damage can result in vocal tremor, causing involuntary rhythmic fluctuations in pitch or volume during speech.
• Difficulty in phonation: Stroke survivors may have difficulty initiating or maintaining sound production (voice production) due to impaired vocal cord coordination or weakness.
• Respiratory problems: Stroke-related weakness or paralysis can affect the coordination of respiratory muscles needed for adequate breath support during speech, further affecting vocal cord function.
• Impact on Communication: Ultimately, the effects of stroke on the vocal cords can significantly impair communication abilities, affecting social interaction, emotional expression, and quality of life.

Dr. Smita Nagaonkar revealed, “It is important to note that the specific effect can vary widely between individuals depending on factors such as the location and extent of the stroke, pre-existing vocal function, and the effectiveness of rehabilitation efforts. Early intervention with speech therapy and rehabilitation programs may help improve vocal cord function and reduce some of these effects.

Regarding the symptoms of dysphonia and dysphagia in adults with laryngomalacia, he said, “Patients with laryngomalacia may experience a hoarse voice and difficulty breathing while resting or lying down.”

Dr. Shama Kovale concludes, “Stroke is another neurological condition in which the vocal folds can be affected, leading to difficulty breathing, difficulty swallowing, or breathing problems. The involvement of the vocal folds depends on the part of the brain affected. Patients may develop unilateral vocal fold paralysis or bilateral vocal fold paralysis, depending on the area of ​​the brain affected. If it is a bilateral stroke and the patient is having difficulty breathing, the first thing to do is to do tracheostomy. In case of unilateral paralysis if the patient is conscious and oriented then injection is an alternative to laryngoplasty. Another option is to start the patient on voice therapy. This is a big topic for discussion and we really need in-depth knowledge when treating these patients.