Objective: To describe the successful treatment of vocal fold atrophy in 2 patients with Parkinson’s disease (PD) and to review key gaps in the relevant literature.

Background: A high proportion of patients with PD experience dysphonia and dysphagia arising from vocal fold paralysis and atrophy. Speech and voice disorders markedly affect quality of life in patients with PD, and progressive dysphagia is associated with an increased risk of aspiration and related life-threatening infections. Speech therapy options become less effective as the underlying PD progresses. Currently, there is limited clinical data published on the procedure of vocal fold augmentation to treat patients with PD who have vocal fold atrophy. The risks and benefits of vocal fold augmentation, and the characteristics of patients in this population who may be likely to benefit have not been well described.

Methods: This report summarizes the diagnosis and treatment of 2 patients with PD who had vocal fold atrophy: an 84-year old female and a 71-year old male. Video laryngostroboscopy was used to confirm diagnosis and to record before-and-after photos. Both patients received bilateral vocal fold injections of calcium hydroxylapatite.

Results: Both patients reported a gradual, long-term onset of symptoms. The female patient described voice quality as breathy and husky; the problem was chronic and severe. The male patient described voice quality as raspy and weak, with additional symptoms including drooling, dysphagia, dyspnea, fatigue, fever, heartburn, odynophagia, otalgia, and post-nasal drainage and weakness. Laryngostroboscopy findings revealed bilateral vocal fold atrophy in both patients. Following bilateral vocal fold injections of calcium hydroxylapatite, both patients reported marked improvements in voice quality and high levels of satisfaction with treatment. The male patient also reported improvement in swallowing and resolution of other negative symptoms.

Conclusions: Vocal fold augmentation may be an important treatment option to consider for patients with PD who have vocal fold atrophy. However, there remains a need for additional clinical studies in this patient population to define the risk-benefit profile of vocal fold augmentation and identify characteristics of patients who may benefit most from treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vocal-fold-augmentation-in-patients-with-parkinsons-disease-a-case-series-and-review-of-the-literature/