Shout It Out: There’s Hope for the ‘Parkinson’s Voice’

Doctor looks at hologram for airflow demonstration

Sid Khosla, MD, shown here in his NIH-funded laboratory, uses a laser to help visualize and measure airflow through vocal cords during phonation. Photo by UC Academic Health Center Communications.

When we think of the symptoms of Parkinson’s disease, we typically think of a shaking hand, a shuffling walk, or a sudden inability to take another step forward. Less dramatic, perhaps, but equally disruptive to an individual’s quality of life, is the loss of voice. More precisely, it is the loss of one’s ability to project one’s voice so that it can be heard and understood.

But patients with Parkinson’s disease need not let their voices be silenced without a fight. Sid Khosla, MD, Director of the UC Health Voice & Swallowing Center and an otolaryngologist with the UC Gardner Neuroscience Institute, addressed the topic at last weekend’s Sunflower Revolution Symposium in Loveland. Dr. Khosla said that therapy, and in some cases surgery, can help patients maintain the strength of their vocal cords.

“Small muscles bring the vocal cords together when we talk and apart when we breathe,” Dr. Khosla said. “Air flows through them and causes vibration, which is the source of sound. Think of a clarinet reed. The vocal cords vibrate because of air flow. They produce a basic sort of humming. If the vocal cords are too close, or too far apart, they can’t vibrate.”

In people with Parkinson’s, vocal cords shrink and are unable to close completely, leaving a gap. Breathing, which produces the air needed for sound, can become weak. And the tongue, which is used to help articulate words, can lose control and quickness. As a result of these three difficulties, an individual’s voice can become weaker, softer and more breathy. Sounds can become less distinguishable and more slurred. More frequent breaths might be required while talking.

“Not everyone with Parkinson’s disease has this problem,” Dr. Khosla noted, “but some do.”

Otolaryngologists can diagnose and assess voice disorders with special tests that enable them to see the vocal cords and surrounding structures. The tests help determine whether the altered voice is being caused by a gap in the vocal cords or whether another medical problem is to blame.

Dr. Khosla praised Lee Silverman Voice Therapy as an established treatment for loss of voice. The therapy involves intensive exercise that focuses simply on “being as loud as you can.” If you can increase pressure below the vocal cords, Dr. Khosla said, “you will close the gap.” The therapy involves four one-hour sessions a week, with extra work at home. It is not helpful for all patients, but it is a good option for some, Dr. Khosla said.

If voice therapy doesn’t help, another option is injection laryngoplasty. During this procedure, material is injected into the vocal cords, adding bulk and closing the gap. The procedure’s benefits last three months. A permanent option is medialization thyroplasty surgery, which involves moving the vocal cords toward the center and thereby closing the gap. Patients who are not helped by voice therapy should consider seeing a specialist who can discuss injection laryngoplasty and possibly surgery, Dr. Khosla said.

The Sunflower Revolution’s motto – move to live & live to move – applies to the vocal cords as well. When the voice is lost, human connections are compromised, and people gradually lose their ability to be heard.

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