Beyond Tremors: Navigating the Intersection of Voice, Swallowing, and Parkinson’s Disease

PROGRAM DESCRIPTION: Otolaryngologists are faced with a growing population of patients with Parkinson’s disease (PD), affecting 2% of patients over the age of 65 and nearly 10 million people worldwide. These patients present with a diversity of conditions, from dysphagia and dysphonia to imbalance issues, medication side effects, sleep issues, and cognitive deficits that can make specific symptom management challenging. 82% of PD patients demonstrate signs of dysphagia, worsening with later disease stage, and most have associated dysphonia. Traditionally managed through an array of voice therapy techniques and specially designed utensils and drinking approaches, innovative new concepts and technologies for treatment have been recently developed. Vocal fold and esophageal procedures show promise in effective dysphonia and dysphagia management.

This expert lecture will explore a holitistic approach of surgical and nonsurgical management of PD dysphonia and dysphagia in the setting of the patient’s disease and cognitive status. Modern voice therapy advancements beyond Lee Silverman Voice therapy (LSVT) to include LSVT-LOUD, Speak-Out, and Phonatory Resistance Training Exercises (PhoRTE), as well as SpeechVive and expiratory muscle strength training (EMST) will be discussed, alongside mounting evidence supporting vocal fold augmentation in select patients. The expectations of vocal fold augmentation for dysphagia and dysphonia will be discussed, as well as the impact of deep brain stimulation (DBS). Advances in diagnostics for esophageal function, including incorporation of esophageal high-resolution manometry, permit otolaryngologists to identify patients that cricopharyngeal intervention may be warranted.