Can Parkinson’s disease or Stroke impact vocal cords? Here's what you should know

Health experts reveal whether Parkinson’s disease or Stroke can impact your vocal cords and everything else that you should know regarding brain and speech link

Parkinson’s disease is a neurodegenerative disorder affecting the older age group and it is a movement disorder caused by the degeneration of the extrapyramidal areas of the brain, particularly the substantia nigra. The hallmark symptoms of the disease are resting tremor, rigidity, bradykinesia (slowed movement) and lack of coordination during movement.

Can Parkinson’s disease or Stroke impact vocal cords? Here's what you should know (File Photo)

What vocal cord complications can arise from vocal cord disease?

In an interview with HT Lifestyle, Dr Smita Nagaonkar, Consultant and Section Co-Ordinator, ENT at Sir HN Reliance Foundation Hospital in Mumbai, shared that Parkinson’s disease also displays laryngeal dysfunction where speech is often affected and vocal impairment may be an early symptom of the disease. According to her, vocal cord complications of PD can include -

1. Dysphonia: Difficulty in producing voice, often resulting in a strained or hoarse voice. Patients with Parkinson’s disease have a characteristic voice that is soft, monopitch, breathy, and harsh. Patients often have difficulty initiating speech, speak in short rushes of words, have inappropriate silences, have a variable speaking rate, and can have a vocal tremor.

2. Reduced vocal volume: Speech may become quieter due to decreased control over vocal cord muscles.

3. Monotone speech: Patients may speak with limited variation in pitch, tone, or inflection.

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

5. Breathiness: Weakness in vocal cord muscles can cause a breathy or whispered quality to speech.

6. Difficulty with articulation: Impaired coordination of vocal muscles can lead to unclear or slurred speech.

7. Dysphagia caused by PD may be due to disturbances in the oral, pharyngeal, and esophageal stages of swallowing. Impaired laryngeal function and movement are significant contributors to post‐swallow residue and impaired laryngeal elevation and laryngeal vestibule closure.

Bringing her expertise to the same, Dr Shama Kovale, Consultant, ENT at Kokilaben Dhirubhai Ambani Hospital in Mumbai, opined, “First, I would like to say that these cannot be called as complications but this is what can happen to the larynx or vocal folds in a person with Parkinson’s. Patient with Parkinson’s disease will have a very low volume and monotonous voice quality. We need to evaluate the larynx with Stroboscopy, which tells us the movements of the vocal folds or any other issue with the larynx. There could be incomplete Glottic closure that means the vocal folds are not closing completely. Vocal fold hypo adduction and bowing of the vocal folds again causing incomplete closure. These could be because of the bradykinesia of the muscles that is in simple terms slow reacting muscle. There also can be swallowing issues in patients suffering from Parkinson’s disease. The treatment in these patients is to get the medicines for Parkinson’s disease titred. We can start them on therapy, Injection laryngoplasty or sometimes a permanent procedure like Type I Thyroplasty.”

In what ways can stroke impact vocal cord function?

Talking about ways in which stroke can impact vocal cord function, Dr Smita Nagaonkar said, “Stroke can present with voice changes. 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. At times, it can also cause a reduction in sensation in the voice box, leading to patients experiencing coughing while eating or at rest, due to choking on their own saliva.”

She asserted that the impact of a stroke on the vocal cords can vary depending on the location and severity of the stroke and highlighted 20 potential points regarding the impact of stroke on vocal cords -

• Dysphonia: Stroke can cause dysphonia, which is a condition characterized by difficulty in producing speech sounds due to weakness, paralysis, or spasticity of the vocal cords.
• Hoarseness: Stroke-induced damage to the nerves controlling the vocal cords can lead to hoarseness or a rough, raspy voice quality.
• Weakness: Vocal cord weakness can result from stroke, leading 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: Paralysis or weakness of the vocal cords can lead to a breathy voice quality due to in complete closure of the vocal folds during speech.
• Strained 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 changes: Stroke can affect the control of vocal fold tension, leading to changes in pitch, such as a higher or lower voice than usual.
• Educed vocal range: Vocal cord dysfunction resulting from stroke may limit the ability to produce sounds across a wide vocal range.
• Difficulty with vocal tasks: Stroke survivors may have difficulty with tasks requiring precise vocal control, such as singing or speaking loudly.
• Impaired swallowing: Stroke-related dysphagia (difficulty swallowing) can also impact vocal cord function, as the same nerves control both swallowing and voice production.
• Aspiration: Weakness or paralysis of the vocal cords can increase the risk of aspiration (food or liquid entering the airway), which can further compromise vocal function and increase the risk of respiratory complications.
• Decreased vocal endurance: Vocal fatigue may occur more quickly in stroke survivors due to compromised vocal cord function, leading to reduced vocal endurance.
• Voice breaks: Weakness or instability of the vocal cords may cause voice breaks or interruptions during speech.
• Loss of vocal fold adduction: Damage to nerves controlling vocal fold adduction (closing) can lead to difficulties with voice onset and sustainment.
• Voice tremor: Stroke-related neurological damage can result in vocal tremor, causing involuntary rhythmic fluctuations in pitch or volume during speech.
• Difficulty with phonation: Stroke survivors may struggle with initiating or sustaining phonation (voice production) due to impaired vocal cord coordination or weakness.
• Breath support issues: Stroke-related weakness or paralysis may affect the coordination of respiratory muscles necessary for adequate breath support during speech, further impacting vocal cord function.
• Impact on communication: Ultimately, the effects of stroke on the vocal cords can significantly impair communication abilities, affecting social interactions, emotional expression, and quality of life.

Dr Smita Nagaonkar revealed, “It's important to note that the specific impact can vary widely among 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 can help improve vocal cord function and mitigate some of these effects.”

As for the symptoms of dysphonia and dysphagia in adults with laryngomalacia, she said, “A husky voice and breathing difficulties at rest or while lying down can be experienced by patients suffering from laryngomalacia.”

Dr Shama Kovale concluded, “Stroke is another neurological condition in which the vocal folds can be affected leading to breathy voice, swallowing difficulties or breathing issues. Depending on the part of the brain affected depends the involvement of the vocal folds. Patients may develop a unilateral vocal fold paralysis or a bilateral vocal fold paralysis depending on the area affected in the brain. If it’s the bilateral stroke and patient has developed breathing difficulty the first thing is to do a tracheostomy. In case of unilateral paralysis there is an option of Injection laryngoplasty if the patient is conscious and oriented. Second option is to start the patient on voice therapy. It’s a huge topic to be discussed and we need to really have an in-depth knowledge when treating these patients.”