Voice and Swallowing Impact from Neurologic Disorders
What impact do neurologic disorders have on voice and swallowing function?
A number of different neurologic disorders can cause changes in voice and/or swallowing function. Often, patients already have a diagnosis from a neurologist and are referred to a laryngologist to be evaluated for interventions that can help with their voice or swallowing. Occasionally, a voice or swallowing problem can be the first or only symptom of a neurologic condition.
Common neurologic disorders affecting voice include:
Spasmodic dysphonia: This disorder primarily affects the voice and not swallowing function. It is caused by abnormal firing of different muscles that move the vocal cords during speech. It gives patients either a strained or breathy voice, depending on which vocal cord muscles are dominantly affected, and may greatly affect the patient’s ability to communicate with others. Patients often report that their voice is worse when speaking on the telephone or when they are anxious or nervous and more normal when laughing or singing.
Tremor: Tremor of the throat or vocal cords can cause changes that make the voice sound “shaky” or unsteady, and it may overlap with the diagnosis of spasmodic dysphonia. Tremor may occur in the muscles of the throat or vocal cords alone but often is part of a systemic tremor that affects the neck, hands, arms or legs.
Parkinson’s disease: This neurologic disease is characterized by tremor and muscle weakness/slowness, both of which can affect voice and swallowing. Many patients notice that their voice becomes weak and tremulous. Patients may experience an inability to project and be heard easily by others.
Stroke: Changes following a stroke range from minor problems from which a patient can fully recover all the way to profound voice and swallowing changes (including complete loss of some muscles that control the vocal cords and swallowing), depending on the areas of the brain and brainstem that were affected.
Rarer neurologic disorders that can dramatically affect voice and swallowing include:
Multiple system atrophy (MSA)
Progressive motor neuron diseases
Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
Voice and Swallowing Impact from Neurologic Disorders Treatment
If your symptoms are mainly voice related, your treatment team will recommend treatments aimed at improving your vocal quality, projection and effort required to speak:
Spasmodic dysphonia and tremor (when appropriate) can be treated in the office setting with botulinum toxin to chemically weaken the muscles that are abnormally firing. Our experts often use specialized electromyography EMG equipment to perform these vocal cord muscle injections. An EMG is used to measure the electrical activity of your vocal muscles.
When appropriate, vocal fold atrophy or vocal cord immobility can be treated with in-office vocal fold injections designed to increase the volume of the vocal cords and help them come together better. This can also help make swallowing safer.
Lee Silverman Voice Treatment is an evidence-based voice therapy program for Parkinson’s disease.
If your problems are mainly swallowing related, your treatment team will discuss with you the treatments options available.
Reviewed by Clint Allen, M.D., from the Department of Otolaryngology-Head and Neck Surgery.