Objective: The purpose of this study is to illustrate the importance of laryngeal examination during fiberoptic endoscopic evaluation of swallow (FEES) with the Parkinson patient population. Since most patients with PD will demonstrate vocal symptoms as part of their disease progression, symptoms indicative of other laryngeal diagnoses may be taken for granted. Therefore, laryngeal examination during FEES may aid in diagnosing unrelated voice disorders which may require treatment or be contraindicated for typical PD voice therapies.
Methods: The FEES studies of 73 patients with PD were reviewed to determine incidence of co-existing laryngeal pathologies. Participants were patients in an outpatient setting reporting initial swallowing concerns or returning for follow-up studies to monitor disease progression. During these studies, clinicians examined the laryngeal vestibule and vocal folds.
Results: Of 73 patients examined, 79% presented with laryngeal pathology findings, with 13% presenting with two or more pathological findings. The most common finding (67%) was vocal fold atrophy which is consistent with previous estimates of its prevalence (Yiu 2019, Stelzig 1999). 15% (11/73) of patients presented with laryngeal muscle tension dysphonia and there were two new findings of vocal fold paresis (3%). Additionally, two patients were diagnosed with vocal fold lesions and referred to laryngology for further assessment along with one patient who presented with a varix on the vocal fold.
Conclusions: As many patients with Parkinson’s Disease will experience voice problems as part of the disease progression it is easy for clinicians to take their voice changes for granted and fail to complete thorough voice assessments. Additionally, such assessments may be costly or difficult to complete due to travel and mobility restrictions. Therefore, examination of the laryngeal vestibule and the vocal folds can be achieved during FEES. Findings from this study showed that 26% of patients examined showed pathologies that would benefit from laryngologist or voice intervention not typically completed for PD (MTD, reflux changes, paresis, lesion, and varix). Additionally, 4% of patients presented with findings that are considered contraindications for traditional Parkinson’s voice therapy such as SPEAK OUT! and LSVT LOUD (lesion, varix).
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