Cases reported "Parkinson Disease"

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1/7. Treatment of Parkinson hypophonia with percutaneous collagen augmentation.

    OBJECTIVES: It has been estimated that more than 70% of patients with parkinson disease experience voice and speech disorders characterized by weak and breathy phonation, and dysarthria. This study reports on the efficacy of treating Parkinson patients who have glottal insufficiency. STUDY DESIGN AND methods: Thirty-five patients underwent collagen augmentation of the vocal folds for hypophonia associated with parkinson disease, using a new technique of percutaneous injection with fiberoptic guidance. Patient response to the collagen augmentation was determined by telephone survey. RESULTS AND CONCLUSIONS: The procedure required minimal patient participation and was safely performed on all the patients who were studied. Results of the survey indicated that 75% of patient responses demonstrated satisfaction with the technique, compared with 16% of patient ratings reflecting dissatisfaction. These results were moderately correlated with the duration of improvement of the dysphonia. Results of this preliminary evaluation demonstrate that voice deficits in parkinson disease are amenable to vocal fold augmentation. Because this procedure requires minimal patient participation and can be safely performed in an office setting, it may also be useful in other severely debilitating neuromotor diseases that result in glottal insufficiency and hypophonia.
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ranking = 1
keywords = voice
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2/7. Involuntary expiratory phonation as a dose-related consequence of L-dopa therapy in a patient with Parkinson's disease.

    We report a case of involuntary phonation caused by abnormal vocal cord movements during expiration in a patient with Parkinson's disease. A 60-year-old woman had been treated for parkinsonism at the outpatient clinic of the Department of neurology since August 1999. She began to groan involuntarily in the daytime in September 2001. She could not eat well while groaning. Stridor was not noted during sleep at night. Endoscopic examination of the larynx revealed insufficient abduction of the bilateral vocal cords, although the glottis was not so small as to cause stridor during inspiration. During expiration, however, the vocal cords adducted, resulting in the involuntary production of voice. electromyography showed an increase in the activity of the thyroarytenoid and lateral cricoarytenoid muscles. This muscle activity was further enhanced during inspiration. The involuntary phonation disappeared when the patient's dose of L-dopa was decreased, although she had a decrease in her systemic mobility as well. When the dose of L-dopa was increased to the therapeutic level, involuntary phonation recurred, and her voluntary systemic activity improved. In the present case, it was considered that excessive dopaminergic denervation occurred in the nerve innervating the laryngeal adductors. Involuntary voice appeared to be produced by hypertonus of the laryngeal adductors because of a lowering in the threshold level for L-dopa, even though the drug was administered at the usual dose.
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ranking = 1
keywords = voice
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3/7. Normalization of voice in spasmodic dysphonia during transient global amnesia.

    We report on the case of a 69-year-old woman with Parkinson's disease and long-standing history of spasmodic dysphonia that reversed during an episode of transient global amnesia (TGA). To our knowledge, this phenomenon has not been reported before. We suggest possible mechanisms by which the pathophysiology of dystonia could reverse during TGA.
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ranking = 2
keywords = voice
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4/7. Glottographic measurement of vocal dysfunction. A preliminary report.

    Objective measurement of vocal function is important in evaluating phonatory disorders, planning treatment, and documenting the effects of therapy. Glottographic measurement, ie, measures that describe glottal movement, can be performed and analyzed relatively easily, and can be related to the pathophysiology of vocal dysfunction. In our clinic, simultaneous recording of acoustic, photoglottographic and electroglottographic signals is being used in the evaluation of patients with voice disorders associated with neurologic impairments. Our experience with these measures indicates that they may provide detailed information about the vibratory patterns of the vocal folds, which appears to differentiate some phonatory characteristics among patients with differing types of disorders.
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ranking = 0.5
keywords = voice
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5/7. levodopa therapy and malignant melanoma.

    Concern has been voiced over a role for levodopa in the induction or stimulation of growth of cutaneous malignant melanoma. Prospective query of 1,099 patients of the melanoma Clinical Cooperative Group at the time of presentation of their primary melanoma showed only one patient who had been taking levodopa. It was concluded that levodopa, if a factor in the induction of melanoma, must be playing an inconsequential role in the rapid rise in incidence observed for this tumor over the past decade.
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ranking = 0.5
keywords = voice
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6/7. Vocal symptoms in parkinson disease treated with levodopa. A case report.

    This is a report of a patient with unusually severe hoarseness in the absence of vocal fold pathology demonstrating parkinson disease as one of the neurological diseases in which vocal symptoms occur. Although it is classifiably a severe, progressive, degenerative disorder, the popularity of pharmacotherapy for parkinson disease during the past decade has resulted in improved functionality for an undetermined course of time in most patients. The classically described deterioration of speech ad voice may develop in a variant manner difficult to distinguish as disease-related, as this case report illustrates. An explanation of the hoarseness based on dyssynchronous vocal fold motion related to the disease is suggested by the acoustic methods (spectrography, waveform analysis) used in this study, and supported by strobe light laryngoscopy. This conclusion is important because of the extremely high incidences of varying degrees of hoarseness reported in recent studies of parkinson disease.
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ranking = 0.5
keywords = voice
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7/7. Treatment efficacy: voice disorders.

    This article reviews the literature on the efficacy of treatment for voice disorders primarily using studies published in peer-reviewed journals. voice disorders are defined, their frequency of occurrence across the life span is reported, and their impact on the lives of individuals with voice disorders is documented. The goal of voice treatment is to maximize vocal effectiveness given the existing disorder and to reduce the handicapping effect of the voice problem. Voice treatment may be (a) the preferred treatment to resolve the voice disorder when medical (surgical or pharmacological) treatments are not indicated; (b) the initial treatment in cases where medical treatment appears indicated; it may obviate the need for medical treatment; (c) completed before and after surgical treatment to maximize long-term post-surgical voice; and (d) a preventative treatment to preserve vocal health. Experimental and clinical data are reviewed that support these roles applied to various disorder types: (a) vocal misuse, hyperfunction and muscular imbalance (frequently resulting in edema, vocal nodules, polyps or contact ulcers); (b) medical or physical conditions (e.g., laryngeal nerve trauma, parkinson disease); and (c) psychogenic disorders (e.g., conversion reactions, personality disorders). Directions for future research are suggested which maximize clinical outcomes and scientific rigor to enhance knowledge on the efficacy of voice treatment.
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ranking = 5.5
keywords = voice
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