April 2008

Dr. Patty Lee, Otolaryngology Associates, P.C.

Our thanks to Dr. Patty Lee from Otolaryngology Associates, P.C for speaking to us. They have offices in Fairfax, Reston and Centreville. The website for her practice is at: www.otolaryngology-assoc.com

The adult larynx changes as we grow older and is not as flexible. Vocal chords are muscles and they can become thinner and not come together correctly to produce sound.

Some of the issues people are having with swallowing may be unrelated to Parkinson disease. These are some non-neurological issues that Dr. Lee would look for first:
–  are your teeth/dentures in good shape?
–  medications working properly?
–  curvature of spine
– bone spurs can affect the transit of food.
–  With PD nerves don’t lose control, it’s more a change in strength and muscle control.
–  Gastric reflux can also cause problems when the acid burns the esophagus.

If the muscles are moving ok but are atrophic (deteriorating – consistent with aging and neurological disease) the voice becomes soft, has a low volume and swallowing may be affected.

What would Dr. Lee do if you went to see her?
–  She would check that your medications are ok.
–  She would also recommend that you receive expert voice therapy from someone familiar with the Lee Silverman method (more information at  http://www.lsvt.org/main_site.htm) Dr. Lee recommends Laura Verdun who is on her staff, and we hope that Ms Verdun will come and speak to us.
–  If muscle quality is weak a “filler” such as a paste made from collagen, hyaluronic acid or Teflon can be used to change the contour of the muscle. More permanent fillers such as sylastic or gore tex can also be used.

What can we do to help ourselves?
We need to use our lungs to deliver air to support our voice.
Use our voice – like our other muscles it the old Use it or Lose it!
Practice good oral hygiene.

From questions that were asked:
Will larynx surgery help swallowing as well as speech?  Yes – indirectly because the vocal muscles will close off, and keep air out which will allow the pharynx to push food down.

Before seeing a therapist, it’s best to see an otolaryngologist to make sure there are no other problems.

It is possible to train even paralyzed vocal chords.

Laryngitis is a swelling because of more fluid. Sort of like fat guitar strings have a lower pitch (i.e. hoarse) as compared to thinner guitar strings having a higher pitch.

When we gargle, it only goes behind the back teeth, in front of the tonsils, therefore it doesn’t affect the larynx.

Will singing help the vocal chords come together better? Yes! If you use your vocal chords, just like with all your other muscles, they will be more firm, and not only maintain but even increase their size. This helps to fight the effects of aging. Humming is good, too. Just don’t whisper . . . .

Some other suggestions to use your voice are to learn a new language (repeat the words and phrases) and read aloud by speaking to the back wall or projecting your voice. A therapist can teach you how to project your voice.

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