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Collagen Limits Voice Disorder in Parkinson's. (Simple Office Procedure).

DENVER -- Percutaneous laryngeal collagen injection is an exciting new, relatively simple and safe office procedure for the voice problems that commonly affect Parkinsonian patients, Dr. Soo Hang Kim declared at the annual meeting of the American Academy of Otolaryngology.

More than 70% of the nearly 2 million Americans with idiopathic Parkinson's disease develop speech or voice difficulties. Indeed, nearly one-third of Parkinsonian patients cite such problems as the most disabling consequence of their neurologic disease.

The characteristic Parkinsonian vocal deficit is breathy, whispery, often unintelligible speech due to glottic insufficiency and associated thyroarytenoid muscle rigidity.

The cause of glottic incompetence in patients with Parkinson's disease remains a topic of debate, but there is now good evidence that percutaneous laryngeal collagen augmentation of the vocal cords brings about significant improvement in speech lasting for several months in many affected patients. And the injections can easily be repeated as needed, said Dr. Kim of the University of Pennsylvania, Philadelphia.

She reported on 18 patients with voice problems secondary to Parkinson's disease. All had incomplete glottic closure on maximal adduction as documented on videostroboscopic examination. All underwent bilateral vocal cord collagen injections to assess the novel therapy's safety and efficacy, as well as to try to identify specific patient subgroups more or less likely to respond.

The procedure entailed injecting Zyplast X-linked collagen through a 25- or 27-gauge needle advanced under nasopharyngoscopic guidance percutaneously through the cricothyroid membrane into the true vocal cords. Patients required 0.3-1.0 mL of collagen to achieve glottic closure.

Eleven of the 18 patients (61%) or their caretakers noticed significant vocal improvement lasting for at least 2 months and for a mean of 3.2 months. All but one responder was ambulatory at the time of the procedure. None of the 11 responders were experiencing difficulty in speech initiation or difficulty swallowing when they underwent collagen injections.

In contrast, four of the seven nonresponders were nonambulatory. Five had marked dysphagia and difficulty in initiating speech at the time of the procedure.

Patients who are less likely to benefit from percutaneous collagen injections are those who have advanced neurologic disease and are unable to walk, or who have difficulty swallowing and/or initiating speech, she said.
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Author:Jancin, Bruce
Publication:Internal Medicine News
Date:Nov 15, 2001
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