Skip to main content Accessibility help

The diagnosis, clinical findings and treatment options for Parkinson's disease patients attending a tertiary referral voice clinic

  • N Gibbins (a1), R Awad (a2) (a3), S Harris (a2) and A Aymat (a1)



Parkinson's disease is a degenerative disorder of the central nervous system, mainly affecting motor functions including the voice. The aetiology of dysphonia changes throughout the course of disease progression.


This study aimed to determine the laryngeal changes seen in early-, mid- and late-stage Parkinson's disease. Thirteen patients with Parkinson's disease are presented, representing the largest series of voice patients with Parkinson's disease seen in a voice clinic in the literature.


Age, gender, severity of handicap caused by voice disorder and possible associated reflux symptoms were examined.


Laryngeal function appeared to change gradually with progression of the disease, and may have been affected by the presence of pre-existing laryngeal pathology.


Laryngeal function in Parkinson's disease appears to go through a series of changes that may be helped by both therapeutic and surgical interventions. These patients should be treated within the confines of a voice clinic multidisciplinary model.


Corresponding author

Address for correspondence: Mr N Gibbins, Department of Otolaryngology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK E-mail:


Hide All

Presented as a poster at the 15th British Academic Conference of Otolaryngology, 8–10 July 2015, Liverpool, UK.



Hide All
1 Ramig, LO, Fox, C, Sapir, S. Speech treatment for Parkinson's disease. Expert Rev Neurother 2008;8:299311
2 Ramig, L, Meyer, T, Fox, C, Blitzer, A, Tagliati, M. Laryngeal function in individuals with Parkinson's disease. Perspectives on Voice and Voice Disorders 2005;15:915
3 Pitcairn, T, Clemie, S, Gray, J, Pentland, B. Non-verbal cues in the self-presentation of parkinsonian patients. Br J Clin Psychol 1990;29:177–84
4 Pitcairn, T, Clemie, S, Gray, J, Pentland, B. Impressions of parkinsonian people from their recorded voices. Br J Clin Psychol 1990;25:8592
5 Miller, N, Noble, E, Jones, D, Burn, D. Life with communication changes in Parkinson's disease. Age Ageing 2006;35:235–9
6 Sapir, S, Ramig, LO, Hoyt, P, Countryman, S, O'Brien, C, Hoehn, M. Speech loudness and quality 12 months after intensive voice treatment (LSVT®) for Parkinson's disease: a comparison with an alternative speech treatment. Folia Phoniatr Logop 2002;54:296303
7 Berardelli, A, Rothwell, JC, Thompson, PD, Hallett, M. Pathophysiology of bradykinesia in Parkinson's disease. Brain 2001;124:2131–46
8 Ramig, LO, Fox, C, Sapir, S. Parkinson's disease: speech and voice disorders and their treatment with the Lee Silverman Voice Treatment. Semin Speech Lang 2004;25:169–80
9 Hammer, MJ, Barlow, SM. Laryngeal somatosensory deficits in Parkinson's disease: implications for speech respiratory and phonatory control. Exp Brain Res 2010;201:401–9
10 Hanson, DG, Gerratt, BR, Ward, PH. Cinegraphic observations of laryngeal function in Parkinson's disease. Laryngoscope 1984;94:348–53
11 Perez, KS, Ramig, LO, Smith, ME, Dromey, C. The Parkinson larynx: tremors and videostroboscopic findings. J Voice 1996;10:354–61
12 Stelzig, Y, Hochhaus, W, Gall, V, Henneberg, A. Laryngeal manifestations in patients with Parkinson disease [in German]. Laryngorhinootologie 1999;78:544–51
13 Yücetürk, AV, Yilmaz, H, Eğrilmez, M, Karaca, S. Voice analysis and videolaryngostroboscopy in patients with Parkinson's disease. Eur Arch Otorhinolaryngol 2002;259:290–3
14 Radad, K, Gille, G, Rausch, W. Short review on dopamine agonists: insight into clinical and research studies relevant to Parkinson's disease. Pharmacol Rep 2005;57:701–12
15 Goberman, A, Coelho, C, Robb, M. Phonatory characteristics of parkinsonian speech before and after morning medication: the ON and OFF states. J Commun Disord 2002;35:217–39
16 Sanabria, J, Ruiz, PG, Gutierrez, R, Marquez, F, Escobar, P, Gentil, M et al. The effect of levodopa on vocal function in Parkinson's disease. Clin Neuropharmacol 2001;24:99102
17 Jiang, J, Lin, E, Wang, J, Hanson, DG. Glottographic measures before and after levodopa treatment in Parkinson's disease. Laryngoscope 1999;109:1287–94
18 Larson, K, Ramig, LO, Scherer, RC. Acoustic and glottographic voice analysis during drug-related fluctuations in Parkinson's disease. J Med Speech Lang Pathol 1994;2:211–26
19 Kompoliti, K, Wang, QE, Goetz, CG, Leurgans, S, Raman, R. Effects of central dopaminergic stimulation by apomorphine on speech in Parkinson's disease. Neurology 2000;54:458–62
20 Trail, M, Fox, C, Ramig, LO, Sapir, S, Howard, J, Lai, EC. Speech treatment for Parkinson's disease. NeuroRehabilitation 2005;20:205–21
21 Biary, N, Pimental, PA, Langenberg, PW. A double-blind trial of clonazepam in the treatment of parkinsonian dysarthria. Neurology 1988;38:255–8
22 Kompoliti, K, Wang, QE, Goetz, CG, Leurgans, S, Raman, R. Effects of central dopaminergic stimulation by apomorphine on speech in Parkinson's disease. Neurology 2000;54:458–62
23 Baker, K, Ramig, LO, Johnson, A, Freed, C. Preliminary speech and voice analysis following foetal dopamine transplants in 5 people with Parkinson's disease. J Speech Hear Res 1997;20:615–26
24 Ghika, J, Ghika-Schmid, F, Fankhauser, H, Assal, G, Vingerhoets, F, Abanese, A et al. Bilateral contemporaneous posteroventral pallidotomy for the treatment of Parkinson's disease: neuropsychological and neurological side effects, report of four cases and review of the literature. J Neurosurg 1999;9:313–21
25 Krack, P, Batir, A, VanBiercom, N, Charbardes, S, Fraix, V, Ardouin, C et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 2003;20:1925–34
26 Törnqvist, AL, Schalén, L, Rehncrona, S. Effects of different electrical parameter settings on the intelligibility of speech in patients with Parkinson's disease treated with subthalamic deep brain stimulation. Mov Disord 2005;20:416–23
27 Ramig, LO, Sapir, S, Countryman, S, Pawlas, AA, O'Brien, C, Hoehn, M et al. Intensive voice treatment (LSVT®) for people with Parkinson's disease: a 2 year follow-up. J Neurol Neurosurg Psychiatr 2001;71:493–8
28 Ramig, L, Sapir, S, Fox, C, Countryman, S. Changes in vocal intensity following intensive voice treatment (LSVT) in people with Parkinson's disease: a comparison with untreated people and with normal age-matched controls. Mov Disord 2001;16:7983
29 Fox, CM, Ramig, LO, Ciucci, MR, Sapir, S, McFarland, DH, Farley, BG. The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang 2006;27:283–99
30 Smith, ME, Ramig, LO, Dromey, C, Perez, KS, Samandari, R. Intensive voice treatment in Parkinson disease: laryngostroboscopic findings. J Voice 1995;9:453–9
31 Luschei, ES, Ramig, LO, Baker, KL, Smith, ME. Discharge characteristics of laryngeal single motor units during phonation in young and older adults and in persons with Parkinson disease. J Neurophysiol 1999;81:2131–9
32 Perez, KS, Ramig, LO, Smith, ME, Dromey, C. The Parkinson larynx: tremor and videostroboscopic findings. J Voice 1996;10:354–61
33 Baker, KK, Ramig, LO, Luschei, ES, Smith, ME. Thyroarytenoid activity muscle associated with hypophonia in Parkinson's disease and aging. Neurology 1998;51:1592–8
34 Ramig, LO, Countryman, S, Thompson, LL, Horii, Y. Comparison of two forms of intensive speech treatment for Parkinson disease. J Speech Hear Res 1995;38:1232–51
35 Ramig, LO, Dromey, C. Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson's disease. J Speech Hear Res 1996;39:798807



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed