Arytenoid cartilage movements are hypokinetic in Parkinson’s disease: A quantitative dynamic computerised tomographic study

BackgroundVoice change is one of the earliest features of Parkinson’s disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into disease biology, aid diagnosis, or track progression, are few.MethodsWe therefore quantified arytenoid cartilage movements and glottic area during repeated phonation in 15 patients with Parkinson’s disease (symptom duration ResultsInter-arytenoid distance in Parkinson’s disease patients was moderately smaller (Mdn = 0.106, IQR = 0.091–0.116) than in controls (Mdn = 0.132, IQR = 0.116–0.166) (W = 212, P = 0.015, r = −0.42), normalised for anatomical and other inter-subject variance, analysed with two-tailed Wilcoxon’s rank sum test. This finding was confirmed in a linear mixed model analysis—Parkinson’s disease significantly predicted a reduction in the dependent variable, inter-arytenoid distance (b = −0.87, SEb = 0.39, 95% CI [−1.66, −0.08], t(31) = −2.24, P = 0.032). There was no difference in glottic area. On perceptual voice evaluation, patients had more breathiness and dysdiadochokinesis, a shorter maximum phonation time, and less variability in loudness than controls. There was no difference in spirometry after adjustment for smoking history.ConclusionsAs predicted, vocal fold adduction movements are reduced in Parkinson’s disease on repeated phonation but glottic area is maintained. Some perceptual characteristics of Parkinsonian speech reflect these changes. We are the first to use 320-slice CT to study laryngeal motion. Our findings indicate how Parkinson’s disease affects intrinsic laryngeal muscle position and excursion.