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Stridor in Parkinson's disease: a case of ‘dry drowning’?

Published online by Cambridge University Press:  11 December 2009

E C Gan ,
D P Lau  and
K L Cheah
E C Gan*
Affiliation:
Department of Otolaryngology, Singapore General Hospital, Singapore
D P Lau
Affiliation:
Department of Otolaryngology, Singapore General Hospital, Singapore
K L Cheah
Affiliation:
Department of Internal Medicine, Singapore General Hospital, Singapore
*
Address for correspondence: Dr Eng Cern Gan, Department of Otolaryngology, Singapore General Hospital, Outram Road, Singapore 169608. Fax: +65 6226 2079 E-mail: ecgan@hotmail.com
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Abstract

Objectives:

(1) To present a rare case of stridor secondary to prolonged laryngospasm in a patient with Parkinson's disease, and (2) to review the literature on stridor in Parkinson's disease.

Methods:

We report a 73-year-old Parkinson's disease patient who developed acute stridor due to prolonged laryngospasm triggered by overspill of excessive secretions. The literature was reviewed, following a Medline search using the keywords ‘Parkinson's disease’ and ‘stridor’ or ‘airway obstruction’ or ‘laryngospasm’ or ‘laryngeal dystonia’ or ‘bilateral vocal cord palsy’.

Result:

Only 12 previously reported cases of stridor in Parkinson's disease patients were identified. Causes included bilateral vocal fold palsy (eight cases), laryngospasm (five), and dystonia of the jaw and neck muscles (two). The mechanism of laryngospasm in our patient was similar to ‘dry drowning’, and has not previously been described.

Conclusion:

Laryngospasm can be triggered in Parkinson's disease by excessive secretions entering the larynx. The mechanism is similar to ‘dry drowning’. Treatment focuses on reducing secretions. The use of botulinum toxin to reduce spasm is inappropriate in this situation. This case emphasises the importance of recognising different causes of stridor in Parkinson's disease patients, as this affects management.

Keywords

Parkinson's DiseaseStridorAirway ObstructionLaryngospasmBilateral Vocal Cord ParalysisDystonia

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 6 , June 2010 , pp. 668 - 673
Copyright
Copyright © JLO (1984) Limited 2009

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References

1 Sammii, A, Nutt, JG, Ransom, BR. Parkinson's disease. Lancet 2004;363:1783–93CrossRefGoogle Scholar
2 De Rijk, MC, Launer, LJ, Berger, K, Breteler, MM, Dartigues, JF, Baldereschi, M et al. Prevalence of Parkinson's disease in Europe: a collaborative study of population-based cohorts. Neurology 2000(11 suppl 5);54:S21–3Google ScholarPubMed
3 De Lau, LM, Giesbergen, PC, de Rijk, MC, Hofman, A, Koudstaal, PJ, Breteler, MM. Incidence of Parkinsonism and Parkinson's disease in a general population: the Rotterdam study. Neurology 2004;63:1240–4CrossRefGoogle Scholar
4 Lew, M. Overview of Parkinson's disease. Pharmacotherapy 2007(12 Pt 2);27:155–60SCrossRefGoogle ScholarPubMed
5 Pinto, S, Ozsancak, C, Tripoliti, , Thobois, S, Limousin-Dowsey, P, Auzou, P. Treatments for dysarthria in Parkinson's disease. Lancet Neurol 2004;3:547–56CrossRefGoogle ScholarPubMed
6 Ramig, L, Fox, C, Sapir, S. Speech treatment for Parkinson's disease. Expert Rev Neurother 2008;8:299–311CrossRefGoogle ScholarPubMed
7 Stelzig, Y, Hochhaus, W, Gall, V, Henneberg, A. Laryngeal manifestations in patients with Parkinson's disease [in German]. Laryngorhinootologie 1999;78:544–51CrossRefGoogle Scholar
8 Perez, KS, Ramig, LO, Smith, ME, Dromey, C. The Parkinson larynx: tremor and videostroboscopic findings. J Voice 1996;10:354–61CrossRefGoogle ScholarPubMed
9 Merati, AL, Heamn-Ackah, YD, Abaza, M, Altman, KW, Sulica, L, Belamowicz, S. Common movement disorders affecting the larynx: a report from the neurolaryngology committee of the AAO-HNS. Otolaryngol Head Neck Surg 2005;113:654–65CrossRefGoogle Scholar
10 Yasuda, T, Yanagi, T. Bilateral vocal cord paralysis in Parkinson's disease [in Japanese]. Rinsho Shinkeigaku 1986;26:578–82Google ScholarPubMed
11 Vas, CJ, Parsonage, M, Lord, OC. Parkinsonism associated with laryngeal spasm. J Neurol Neurosurg Psychiatry 1965;28:401–3CrossRefGoogle ScholarPubMed
12 Plasse, HM, Lieberman, AN. Bilateral vocal cord paralysis in Parkinson's disease. Arch Otolaryngol 1981;107:252–3CrossRefGoogle ScholarPubMed
13 Read, D, Young, A. Stridor and parkinsonism. Postgrad Med J 1983;59:520–1CrossRefGoogle ScholarPubMed
14 Corbin, DOC, Williams, AC. Stridor during dystonic phases of Parkinson's disease. J Neurol Neurosurg Psychiatry 1987;50:821–2CrossRefGoogle ScholarPubMed
15 Takayama, H, Sato, H, Ota, Z, Nishizaki, K, Ogawa, N. Bilateral vocal cord paralysis due to laryngeal carcinoma in Parkinson's disease. J Med 1987;18:251–8Google ScholarPubMed
16 Lew, MF, Shindo, M, Moskowitz, CB, Wilhelmsen, KC, Fahn, S, Waters, CH. Adductor laryngeal breathing dystonia in a patient with lubag (X-linked dystonia-Parkinsonism syndrome). Mov Disord 1994;9:318–20CrossRefGoogle Scholar
17 Nakane, S, Motomura, M, Furuya, T, Shirabe, S, Nakamura, T. A case of juvenile Parkinson disease with vocal cord abductor paralysis in the course of malignant syndrome [in Japanese]. Rinsho Shinkeigaku 1999;39:370–2Google ScholarPubMed
18 Onoue, H, Yukitake, M, Kurohara, K, Takasima, H, Kuroda, Y. A case report of Parkinson's disease presenting with recurrent dyspneic attacks due to focal laryngeal dystonia [in Japanese]. Rinsho Shinkeigaku 2003;43:192–4Google ScholarPubMed
19 Qayyum, A, Mierzwa, K, See, M, Sharma, A, Montgommery, PQ. Laser arytenoidectomy for bilateral vocal fold palsy in Parkinson's disease. J Laryngol Otol 2005;119:831–3CrossRefGoogle ScholarPubMed
20 Huppler, EG, Schmidt, HW, Devine, D, Gage, RP. Causes of vocal cord paralysis. Mayo Clin Proc 1955;30:518–21Google ScholarPubMed
21 Holinger, LD, Holinger, PC, Holinger, PH. Etiology of bilateral vocal cord paralysis: a review of 389 cases. Ann Otol Rhinol Laryngol 1976;85:428–36CrossRefGoogle ScholarPubMed
22 Isozaki, E, Matsubara, S, Hayashida, T, Oda, M, Hirai, S. Morphometric study of nucleus ambiguus in multiple system atrophy presenting with vocal cord abductor paralysis. Clin Neuropathol 2000;19:213–20Google ScholarPubMed
23 Blumin, JH, Berke, GS. Bilateral vocal fold paresis and multiple system atrophy. Arch Otolaryngol Head Neck Surg 2002;128:1404–7CrossRefGoogle ScholarPubMed
24 Isozaki, E, Miyamoto, K, Osanai, R. Clinical studies of 23 patients with multiple system atrophy presenting with vocal cord paralysis [in Japanese]. Rinsho Shinkeigaku 1991;31:249–54Google ScholarPubMed
25 Obholzer, RJ, Nouraei, SAR, Ahmed, J, Kadhim, MR, Sandhu, GS. An approach to the management of paroxysmal laryngospasm. J Laryngol Otol 2008;122:57–60CrossRefGoogle Scholar
26 Zarzur, AP, Duprat, AC, Shinzato, G, Eckley, CA. Laryngeal electromyography in adults with Parkinson's disease and voice complaints. Laryngoscope 2007;117:831–4CrossRefGoogle ScholarPubMed
27 Grillone, GA, Chan, T. Laryngeal dystonia. Otolaryngol Clin North Am 2006;39:87–100CrossRefGoogle ScholarPubMed
28 Green, T, Franklin, W, Tanz, R. Paediatrics: Just Facts. New York: McGraw-Hill, 2005Google Scholar
29 Tolosa, E, Compta, Y. Dystonia in Parkinson's disease. J Neurol 2006;253:7–13CrossRefGoogle ScholarPubMed
30 Nobrega, AC, Rodrigues, B, Torres, AC, Enzo, A, Melo, A. Does botulinum toxin decrease frequency and severity of sialorrhea in Parkinson's disease? J Neurol Sci 2007;253:85–7CrossRefGoogle ScholarPubMed
31 Mancini, F, Zangaglia, R, Cristina, S, Sommaruga, MG, Martignoni, E, Nappi, G et al. Double-blind, placebo-controlled study to evaluate the efficacy and safety of botulinum toxin type A in the treatment of drooling in parkinsonism. Mov Disord 2003;18:685–8CrossRefGoogle ScholarPubMed