Neurological illness causing hoarseness are Parkinson’s disease, Lou Gehrig disease (=AML) or myasthenia gravis, as they can all cause the vocal nerve control to falter leading to a hoarse voice and a danger for aspiration.
The protective reflexes in the back of the throat are disturbed. Normally the body has one “program” for swallowing food that is protected by a proper sequence of swallowing mechanisms and protection of the airways by flipping the epiglottis over the upper larynx opening.
If anything should go wrong, a powerful cough reflex expels air from the lungs to push foreign bodies or fluid back out that attempts to enter into the airways instead of into the esophagus.
Neurological illness causing hoarseness such as the ones mentioned above or following strokes or seizures there can be an interruption of these protective reflexes and/or there can be swallowing problems causing aspiration. The patient very quickly would turn sick and get aspiration pneumonia and often has to be taken care of in a hospital setting (Ref. 2, p. 1765).It is best to have these patients assessed by both a neurologist and an ENT specialist and treat whatever factor of their condition is treatable. Unfortunately not everybody can be helped. Hopefully newer treatments like mesenchymal stem cell treatments (extracted by liposuction from the patient’s own fatty tissue) may be helpful although this is considered experimental at this time.
References
1. James Chin et al., Editors: Control of Communicable Diseases Manual, 17th edition, 2000, American Public Health Association.
2. Behrman: Nelson Textbook of Pediatrics, 16th ed., 2000, W. B. Saunders Company
4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001 Mosby, Inc.
5. Abeloff: Clinical Oncology, 2nd ed.,2000,Churchill Livingstone, Inc.
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
