Changes in control of the face, mouth and throat
Parkinson’s disease can affect the muscles used for speaking, swallowing and controlling saliva. This can lead to a softer or less clear voice, difficulty swallowing safely and drooling.
Key points
- Speech, swallowing and saliva control problems in Parkinson’s disease share a common cause: slowness and reduced coordination of the muscles in the face, mouth and throat.
- Speech pathology assessment is central to managing all three symptoms and can offer practical, effective strategies.
Next steps:
- book a GP visit
- request an assessment for Parkinson’s disease
- request a speech pathology referral.
Speech, swallowing and saliva control
In Parkinson’s disease, slowness of movement (bradykinesia) and rigidity can affect the muscles in the face, mouth and throat. This can disrupt all three functions, which is why they are often assessed and managed together.
Speech changes can occur when reduced muscle movement affects volume, clarity and articulation. It may even lead to:
- monotone speech with less variation in pitch or emphasis
- reduced clarity or a ‘mumbling’ quality
- softer voice (hypophonia), sometimes without the person noticing
- speech that trails off toward the end of sentences.
Swallowing difficulty (dysphagia) occurs when the coordinated sequence of muscle movements required to move food and liquid safely to the stomach are disrupted. It may lead to:
- coughing or choking with food or drink
- difficulty managing mixed textures, eg soup with solid pieces
- sensation of food sticking or needing multiple swallows to clear a mouthful
- wet or ‘gurgly’ voice quality after swallowing.
Saliva control issues and drooling (sialorrhea) occur not because more saliva is produced, but because saliva that would normally be swallowed automatically and unconsciously, pools in the mouth due to reduced swallowing frequency. It may lead to:
- drooling that is worse when the head is tilted down, eg reading or using a phone
- increased drooling at night, sometimes noticed on the pillow
- saliva pooling in the mouth or drooling from the corners of the mouth
- skin irritation or soreness around the mouth or chin with persistent drooling.
Speech and swallowing difficulties can occur for many reasons besides Parkinson’s disease. Other possible causes include:
- anxiety or general muscle tension affecting voice projection
- certain medications affecting saliva production or muscle coordination
- dental problems or poorly fitted dentures affecting mouth closure and speech clarity
- hearing loss, which can be mistaken for a speech problem in conversation
- nasal or sinus congestion increasing mouth breathing and saliva pooling
- stroke or other neurological conditions affecting the muscles of speech and swallowing.
When to consider specialist review
Speak with your neurologist, GP or speech pathologist if your speech, swallowing or drooling symptoms are:
- new or worsening
- causing social distress
- occur alongside coughing, choking or recurrent chest infections.
These symptoms may need a more detailed assessment.
When to seek urgent help
Seek urgent medical attention if you experience:
- a rapid worsening of speech or swallowing
- signs of a chest infection, such as fever, cough or shortness of breath
- sudden difficulty swallowing, coughing or choking with food or drink.
These symptoms may indicate aspiration or another acute problem requiring prompt assessment.