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Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life, systematic assessments of laryngeal dysfunction in large cohorts are missing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective of this study was to systematically assess laryngeal dysfunction in MSA and PD and identify laryngeal symptoms that allow for differentiating MSA from PD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with probable or possible MSA underwent flexible endoscopic evaluation of swallowing performing a systematic task protocol. Findings were compared with an age\u2010matched PD cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 57 patients with MSA (64 [59\u201371] years; 35 women) were included, and task assessments during endoscopic examination compared with 57 patients with PD (67 [60\u201373]; 28 women). Patients with MSA had a shorter disease duration (4 [3\u20135] years vs 7 [5\u201310]; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and higher disease severity (Hoehn &amp; Yahr stage 4 [3\u20134] vs 3 [2\u20134]; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Of the patients with MSA, 43.9% showed clinically overt laryngeal dysfunction with inspiratory stridor. During endoscopic task assessment, however, 93% of patients with MSA demonstrated laryngeal dysfunction in contrast with only 1.8% of patients with PD (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Irregular arytenoid cartilages movements were present in 91.2% of patients with MSA, but in no patients with PD (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Further findings included vocal fold motion impairment (75.4%), paradoxical vocal fold motion (33.3%), and vocal fold fixation (19.3%). One patient with PD showed vocal fold motion impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Laryngeal movement disorders are highly prevalent in patients with MSA when assessed by a specific task protocol despite the lack of overt clinical symptoms. Our data suggest that irregular arytenoid cartilage movements could be used as a clinical marker to delineate MSA from PD with a specificity of 1.0 and sensitivity 0.9. \u00a9 2020 The Authors. <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.28220","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T08:30:39Z","timestamp":1596616239000},"page":"2174-2183","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Laryngeal Movement Disorders in Multiple System Atrophy: A Diagnostic Biomarker?"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2874-9817","authenticated-orcid":false,"given":"Florin","family":"Gandor","sequence":"first","affiliation":[{"name":"Movement Disorders Hospital Kliniken Beelitz GmbH  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