title: Surgical improvement of speech disorder caused by amyotrophic lateral sclerosis.
abstract: Amyotrophic lateral sclerosis (ALS) is a progressive debilitating neurological disease.  ALS disturbs the quality of life by affecting speech, swallowing and free mobility of the arms without affecting intellectual function.  It is therefore of significance to improve intelligibility and quality of speech sounds, especially for ALS patients with slowly progressive courses.  Currently, however, there is no effective or established approach to improve speech disorder caused by ALS.  We investigated a surgical procedure to improve speech disorder for some patients with neuromuscular diseases with velopharyngeal closure incompetence.  In this study, we performed the surgical procedure for two patients suffering from severe speech disorder caused by slowly progressing ALS.  The patients suffered from speech disorder with hypernasality and imprecise and weak articulation during a 6-year course (patient 1) and a 3-year course (patient 2) of slowly progressing ALS.  We narrowed bilateral lateral palatopharyngeal wall at velopharyngeal port, and performed this surgery under general anesthesia without muscle relaxant for the two patients.  Postoperatively, intelligibility and quality of their speech sounds were greatly improved within one month without any speech therapy.  The patients were also able to generate longer speech phrases after the surgery.  Importantly, there was no serious complication during or after the surgery.  In summary, we performed bilateral narrowing of lateral palatopharyngeal wall as a speech surgery for two patients suffering from severe speech disorder associated with ALS.  With this technique, improved intelligibility and quality of speech can be maintained for longer duration for the patients with slowly progressing ALS.
authors.affiliation: Department of Otolarynology, Nippon Medical School, Tokyo, Japan. s-hideto@nms.ac.jp
authors.forename: Hideto
authors.initials: H
authors.lastname: Saigusa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Taro
authors.initials: T
authors.lastname: Komachi
authors.forename: Osamu
authors.initials: O
authors.lastname: Kadosono
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Makoto
authors.initials: M
authors.lastname: Saigusa
authors.forename: Seiji
authors.initials: S
authors.lastname: Niimi
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D010609:Pharyngeal Muscles / Q000601:surgery*; D013018:Sound Spectrography; D013064:Speech Disorders / Q000209:etiology / Q000601:surgery*; D013065:Speech Intelligibility / Q000502:physiology; D013068:Speech Production Measurement; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000601:surgery*