title: Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings.
abstract: OBJECTIVE
  To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia.
  
  
  METHODS
  A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia.
  
  
  RESULTS
  Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex.
  
  
  CONCLUSIONS
  Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS.
authors.affiliation: Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ruoppolo
authors.forename: I
authors.initials: I
authors.lastname: Schettino
authors.forename: V
authors.initials: V
authors.lastname: Frasca
authors.forename: E
authors.initials: E
authors.lastname: Giacomelli
authors.forename: L
authors.initials: L
authors.lastname: Prosperini
authors.forename: C
authors.initials: C
authors.lastname: Cambieri
authors.forename: R
authors.initials: R
authors.lastname: Roma
authors.forename: A
authors.initials: A
authors.lastname: Greco
authors.forename: P
authors.initials: P
authors.lastname: Mancini
authors.forename: M
authors.initials: M
authors.lastname: De Vincentiis
authors.forename: V
authors.initials: V
authors.lastname: Silani
authors.forename: M
authors.initials: M
authors.lastname: Inghilleri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
keywords: amyotrophic lateral sclerosis; cough reflex; deglutition disorders; dysphagia