Dysphagia in Amyotrophic Lateral Sclerosis: Relationships between disease progression and Fiberoptic Endoscopic Evaluation of Swallowing

• Published in: Auris, nasus, larynx nasus, larynx, 2017-06, Vol.44 (3), p.306-312
• Main Authors: Fattori, Bruno, Siciliano, Gabriele, Mancini, Valentina, Bastiani, Luca, Bongioanni, Paolo, Caldarazzo Ienco, Elena, Barillari, Maria R, Romeo, Salvatore O, Nacci, Andrea
• Format: Article
• Language: English
• Subjects: Aged; ALSFRS; Amyotrophic Lateral Sclerosis; Amyotrophic Lateral Sclerosis - complications; Amyotrophic Lateral Sclerosis - physiopathology; b-ALSFRS; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Disease Progression; Dysphagia; Female; Fiberoptic Endoscopic Evaluation of Swallowing; Humans; Laryngoscopy; Male; Middle Aged; Otolaryngology; Respiratory Aspiration - etiology; Respiratory Aspiration - physiopathology; Severity of Illness Index
• ISSN: 0385-8146; 1879-1476
• DOI: 10.1016/j.anl.2016.07.002

Abstract Objective Our aim was to evaluate the relationship between the disease severity of Amyotrophic Lateral Sclerosis (ALS) and the following parameters of Fiberoptic Endoscopic Evaluation of Swallowing (FEES): premature spillage, post-swallowing residue and aspiration. Methods We studied 202 patients (95 women and 107 men) with ALS; of these, 136 had spinal and 66 had bulbar onset. They were analyzed according to the Amyotrophic Lateral Sclerosis Functioning Rating Scale (ALSFRS) and the b-ALSFRS subscale (bulbar scale). All subjects underwent FEES. Post-swallowing residue was classified into four classes (0–3); premature spillage and aspiration were considered either present or absent. Results Spearman's correlation test showed a highly significant correlation ( p < 0.0001) between the value of ALSFRS and b-ALSFRS and the FEES parameters as the following: disease severity and dysphagia severity are closely related, both in spinal and bulbar onset, no matter what bolus texture was used. Spearman's Rho was more significant for post-swallowing residue, ≤−0.500 with all three consistencies ( p < 0.0001) in spinal onset and −0.520 only with liquid bolus ( p < 0.0001) in bulbar onset. Independent T -Test revealed a significant difference ( p < 0.0001) between the mean ALSFRS and b-ALSFRS scores and the presence/absence of aspiration. For the premature spillage in spinal onset (ALSFRS), we found a statistically significant difference for all three bolus textures ( p < 0.0001). Analysis of variance for the post-swallowing residue in spinal onset (ALSFRS) revealed a statistically significant difference ( p < 0.0001) for most of the comparisons between groups for all three textures. For the premature spillage in bulbar onset (b-ALSFRS), we found a statistically significant difference for all three textures ( p < 0.0001). Analysis of variance for the post-swallowing residue in bulbar onset (b-ALSFRS) showed a statistically significant difference ( p < 0.0001) for most of the comparisons between groups for all three textures. Kruskal–Wallis test showed a highly significant association between the classes of severity in bulbar forms and all the FEES parameters, no matter what type of bolus was administered ( p < 0.0001), whereas a significant correlation in spinal forms only for post-swallowing residue with solid ( p = 0.026) and semisolid ( p = 0.031) boluses. Conclusion There is a highly significant relationship as the following between the FEES parameters and