Profile of laryngological abnormalities in patients with amyotrophic lateral sclerosis

Abstract

Few studies have described laryngological evaluation of patients with amyotrophic lateral sclerosis. We assessed the laryngological abnormalities of 35 such patients (24 bulbar onset and 11 limb onset). In nine limb onset patients, we discovered signs of early vagal nerve dysfunction, prior to any clinical presentation of bulbar failure. However, in all bulbar onset patients studied, we noticed changes in the uni/bilateral position of the vocal folds and in the voice quality.

Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis

“…24 Transnasal fibre-optic laryngoscopy during ongoing MI-E in patients with ALS has not been described previously, but has been used to describe the larynx during simple tasks (eg, vocalising, spontaneous cough and forced exhalation). 25 26 We encountered some technical challenges. First, as the larynx moved downwards and upwards during insufflation and exsufflation, dynamic adjustments of the laryngoscope position were required.…”

The Evaluation of Abnormal Voice Qualities in Patients with Amyotrophic Lateral Sclerosis

“…The literature highlights the fact that dysphonia is commonly an initial symptom of the bulbar syndrome seen in these patients [1,2,3,4,5,6,7]. Studies carried out by Hillel et al [2], Aronson et al [8], and Klasner et al [9] have shown the presence of the following abnormalities: paradoxical excessive glottal closure, nonperiodic vibrations of vocal folds, abnormal adduction of false folds, and impaired glottal closure.…”

Laryngeal Response Patterns to Mechanical Insufflation-Exsufflation in Healthy Subjects

“…Several neurological conditions with impairment of sensory afferents, abnormal reflexes, poor coordination or motor weakness can severely disrupt laryngeal function. 76 Thus, problems of upper airway function are frequently encountered in ALS 39,77 and laryngological presentations of ALS are described in the literature, 39,[78][79][80][81][82] particularly in relation to distinguishing between bulbar versus spinal onset ALS. 39,78,83 Bulbar innervated involvement in ALS leads to abnormalities of the control and strength of the laryngeal and pharyngeal muscles.…”

“…76 Thus, problems of upper airway function are frequently encountered in ALS 39,77 and laryngological presentations of ALS are described in the literature, 39,[78][79][80][81][82] particularly in relation to distinguishing between bulbar versus spinal onset ALS. 39,78,83 Bulbar innervated involvement in ALS leads to abnormalities of the control and strength of the laryngeal and pharyngeal muscles. 39,40 Hillel and Miller described the typical progressive pattern of bulbar ALS, affecting firstly tongue and lips, secondly the palatal-, jaw-and pharyngeal muscles, thirdly facial-, upper trunk-, and laryngeal muscles, and finally the extra-ocular muscles.…”

“…68,182,183 TFL has not routinely been used in ALS, but some studies have reported on vocal cord function during simple tasks such as vocalizing, spontaneous coughing, forced exhalation or swallowing. 39,76,78,80,87,90,187,188 We hypothesized that visualizing the larynx by means of video recorded TFL applied during ongoing MI-E in patients with ALS could contribute to a better understanding of the functional role played by the larynx in this contextual setting. The ultimate aim of this project was to apply this knowledge to improve the clinical management of impaired airway secretion clearance in patients with ALS.…”