• XiangLi Yang, Lin Niu, ChunWei Yang, Lin Wang, JiXiang Liu, and GuoYing He.
• Department of Otolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin 300121, China.
• Am J Otolaryngol. 2019 Mar 1; 40 (2): 292-296.

BackgroundMyasthenia gravis (MG) is an autoimmune disease. Dysarthria, dysphagia, and difficulty swallowing as exclusive initial and primary complaints in MG (laryngeal MG) are rare and seldom reported.MethodsHere we review and analyze the largest series of laryngeal MG patients.ResultsA total of 30 patients with laryngeal MG as primary manifestation were found in 20 case reports/series. Dysarthria was the most frequent primary symptom (14/30), followed by dysphagia (11/30), slurred speech (4/30) and dysphonia (1/30). Sixty-three percent visited the otolaryngology department first. Only 23.33% of patients were diagnosed with MG at the first clinic visit. Forty-five percent laryngeal MG patients were acetylcholine receptor (AChR) antibody positive, 52.9% showed decremental response in the repetitive nerve stimulation (RNS) test, and 92.6% were positive in the neostigmine/edrophonium test. Fluctuating weakness was examined in 16 of 30 patients and observed in 14/16 patients.ConclusionLaryngeal MG is a rare and possibly under-diagnosed condition. The patients can present with dysarthria, dysphagia, or difficulty swallowing. Fluctuation in severity of disease by neostigmine/edrophonium test is a typical feature for MG patients. AChR antibody and RNS tests should be included to evaluate the pathologic changes in the neuromuscular junction.Copyright © 2018 Elsevier Inc. All rights reserved.

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