• G Ruoppolo, I Schettino, V Frasca, E Giacomelli, L Prosperini, C Cambieri, R Roma, A Greco, P Mancini, M De Vincentiis, V Silani, and M Inghilleri.
• Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Rome, Italy.
• Acta Neurol. Scand. 2013 Dec 1;128(6):397-401.

ObjectivesTo 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.Materials And MethodsA 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.ResultsPatients 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.ConclusionsDysphagia 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.© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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