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Vol. 70. Issue 1.
Pages 25-31 (January - February 2019)
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Vol. 70. Issue 1.
Pages 25-31 (January - February 2019)
Orignal article
Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis
Protocolo clínico multi-disciplinar para el diagnóstico de la esclerosis lateral amiotrófica bulbar
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Rita Chiaramontea,
Corresponding author
ritachiaramd@gmail.com

Corresponding author.
, Carmela Di Lucianob, Ignazio Chiaramontec, Agostino Serrad, Marco Bonfigliob
a Department of Physical Medicine and Rehabilitation, University of Catania, 95125 Catania, Italy
b Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
c Departments of Radiology, University of Catania, 95125 Catania, Italy
d Departments of Otolaryngology, University of Catania, 95125 Catania, Italy
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Figures (2)
Tables (6)
Table 1. Vocal performance during physical examination.
Table 2. Vocaligram.
Table 3. Spectrogram.
Table 4. Fiberoptic endoscopic patterns of velo-pharyngeal (VP) function.
Table 5. Fiberoptic endoscopic evaluation of swallowing (FEES).
Table 6. Fiberoptic endoscopic patterns of velo-pharyngeal (VP) function.
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Abstract
Introduction and objectives

The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time.

Materials and methods

22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing.

Results

In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration.

Conclusions

A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.

Keywords:
Speech-language pathology
Dysphagia
Severity of illness index
Clinical protocol
Resumen
Introducción y objetivos

El objetivo de este estudio fue examinar la función de los diferentes especialistas en el diagnóstico de la esclerosis lateral amiotrófica (ELA), para comprender quèc) cambios se produjeron en cuanto a expresión verbal, dinámica fonatoria y respiratoria, y deglución, en un breve periodo de tiempo.

Materiales y mèc)todos

Se sometió a 22 pacientes con ELA bulbar a evaluación de la voz, examen ORL, programa de voz multi-dimensional (MDVP), espectrograma, electroglotografía y evaluación de la deglución mediante endoscopía de fibra óptica.

Resultados

En la etapa temprana de la enfermedad, el tracto oral y el cierre velofaríngeo se vieron comprometidos. Transcurridos 3 meses de los síntomas iniciales, la mayoría de los pacientes presentó ronquera, voz entrecortada, disartria, problemas de modulación de la afinación y dificultades de pronunciación de las consonantes oclusivas, velares y linguales. Los valores del MDVP se vieron alterados. El espectrograma reflejó un formante adicional, debido a la resonancia nasal. La electroglotografía mostró una oscilación periódica de las cuerdas vocales únicamente durante el ciclo vocal corto. La deglución se vio caracterizada por debilidad y descoordinación de los músculos orofaríngeos, con penetración o aspiración.

Conclusiones

Se diseñó un protocolo clínico multidisciplinar específico para reportar los parámetros vocales y los trastornos deglutorios que experimentan un cambio más rápido en los pacientes con ELA bulbar. Además, se estratificaron los pacientes con arreglo al compromiso de las estructuras faríngeas y el índice de gravedad.

Palabras clave:
Patología del habla y lenguaje
Disfagia
Índice de gravedad de la enfermedad
Protocolo clínico

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