TY - JOUR T1 - Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis JO - Acta Otorrinolaringológica Española T2 - AU - Chiaramonte,Rita AU - Di Luciano,Carmela AU - Chiaramonte,Ignazio AU - Serra,Agostino AU - Bonfiglio,Marco SN - 00016519 M3 - 10.1016/j.otorri.2017.12.002 DO - 10.1016/j.otorri.2017.12.002 UR - https://www.elsevier.es/es-revista-acta-otorrinolaringologica-espanola-102-articulo-multi-disciplinary-clinical-protocol-for-diagnosis-S0001651918300566 AB - Introduction and objectivesThe 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 methods22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing. ResultsIn 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. ConclusionsA 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. ER -