Early alterations of oropharyngeal dysphagia in bulbar and spinal amyotrophic lateral sclerosis. Cases and control study

Introduction and objective:The objective of the study is to establish the early alterations of oropharyngeal dysphagia (OD) in bulbar ALS and spinal ALS, to verify possible differences between both groups and to know the percentage of patients with ALS who require dietary adaptations after their first visit to the otorhinolaryngologist (ENT).Method:Retrospective study of 10 patients with bulbar ALS and 10 patients with spinal ALS from our hospital, evaluated by ENT at the recent diagnosis of ALS. Variables collected: demographic (age, sex) and clinical, including early alterations in the swallowing test under fiberoendoscopy (FEES) and the type of diet of each patient; and comparison of the findings between both groups.Results:Of 20 patients (median age= 68 years), 50 % presented spinal ALS and 50 % presented bulbar ALS. The swallowing test demonstrated incompetence in the propulsion of the bolus (15 % of patients) and pharyngolaryngeal residue (40 % of patients). Statistically significant differences are evident between both groups in the penetrations and aspirations observed under FEES (p<0.05) and in the need for dietary adaptations after ENT evaluation, predominating in bulbar ALS.Discussion:We found significant differences in OD between bulbar and spinal ALS, describing a greater alteration in patients diagnosed with bulbar ALS.Conclusions:The fundamental role of the otorhinolaryngologist lies in the early detection of OD in patients with ALS, preventing and/or reducing potential respiratory complications derived from it.