# Fiberoptic endoscopic evaluation of swallowing in amyotrophic lateral sclerosis: comparison with older people with dysphagia and relationship with time since diagnosis

## TL;DR

This study compares swallowing difficulties in people with ALS and older adults, finding that ALS patients show more severe issues and that symptoms worsen over time since diagnosis.

## Contribution

The study identifies specific swallowing impairments in ALS patients and links them to the time since diagnosis, offering insights for clinical management.

## Key findings

- ALS patients showed significant differences in multiple swallowing parameters compared to older adults.
- Time since diagnosis was a determining factor for pharyngeal response, residues, and oral intake in ALS patients.
- Swallowing impairments in ALS worsen with time, particularly after three years since diagnosis.

## Abstract

(1) to compare the findings of the instrumental swallowing assessment between individuals with amyotrophic lateral sclerosis (ALS) and older dysphagic adults without neurological diagnosis; (2) to compare the onset of pharyngeal response, pharyngeal residues, and the level of oral intake in relation to the time since diagnosis in the ALS group.

This cross-sectional, retrospective study collected data from medical records. Altogether, 101 individuals with dysphagia were included and stratified into two groups: the first had 56 patients diagnosed with ALS, and the second had 45 older adults. Dysphagia signs were analyzed through fiberoptic endoscopic evaluation of swallowing, using four food consistencies, classified by the International Dysphagia Diet Standardisation Initiative (IDDSI). Pharyngeal residues were classified by the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), and oral intake by the Functional Oral Intake Scale (FOIS).

The ALS group had differences in multiple swallows with one IDDSI consistency; posterior oral leakage, pharyngeal residues, and laryngeal penetration with three consistencies; and aspiration with one consistency. Individuals with more than 3 years since diagnosis had differences in the onset of the pharyngeal response in the pyriform sinuses, moderate pharyngeal residues, and oral intake.

The ALS group had significant differences in the occurrence of multiple swallows, posterior oral leakage, pharyngeal residues, penetration, and aspiration with three IDDSI consistencies. Furthermore, the time since diagnosis was a determining factor for all three parameters.

(1) comparar os achados da avaliação instrumental da deglutição entre indivíduos com Esclerose Lateral Amiotrófica (ELA) e idosos disfágicos sem diagnóstico neurológico; (2) comparar o início de resposta faríngea, resíduos faríngeos e o nível de ingestão oral em relação ao tempo de diagnóstico no grupo com ELA.

Trata-se de um estudo transversal e retrospectivo com coleta de dados nos prontuários. Foram incluídos 101 indivíduos com disfagia, estratificados em dois grupos: o primeiro foi composto por 56 pacientes com diagnóstico de ELA e o segundo por 45 idosos. Os sinais de disfagia foram analisados por meio da videoendoscopia da deglutição, utilizando quatro níveis de consistência alimentar, classificados pelo International Dysphagia Diet Standardisation Initiative (IDDSI). Os resíduos faríngeos foram classificados pela Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), e a ingestão oral, pela Functional Oral Intake Scale (FOIS).

O grupo com ELA apresentou diferenças em relação às deglutições múltiplas em um nível; escape oral posterior, resíduos faríngeos e penetração laríngea em três níveis; e aspiração em um nível do IDDSI. Os indivíduos com mais de três anos de diagnóstico apresentaram diferenças no início da resposta faríngea nos seios piriformes, resíduos faríngeos moderados e no nível de ingestão oral.

O grupo de indivíduos com ELA apresentou diferenças significativas na ocorrência de deglutições múltiplas, escape oral posterior, resíduos faríngeos, penetração e aspiração em três níveis do IDDSI. Além disso, o tempo de diagnóstico foi um fator determinante para os três parâmetros analisados.