ALS patients in otorhinolaryngology: A retrospective study

Jesper Rautiola; Hannu Laaksovirta; Ahmed Geneid; Taru Ilmarinen; Petra Pietarinen; Teemu J Kinnari

doi:10.1002/lio2.859

ALS patients in otorhinolaryngology: A retrospective study

Laryngoscope Investig Otolaryngol. 2022 Jul 12;7(4):1071-1077. doi: 10.1002/lio2.859. eCollection 2022 Aug.

Authors

Jesper Rautiola¹, Hannu Laaksovirta^{2

3}, Ahmed Geneid¹, Taru Ilmarinen¹, Petra Pietarinen¹, Teemu J Kinnari¹

Affiliations

¹ Department of Otorhinolaryngology - Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland.
² Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland.
³ Research Program Unit University of Helsinki Helsinki Finland.

Abstract

Objectives: Given its rarity and the lack of clear clinical markers, amyotrophic lateral sclerosis (ALS) remains a diagnostic challenge. Because bulbar-onset ALS (buALS) presents with impaired speech or swallowing, patients are often primarily referred to an otolaryngologist (ORL) or phoniatrician. The objectives of this retrospective cohort study were to analyze the role of ORLs and phoniatricians in ALS diagnostics and treatment and the potential diagnostic delay related to initial visit to aforementioned specialists.

Methods: We reviewed data for all 327 patients treated for ALS through the Hospital District of Helsinki and Uusimaa (HUS) between 2010 and 2014, focusing specifically on 110 (34%) patients presenting with bulbar nerve onset (buALS). Their presenting symptoms, referral to specialized care, and delay in referral to a neurology clinic were assessed. Indications and findings from swallowing studies were reviewed as well as the incidence of percutaneous endoscopic gastrostomy (PEG) and tracheostomy.

Results: Among the 110 patients with buALS, 64 (58%) were primarily referred to a neurologist, 28 (25%) to an ORL, and five (5%) to a phoniatrician. The most common presenting symptom was dysarthria in 89 patients, (81%), followed by dysphagia in 26 (24%). In most cases, an ORL or phoniatrician suspected a neuromuscular disease; however, in eight (24%) cases, the neurological etiology of symptoms was missed. Overall, 49 (45%) patients underwent a swallowing study and 86 (78%) patients underwent PEG placement.

Conclusions: Among buALS patients, 30% initially consulted an ORL or phoniatrician and 45% underwent a swallowing study. Based on our results, swallowing studies rarely lead to immediate PEG placement. An initial visit to other specialists had no impact on diagnostic delays or survival.

Keywords: amyotrophic lateral sclerosis; dysphagia; fiberoptic endoscopic examination of swallowing; motor neuron disease; percutaneous endoscopic gastrostomy.