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

Araújo, Ramon Cipriano Pacheco de; Godoy, Cynthia Meira de Almeida; Ferreira, Lidiane Maria de Brito Macedo; Godoy, Juliana Fernandes; Magalhães, Hipólito

doi:10.1590/2317-1782/e20240296pt

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Original Article • CoDAS 37 (6) • 2025 • https://doi.org/10.1590/2317-1782/e20240296en linkcopy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose (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.

Methods 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).

Results 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.

Conclusion 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.

Keywords:
Amyotrophic Lateral Sclerosis; Deglutition Disorders; Deglutition; Aged; Pharynx

Variables	Groups		p-value
	ALS	Older adults
	n = 56 (%)	n = 45 (%)
Sex
Males	32 (57.1)	19 (42.2)	0.136
Females	24 (42.9)	26 (57.8)
Age (years)	62.1 (± 11.4)	71.0 (± 7.72)	<0.001*

Fiberoptic endoscopic findings by food consistency (IDDSI)	Groups		p-value
	ALS	Older adults
	n = 56 (%)	n = 45 (%)
Pharyngeal sensitivity
Preserved	48 (85.7)	35 (77.8)	0.3
Reduced	8 (14.3)	10 (22.2)	0.3
Glottal closure
Preserved	53 (94.6)	44 (97.8)	0.422
Reduced	3 (5.4)	1 (2.2)	0.422
Thin liquid (level 0)
Multiple swallowing
Absent	46 (82.1)	43 (95.6)	0.038**
Present	10 (17.9)	2 (4.4)	0.038**
Posterior oral leakage
Absent	20 (35.7)	27 (60.0)	0.015*
Present	36 (64.3)	18 (40.0)	0.015*
Pharyngeal residues
Absent	14 (25.0)	25 (55.6)	0.002*
Present	42 (75.0)	20 (44.4)	0.002*
Laryngeal penetration
Absent	41 (73.2)	44 (97.8)	<0.001**
Present	15 (26.8)	1 (2.2)	<0.001**
Laryngotracheal aspiration
Absent	45 (80.4)	44 (97.8)	0.011**
Present	11 (19.6)	1 (2.2)	0.011**
Mildly thick liquid (level 2)
Multiple swallowing
Absent	48 (85.7)	43 (95.6)	0.178
Present	8 (14.3)	2 (4.4)	0.178
Posterior oral leakage
Absent	26 (46.4)	34 (75.6)	0.003*
Present	30 (53.6)	11 (24.4)	0.003*
Pharyngeal residues
Absent	16 (28.6)	26 (57.8)	0.003*
Present	40 (71.4)	19 (42.2)	0.003*
Laryngeal penetration
Absent	46 (82.1)	44 (97.8)	0.021**
Present	10 (17.9)	1 (2.2)	0.021**
Laryngotracheal aspiration
Absent	51 (91.1)	45 (100)	0.064
Present	5 (8.9)	0 (0.0)	0.064
Extremely thick liquid (level 4)
Multiple swallowing
Absent	46 (82.1)	43 (95.6)	0.061
Present	10 (17.9)	2 (4.4)	0.061
Posterior oral leakage
Absent	27 (48.2)	31 (68.9)	0.037*
Present	29 (51.8)	14 (31.1)	0.037*
Pharyngeal residues
Absent	18 (32.1)	25 (55.6)	0.018*
Present	38 (67.9)	20 (44.4)	0.018*
Laryngeal penetration
Absent	50 (89.3)	45 (100)	0.032**
Present	6 (10.7)	0 (0.0)	0.032**
Laryngotracheal aspiration
Absent	53 (94.6)	45 (100)	0.251
Present	3 (5.4)	0 (0.0)	0.251
Regular solid food (level 7)
Multiple swallowing
Absent	53 (94.6)	45 (100)	0.251
Present	3 (5.4)	0 (0.0)	0.251
Posterior oral leakage
Absent	49 (87.5)	40 (88.9)	0.83
Present	7 (12.5)	5 (11.1)	0.83
Pharyngeal residues
Absent	40 (71.4)	39 (86.7)	0.065
Present	16 (28.6)	6 (13.3)	0.065
Laryngeal penetration
Absent	56 (100)	45 (100)	-
Present	0 (0.0)	0 (0.0)	-
Laryngotracheal aspiration
Absent	56 (100)	45 (100)	-
Present	0 (0.0)	0 (0.0)	-

Variables	Groups		p-value
	ALS	Older adults
	n = 56 (%)	n = 45 (%)
Onset of pharyngeal response
Valleculae	39 (69.6)	39 (86.7)	0.043*
Pyriform sinuses	17 (30.4)	6 (13.3)
YPRSRS	3 (3-3)	2 (1-3)	<0.001**
FOIS	5 (4-6)	6 (5-7)	<0.001**

Variables	Time since diagnosis in the ALS group		p-value
	Up to 3 years	More than 3 years
	n = 42 (%)	n = 14 (%)
Onset of pharyngeal response
Valleculae	35 (83.3)	4 (28.5)	<0.001*
Pyriform sinuses	7 (16.6)	10 (71.4)
YPRSRS	3 (1-3)	4 (3–5)	<0.001**
FOIS	5 (5-6)	3 (1.2-4.7)	<0.001**

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[2] Caption: ALS = amyotrophic lateral sclerosis