Koichi Tsunoda1, Mihiro Takazawa2, Tonghyo Chong3, Yoko Morita4. 1. Department of Artificial Organs and Medical Creations, Otorhinolaryngology National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan. Electronic address: tsunodakoichi@kankakuki.go.jp. 2. Department of Artificial Organs and Medical Creations, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. 3. Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. 4. Department of Neurology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Abstract
OBJECTIVE: Otorhinolaryngologic examinations at an early stage, particularly those conducted by vocal specialists, can make potentially important contributions to the diagnosis of bulbar-onset ALS patients. METHODS: We analyzed 2623 patients (2010-2017) visited the ENT Voice Clinic, National Hospital Organization Tokyo Medical Center, with the primary complaint of speech or vocal dysfunction at the initial visit. Among those, 12 patients visited the voice clinic after consultations with other physicians but before receiving a diagnosis and we initially suspected bulbar-onset ALS due to slow, slurred speech (SSS). We analyzed the detail of those suspected ALS cases. RESULTS: Every patient suspected ALS patients consulted an average of 2.2 physicians before visiting the voice clinic and a total of 3.2 physicians before receiving the final diagnosis. The mean speech symptom duration before visiting the vocal clinic was 7.83 months in ALS, 24 months in MSA patients. The duration until final diagnosis after we referred them to neurologists was 2.16 months and 15.3 months, respectively. CONCLUSION: Otolaryngologists and primary care physicians to consider the possibility of ALS when patients present even with an only symptom of SSS. They should then refer such patients to neurologists for definitive diagnoses, leading to early detection and treatment of ALS.
OBJECTIVE: Otorhinolaryngologic examinations at an early stage, particularly those conducted by vocal specialists, can make potentially important contributions to the diagnosis of bulbar-onset ALSpatients. METHODS: We analyzed 2623 patients (2010-2017) visited the ENT Voice Clinic, National Hospital Organization Tokyo Medical Center, with the primary complaint of speech or vocal dysfunction at the initial visit. Among those, 12 patients visited the voice clinic after consultations with other physicians but before receiving a diagnosis and we initially suspected bulbar-onset ALS due to slow, slurred speech (SSS). We analyzed the detail of those suspected ALS cases. RESULTS: Every patient suspected ALSpatients consulted an average of 2.2 physicians before visiting the voice clinic and a total of 3.2 physicians before receiving the final diagnosis. The mean speech symptom duration before visiting the vocal clinic was 7.83 months in ALS, 24 months in MSA patients. The duration until final diagnosis after we referred them to neurologists was 2.16 months and 15.3 months, respectively. CONCLUSION: Otolaryngologists and primary care physicians to consider the possibility of ALS when patients present even with an only symptom of SSS. They should then refer such patients to neurologists for definitive diagnoses, leading to early detection and treatment of ALS.
Authors: Jesper Rautiola; Hannu Laaksovirta; Ahmed Geneid; Taru Ilmarinen; Petra Pietarinen; Teemu J Kinnari Journal: Laryngoscope Investig Otolaryngol Date: 2022-07-12