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Dysphagia, Dysarthria, and Dysphonia with ALS

Richard Adler ., Ph.D,CCC-SLP

July 17, 2006

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Question

I have 77 year old patient who had a post-operative onset of dysphagia, dysarthria and dysphonia following anterior cervical spine surgery. Laryngoscopy revealed a unilateral vocal cord paralysis. The patient is now diagnosed with late stage ALS. She was

Answer

Let me first say that ALS as far as I can tell has never been diagnosed suddenly.... and here are some other points to consider:

  1. Cervical surgery was the possible cause of the dysphagia.....the recurrent laryngeal nerve is very vulnerable when cervical surgery is performed. It was probably damaged and this caused the unilateral vocal cord paralysis and in turn the dysphonia.

  2. Dysphagia is probably due to the cord not approximating with the other cord and thus leaving the patient with difficulty in swallowing the bolus...can cause choking, coughing, and an inability to swallow solids or thin liquids..not always the case in Unilateral Paralysis of the cord but it could happen.

  3. The deconditioning from the surgery most likely exacerbated the ALS whereby the patient did not show symptoms necessarily but when the surgery was performed they showed up.........from the anesthesia, or from the surgery itself, and the concommitent symptoms that showed up after surgery. ALS is not a sudden onset disease......in this case something (the surgery and post surgery problems) most likely is the cause of the exacerbated ALS signs and symptoms.

  4. I am assuming that a neurologist diagnosed the patient with ALS due to the type of dysarthria (hypernasal flaccid dysarthria and sometime mixed dysarthria. Joseph Duffy has stated that many ALS patients most often show signs and symptoms of Dysarthria and Dysphagia when they are first diagnosed. So since this person was dancing the night before, it is most likely that the surgery exacerbated the symptoms that would have eventually been diagnosed by themselves. Exact time of onset of ALS is difficult to pinpoint because half of the anterior horn cells must be lost before weakness is apparent since patients can sometimes adapt to the initial weakness and not attribute it to a disease but rather too much activity.
Richard K. Adler, Ph.D., CCC, SLP, F-ASHA is a professor of Speech Language Hearing Sciences at Minnesota State University, Moorhead, MN. He teaches courses in Adult and Pediatric Motor Speech as well as Adult and Pediatric Neurological Language Disorders. He also directs the voice clinic at the university supervising graduate students who are assigned clients with voice disorders due to Cerebral Palsy, CVA, Traumatic Brain Injury and other neurological disorders including acquired epileptic aphasia.


richard adler

Richard Adler ., Ph.D,CCC-SLP


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