Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients.Level of Evidence Level IV.

The finding of minimal laryngeal dysfunctions in professional voice users is essential to prevent the onset of organic vocal pathologies. The purpose of this study is to identify an objective parameter that supports the phoniatric evaluation in detecting minimal laryngeal dysfunctions in singers. 54 professional and non-professional singers have been evaluated with laryngostroboscopy, Multi-Dimensional Voice Program (MDVP), Dysphonia Severity Index (DSI), maximum phonation time (TMF), minimum intensity of sound emission (I-min), maximum frequency (F-max), voice handicap index (VHI), singing voice handicap index (SVHI), manual phonogram and audiometric examination. The SVHI of all the “healthy” singers was on average 23.7 ± 22.5, while that of the “dysfunctional” 20.9 ± 18. No statistically significant difference was found between the SVHI scores of the total of healthy singers compared to the scores of the dysfunctional ones on the VSL (p = 0.6). The between-group comparison of the means of individual parameter values of DSI, TMF, F-max, Jitter, Shimmer, NHR, and SPI was not statistically significant (respectively p = 0.315, 0.2, 0.18, 0.09, 0.2, 0.08, 0.3). The only parameter analyzed that was statistically significant was the I-min (p < 0.05). SVHI is a valid instrument for the evaluation after a therapy but in our experience, it is not useful in distinguishing healthy from dysfunctional patients. The minimum intensity of sound emission measured with the sound level meter (I-low2) resulted a reliable parameter to identify minimal laryngeal dysfunctions and a useful tool in supporting the phoniatric diagnostic-therapeutic process in singers.

Background Oropharyngeal dysphagia (OD) screening tests have improved patient management; however, the complex applicability and high percentage of false negatives do not allow these tests to be considered completely reliable if not supported by an instrumental investigation. The aim of the present study is to evaluate an OD screening test, the Dysphagia Standard Assessment (DSA®) with different volumes and viscosities. Materials and methods Prospective study of 72 patients evaluated for suspected OD through a double-blind methodology conducted by two operators. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) as a reference test and a separate DSA® test. DSA® was performed by administering boluses with different viscosities, with the signal of interruption of the test being: onset of the cough reflex, wet voice after swallowing, and/or desaturation of O2 ≥ 5%. The Penetration-Aspiration Scale (PAS) was evaluated by FEES. The cut-off identified to diagnose OD was PAS ≥ 3. Results The test showed an accuracy of 82%, a sensitivity of 0.93 (95% C.I. 0.84–0.97), and a specificity of 0.78 (95% C.I. 0.67–0.87); positive predictive value 0.55 (95% C.I. 0.43–0.67); negative predictive value 0.97 (95% C.I. 0.90–0.99), positive likelihood ratio 4.37 (95% C.I. 3.6–5.2); likelihood negative ratio 0.08 (95% C.I. 0.06–0.09). Conclusions According to the preliminary results, the test showed good outcomes in determining the presence or absence of OD with a wide spectrum of applicability with some limitations that could be overcome by the selection of a target population. For this reason, a flowchart to address patient eligibility was developed.