Association between Maximum Tongue Pressure and FEES Findings in patients with Amyotrophic Lateral Sclerosis

Introduction Dysphagia is a common finding in ALS, with reduction of swallowing safety and efficacy. Tongue has an important role in swallowing function for oral processing and bolus propulsion through the pharynx. The study aims to analyze the association between signs of dysphagia and maximum tongue pressure (MTP). Material and Methods Patients with ALS referred for FEES were recruited. FEES was conducted to test swallowing function with liquid (5ml, 10ml, and 20ml), semisolid (5ml, 10ml, and 20ml), and solid. FEES recordings were assessed for swallowing safety, using the Penetration Aspiration Scale (PAS), and for swallowing efficacy, using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). PAS scores >2 were suggestive of penetration, PAS scores >5 of aspiration, and YPRSRS scores >2 of residue. MTP was measured using the Iowa Oral Performance Instrument. Tongue pressure measurements were compared between patients with and without signs of dysphagia. Results Fifty-five patients with ALS were included. Patients with residue in the pyriform sinus had a significantly lower MTP than patients without residue in the pyriform sinus with semisolids 10ml (p=0.011) and 20 ml (p=0.032). No significant differences were found for residue in the valleculae and penetration/aspiration. Conclusion In patients with ALS, MTP is significantly associated with an impairment of swallowing efficacy. The association was found with larger volumes and more viscous consistencies.