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dc.contributor.authorAndersen, Tiina Maariten_US
dc.contributor.authorSandnes, Astriden_US
dc.contributor.authorBrekka, Anne Kristineen_US
dc.contributor.authorHilland, Magnusen_US
dc.contributor.authorClemm, Hegeen_US
dc.contributor.authorFondenes, Oveen_US
dc.contributor.authorTysnes, Ole Bjørnen_US
dc.contributor.authorHeimdal, John-Helgeen_US
dc.contributor.authorHalvorsen, Thomasen_US
dc.contributor.authorVollsæter, Mariaen_US
dc.contributor.authorRøksund, Ola Drangeen_US
dc.PublishedThorax 2017;72:221-229eng
dc.description.abstractBackground: Most patients with amyotrophic lateral sclerosis (ALS) are treated with mechanical insufflation–exsufflation (MI-E) in order to improve cough. This method often fails in ALS with bulbar involvement, allegedly due to upper-airway malfunction. We have studied this phenomenon in detail with laryngoscopy to unravel information that could lead to better treatment. Methods: We conducted a cross-sectional study of 20 patients with ALS and 20 healthy age-matched and sex-matched volunteers. We used video-recorded flexible transnasal fibre-optic laryngoscopy during MI-E undertaken according to a standardised protocol, applying pressures of ±20 to ±50 cm H2O. Laryngeal movements were assessed from video files. ALS type and characteristics of upper and lower motor neuron symptoms were determined. Results: At the supraglottic level, all patients with ALS and bulbar symptoms (n=14) adducted their laryngeal structures during insufflation. At the glottic level, initial abduction followed by subsequent adduction was observed in all patients with ALS during insufflation and exsufflation. Hypopharyngeal constriction during exsufflation was observed in all subjects, most prominently in patients with ALS and bulbar symptoms. Healthy subjects and patients with ALS and no bulbar symptoms (n=6) coordinated their cough well during MI-E. Conclusions: Laryngoscopy during ongoing MI-E in patients with ALS and bulbar symptoms revealed laryngeal adduction especially during insufflation but also during exsufflation, thereby severely compromising the size of the laryngeal inlet in some patients. Individually customised settings can prevent this and thereby improve and extend the use of non-invasive MI-E.en_US
dc.relation.ispartof<a href="" target="blank"> Laryngeal response patterns during mechanically assisted cough in Amyotrophic Lateral Sclerosis</a>
dc.rightsAttribution CC BY-NCeng
dc.titleLaryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosisen_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2016 The Author(s)

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