TY - JOUR T1 - Laryngeal response patterns in amyotrophic lateral sclerosis during mechanical insufflation-exsufflation JF - European Respiratory Journal JO - Eur Respir J VL - 40 IS - Suppl 56 SP - P1185 AU - Tiina Andersen AU - Magnus Hilland AU - Astrid Sandnes AU - Thomas Halvorsen AU - Ove Fondenes AU - John-Helge Heimdal AU - Ole-Bjørn Tysnes AU - Tom Karlsen AU - Thor-Andre Ellingsen AU - Ola Røksund Y1 - 2012/09/01 UR - http://erj.ersjournals.com/content/40/Suppl_56/P1185.abstract N2 - Introduction: Mechanical insufflation-exsufflation (MI-E) is the most effective approach to increase peak cough airflow in patients with neuromuscular diseases, thereby potentially augmenting airway clearance. Co-ordinated movements of the glottis may be crucial for effect in amyotrophic lateral sclerosis (ALS), but laryngeal response patterns to MI-E have not been studied.Aims: To visualize laryngeal response patterns to MI-E in ALS patients.Methods: Continuous videorecorded transnasal fiberoptic laryngoscopy (TFL) was obtained in eight ALS patients (two non-bulbar and six bulbar) during MI-E intervention (Cough Assist®, Respironics, USA), applying pressures of ±20 to ±50 cmH2O, and instruction to inhale during insufflation and to actively exhale and cough during exsufflation. Laryngeal movements were assessed from the videorecordings.Results: In one patient, severe hypopharyngeal obstruction was observed already ±20 cmH2O. In the remaining patients, hypopharyngeal obstruction was observed during insufflation at 20-40cmH2O in two and at 50cmH2O in four patients, during pressure drop from + to - at 20-40 cmH2O in five, at 50 cmH2O in six, and during exsufflation in all patients, regardless of pressure. Aryepiglottic folds adducted during insufflation in four patients. The response of the vocal folds could not be observed in five patients due to hypopharyngeal obstruction or severe adduction of aryepiglottic folds.Conclusion: Larynx can be studied with TFL during MI-E. Marked hypopharyngeal obstruction was observed during exsufflation and during high insufflation pressures. This may obstruct airflow, potentially disrupting positive effects of MI-E. ER -