Pharyngolaryngeal manifestations of post-polio syndrome

Summary

Introduction: The post-polio syndrome (PPS) is characterized by a new episod of atrophy or muscle weakness in individuals previously affected by poliomyelitis. The symptoms start from an extended period of clinical stability ranging from 20 to 40 years, after the initial chart of polio. Among the pathophysiological mechanisms, the most likely is that the syndrome represents a process of attrition and neuronal metabolic exhaustion due to a continuous process of denervation reinnervation which begins after the initial acute.

Objective: Review the clinical characteristics and pathophysiological of PPS,as well as present the approach in cases with pharyngolaryngeal manifestations.

Case Report: We present the clinical case of a male patient with 48 years old, with main complaints of dysphonia, dysphagia and previous history of polio. The patient underwent a diagnostic investigation, in which the voice psychoacoustic findings are described. Laringoscopic, electromyographic and the videoendoscopy of swallowing compatible with PPS. The treatment consisted in phonotherapy in a total of 11 weekly sessions and guidelines for swallowing, with satisfactory improvement of the symptoms.

Final comments: The pharyngolaryngeal manifestations of PPS are susceptible to treatment, obtaining satisfactory results, with improvement of life quality of the patients.

Resumo

Introdução: A Síndrome pós-poliomielite (SPP) caracteriza-se por um novo episódio de atrofia ou fraqueza muscular em indivíduos acometidos por poliomielite prévia. Os sintomas iniciam-se após um período prolongado de estabilidade clínica que varia de 20 a 40 anos depois do quadro inicial da poliomielite. Dentre os mecanismos fisiopatológicos, o mais provável é que a síndrome represente um processo de desgaste e exaustão metabólica neuronal devido a um processo contínuo de desnervação-reinervação que se inicia após o quadro agudo inicial.

Objetivo: Revisar as características clínicas e fisiopatológicas da SPP, assim como apresentar a abordagem em casos com manifestações faringo-laríngeas.

Relato do Caso: Apresentamos o caso clínico de um paciente masculino com 48 anos de idade, com queixas principais disfonia e disfagia e história prévia de poliomielite. O paciente foi submetido à investigação diagnóstica, na qual encontram-se descritos os achados psicoacústicos da voz, laringoscópicos, eletromiográficos e da videoendoscopia da deglutição compatíveis com SPP. O tratamento consistiu em fonoterapia num total de 11 sessões semanais e orientações gerais para deglutição com melhora satisfatória dos sintomas.

Comentários Finais: As manifestações faringo-laríngeas da SPP são passíveis de tratamento, obtendo-se resultados satisfatórios com melhora na qualidade de vida dos pacientes.

Keywords

poliomyelitis - post-polio syndrome - neuromuscular diseases - larynx diseases - voice disorders.

Palavras-chave

poliomielite - síndrome pós-poliomielite - doenças neuromusculares - doenças da laringe - distúrbios da voz

• Bibliographical References

• 1 Kidd D, Williams AJ, Howard RS. Poliomyelitis. Postgrad Med J 1996; 72: 641-7
• 2 Blondel B, Duncan G, Courdec T , et al. Molecular aspects of poliovirus biology with a special focus on the interactions with nerve cells. J Neurovirol 1998; 4 (1) 1-26
• 3 Horstmann DM. Epidemiology of poliomyelitis and allied diseases. Yale J Biol Med 1963; 36: 5-26
• 4 Agre JC, Rodriguez AA, Tafel JA. Late effects of Polio: critical review of the literature on neuromuscular function. Arch Phys Med Rehabil 1991; 72: 923-31
• 5 Klingman J, Chui H, Corgiat M, Perry J. Functional recovery. A major risk factor for the development of postpoliomyelitis muscular atrophy. Arch Neurol 1988; 45: 645-7
• 6 Abaza MM, Sataloff RT, Hawkshaw MJ, Mandel S. laryngeal manifestations of Postpoliomyelitis Syndrome. J Voice 2001; 14 (3) 291-4
• 7 Dalakas MC, Elder G, Hallet M , et al. A long-term follow-up study of patients with post polio neuromuscular symptoms. N Engl Med 1986; 314: 959-63
• 8 Raymond M. Paralysie essentialle de l'enfance atrophie musculaire consecutive. Gaz Med Paris 1875; 226
• 9 Codd MB, Mulder DW, Kurland LT, Beard CM, O'Fallon WM. Poliomyelitis in Rochester, MN 1935–1955: epidemiology and long-term sequelae, a preliminary report. In: Halsted LS, Wiechers DO, (eds). Late effects of poliomyelitis. Miami: Symposia Foundation; 1985. . pp. 121–134
• 10 Robinson LR, Allen DH, Waugh PF. New laryngeal Muscle Weakness in Post-Polio Syndrome. Laryngoscope 1998; 108: 732-4
• 11 Halstead LS, Rossi CD. New problems in old polio patients: results of a survey of 539 polio survivors. Orthopedics 1985; 8: 845-50
• 12 Ravits J, Hallett M, Baker M, Nilsson J, Dalakas MC. Clinical and eletromyographic studies of post polio progressive muscular atrophy. Muscle Nerve 1990; 13: 667-74
• 13 Jubelt B, Cashman NR. Neurological manifestations of the post-polio syndrome. Crit Rev Clin Neurobiol 1987; 3: 199-220
• 14 Ivanyi B, Phoa SS, de Visser M. Dysphagia in postpolio patients: a videoflurographic follow-up study. Dysphagia 1994; 9: 96-8
• 15 Klingman J, Chui H, Corgiat M, Perry J. Functional recovery. A major risk factor for the development of postpoliomyelitis muscular atrophy. Arch Neurol 1988; 45: 645-7
• 16 Agre JC, Rodriguez AA, Sperling KB. Symptoms and clinical impressions of patients seen in a postpolio clinic. Arch Phys Med Rehabil 1989; 70: 367-70
• 17 Herbison GJ, Jaweed MM, Ditunno Jr JF. Exercise therapies in peripheral neuropathies. Arch Phys Med Rehabil 1983; 64: 201-5
• 18 Cashman NR, Maselli R, Wollman RL , et al. Late denervation in patients with antecedent paralytic poliomyelitis. N Engl J Med 1987; 317: 7-12
• 19 Birk TJ. Poliomyelitis and the post-polio syndrome: exercise capacities and adaptation - current research, future directions and widespread applicability. Med Sci Sports Exerc 1993; 25 (4) 466-72