Lack of testing, care for speech, swallowing problems in MG: Study
Yet data show high prevalence of such symptoms among US patients
Problems speaking and swallowing are common among people with myasthenia gravis (MG), but speech-language evaluations and treatment are not carried out as part of routine care for MG patients, a new study by a trio of U.S. researchers has found.
Indeed, compared with the general population, individuals with MG have “strikingly increased odds” of both dysarthria, or difficulty in speaking, and dysphagia, which is the medical term for problems with swallowing, the data showed.
However, the team “found very low rates of formal evaluation and treatment for speech and swallow,” with most patients “unaware” of therapy services offered by speech-language pathologists.
Overall, according to the researchers, “these findings suggest a need for more routine speech-language pathology [disease symptom] evaluation among individuals with MG.”
The study, “Prevalence of Speech and Swallowing Dysfunction and Intervention Among Individuals With Myasthenia Gravis,” was published in the journal OTO Open.
MG patients found 4 times more likely to have swallowing problems
Muscle weakness associated with MG — an autoimmune disease driven by self-reactive antibodies that disrupt nerve-muscle communication — may affect muscles in the face, neck, and throat, leading to difficulties in swallowing and speaking.
“Although speech and swallow symptoms are common in MG, knowledge of the prevalence of these symptoms, particularly in comparison to individuals without MG, is limited,” the researchers wrote, adding that it’s also unknown how frequently such symptoms are formally evaluated or treated in MG patients.
To answer these questions, two researchers from the Keck School of Medicine at the University of Southern California and one from the University of Pittsburgh carried out a retrospective study using anonymized electronic medical records. The team compared data from 3,724 patients with information from the same number of individuals without an MG diagnosis, who served as controls. Individuals in the control group were matched to people in the MG group by age, sex, race, and history of gastroesophageal reflux disease, which also can cause difficulty swallowing.
People in both groups had a mean age of 61.5 at the time of evaluation.
Comparisons between the two groups revealed that MG patients were more likely to experience symptoms associated with speech or swallowing impairments.
Altogether, one-quarter of the individuals in the MG group had a diagnosis of dysphagia. Statistical analyses also showed the odds of receiving a dysphagia diagnosis were 4.18 times higher in the MG group than in the control group.
Individuals in the MG group also were 2.69 times more likely to develop aspiration pneumonia, an infection caused by accidentally inhaling food or liquids into the lungs.
Similarly, people with MG were 2.63 times more likely to receive a diagnosis of dysphonia, or alterations in speech quality — hoarseness, low volume, and breathiness, as exampless. The likelihood of being diagnosed with dysarthria, or difficulty speaking, was nearly 10 times higher among those with MG.
Results suggest ‘significant underutilization’ of resources for patients
To investigate speech and swallowing evaluation and care, the researchers then analyzed data from a larger group of 65,310 people with MG.
These data showed that 83.1% of MG patients in this group did not receive evaluation or treatment for speech or swallowing impairments. Among a subgroup of 18,701 MG patients with documented speech or swallowing issues, 53% had no record of being evaluated or treated with speech-language techniques.
Despite … higher odds [of having such problems], rates of evaluation and treatment for these symptoms were relatively low, even among those diagnosed with [one] or more types of speech or swallow dysfunction.
Swallowing evaluation was more common than voice evaluation, and swallowing therapy was more common than voice therapy. This held across analyses, including in a subgroup of patients diagnosed with dysarthria and/or dysphonia, although these symptoms would likely be more effectively addressed with voice evaluation and therapy.
“Despite … higher odds [of having such problems], rates of evaluation and treatment for these symptoms were relatively low, even among those diagnosed with [one] or more types of speech or swallow dysfunction,” the researchers wrote.
The team noted the study had some notable limitations, including that it relied on standardized medical codes, which may be incomplete or inconsistent, to identify symptoms associated with speech or swallowing impairments and the use of speech-language services in patient records.
Nevertheless, they noted this study shows that despite the high prevalence of speech and swallowing symptoms among people with MG, many do not receive potentially beneficial care or evaluation.
“This suggests significant underutilization of a potentially important resource for individuals with MG,” the team wrote.
More research into the efficacy of speech-language therapies in MG is needed, according to the researchers, but these results suggest that such services could be more fully incorporated in current MG care.
“Future studies should seek to prospectively assess the rate of speech and swallow dysfunction among individuals with MG, including among those who do and do not report such symptoms, … to understand the need for speech and swallow evaluation in this population,” the team wrote.
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