Dysphagia and post-polio syndrome: past, present, and future.

Swallowing difficulties, oral motor weakness, and oral pharyngeal paralysis have been reported in the historical literature on polio and post-polio. Attention to this finding was minimal in the original epidemics as many persons with bulbar polio who may have been dysphagic did not survive. Swallowing was often supplemented by artificial feeding for those who were placed in respirators. Although swallowing difficulty was often present in the acute stages of the initial attack, it usually subsided or disappeared after several weeks. In cases in which bulbar polio was diagnosed, swallowing impairment may have lingered, but most survivors learned to produce compensatory maneuvers to aid them to swallow and did not complain of difficulty. In the recent decades of the 20th century, many persons who had believed themselves fully recovered from the insult of polio began to experience new symptoms; among them were new or heightened complaints of swallowing difficulty. Studies of these patients with PPS have revealed that dysphagia is not only present but may be progressive, and suggest that there is a slowly progressive deterioration of the bulbar neurons of PPS patients underlying the finding of new or exacerbated swallowing signs. Patients with PPS should be referred to speech-language pathologists for evaluation of voice, phonatory-respiratory, and swallowing function and initiation of appropriate remediation strategies to avoid the potential negative consequences of dysphagia.