Otolaryngologic symptoms in multiple sclerosis: a review

Many symptoms of multiple sclerosis may affect the ear, nose and throat. The most common otolaryngologic symptoms of multiple sclerosis are speech disorders, followed by sleep disorders, vertigo and disequilibrium, dysphagia, smell alterations, and hearing loss. Less common symptoms include sialorrhea, facial palsy, taste alterations, trigeminal neuralgia and tinnitus. The origin of otolaryngologic symptoms in multiple sclerosis is mainly central, although increasing evidence also suggests a peripheral involvement. Otolaryngologic symptoms in multiple sclerosis may have different clinical presentations; they can appear in different stages of the pathology, in some cases they can be the presenting symptoms and their worsening may be correlated with reactivation of the disease. Many of these symptoms significantly affect the quality of life or patients and lead to increased morbidity and mortality. Otolaryngologic symptoms are common in multiple sclerosis; however, they are often overlooked. In many cases, they follow the relapsing-remitting phases of the disease, and may spontaneously disappear, leading to a delay in multiple sclerosis diagnosis. Clinicians should be aware of otolaryngologic symptoms of multiple sclerosis, especially when they are associated to neurologic symptoms, as they may be early signs of a still undiagnosed multiple sclerosis or could help monitor disease progression in already diagnosed patients.