in fact best test was mentioned here few days ago (I can not remember where): 1) if you do not have to cope with swallowing CONSTANTLY and could be distracted even a few times a day; 2) if you do not have to eat one sandwich for few hours struggling to swallow it (however I read about people with a swallowing phobia - yes yes it also happens! - who managed to present that symptome being not paralysed but only feared of chocking!) 3) if it does not make worse quite soon (weeks/months), including simultaneous worsening of speech up to clear messing, inability to swallow liquids - to drooling like in a rabies, lost voice tone (not a hoarse voice but flat toneless one like in a person after stroke) etc/ etc. - it is not bulbar but neurogastral, anxiety GERD - whaterver.Bulbar palsy, as far as I understand, is not a feeling of tightness in the troat or pain (this is a symptome of esophagal or throat spasm), but first of all it is a matter of swallowing REFLEX died. When we swallow, the throat muscles open under the pressure of food or liquid - normally, but in case of ALS this fine chain of muscle actions is interrupted, and the throat completely CLOSES under that signal. That is why bulbar palsy victimes drool and can not eat and have to be placed on suction devices and gastrostoma. People in bulbar are chocking not because the food goes in not the right pipe, as it is often happens to us, but just because the throat is not opened under the pressure signal. That symptome must be felt like a real mess and must be awful... while absolute most of us still can swallow, however through some pain (in some cases bloody strong) and resistance caused by spasms, which, in turn, are caused by autonomous system hyperreactivity. We also swallow a lot of air and it causes tight feeling in a throat (and later might be put out as a burp - it is called aerophagia and it is also anxiety disorder symptome).fascial twithces practically mean that you have fascial muscles hyperexcited -and they can be induced even by slight tapping on fascial nerve (Chvostek sign), which most often (unless do not have epilepsy, tetanus, rabies or encephalitis) means that your muscles are hyprexcited due to much milder and benign reasons. with your particularly strong focus on the mouth, lips and throat they can twitch exactly because of that, and I am sure you are frequently open your mouth to see how it goes. So they have a lot of extra work and stretch and react. Many of us demonstrate Chvostek sign, for example Chrissi has it quite in a prominent way.(Please also remember that one for the fellows just recently was so persistent in looking on his tongue that he got a jaw dislodging. So be careful!)and we have herer even people who had their tongues tested and still fear about the bulbar. Alas! This is anxiety power!
