Multiple Sclerosis and Related Disorders 47 (2021) 102660 Available online 2 December 2020 2211-0348/© 2020 Elsevier B.V. All rights reserved. Original article ENT-MS-12 questionnaire: A novel tool to investigate otolaryngology symptoms in patients with relapsing-remitting multiple sclerosis. Results from a pilot study Arianna Di Stadio a, b, 1, * , Massimo Ralli c, 1 , Marta Altieri d , Michael J Brenner e , Laura Dipietro f , Daniela Messineo g , Diego Kaski h , Evanthia Bernitsas i a Department of Otolaryngology, University of Perugia, Perugia, Italy b Neuroinfammation Laboratory, Queen Square Neurology, UCL, London, United Kingdom c Department of Sense Organs, Sapienza University of Rome, Rome, Italy d Department of Neurology, Sapienza University of Rome, Rome, Italy e Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA f Highland Instruments, Cambridge (MA), USA g Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy h Department of Clinical and Motor Neurosciences, Institute of Neurology, University College London, UK i Wayne State University, Multiple Sclerosis Center, Detroit, USA A R T I C L E INFO Keywords: multiple sclerosis otolaryngology symptoms questionnaire relapsing remitting expanded disability status scale demyelination ABSTRACT Background: Multiple sclerosis (MS) is associated with otolaryngology-related manifestations including vestibular or auditory symptoms; facial motor or sensory disorders; voice or swallowing impairment; and snoring/sleep apnea. Because these symptoms are nonspecifc, their signifcance in MS is seldom recognized by patients with MS and their physicians; yet, presence of these symptoms may be a harbinger of impending relapse or disease progression. We developed and investigated a survey instrument, the ENT-MS-12, to standardize reporting of otolaryngology symptoms in patients with MS, correlating its scoring with disability and lesions. Methods: The ENT-MS-12 was administered to 40 patients with relapsing-remitting MS in different phases of their disease. We collected data using the Expanded Disability Status Scale (EDSS) and analyzed patient brain MRIs to evaluate the state (active or non-active) of brain lesions based on gadolinium enhancement. Odds ratios for diverse otolaryngology symptoms across the EDSS scores and brain lesions were calculated. Results: Higher EDSS scores were associated with auditory and vestibular symptoms (Odd Ratio (OR): 3.06; p: 0.0003); voice and swallowing symptoms (OR: 6.8; p=0.007); and snoring/sleep apnea (OR: 5.1; p=0.03). Presence of active brain lesions was also associated with auditory and vestibular symptoms (OR: 6.7); voice and swallowing symptoms (OD: 5.7); and snoring/sleep apnea (OR: 5). Conclusions: The ENT-MS-12 survey instrument standardizes reporting of otolaryngology symptoms in patients with MS and documents association between symptoms and phase of disease in this series. Because ear, nose and throat (ENT)- related symptoms (i.e., sensory symptoms, such as numbness) are under-reported in MS, further investigation is warranted, as such data may improve clinical management of MS. 1. Introduction Otolaryngology symptoms are common in patients with multiple sclerosis (MS) (Gelfand, 2014, Brownlee et al., 2017), but prevalence of individual symptoms varies across the MS population: auditory, vestibular, gustatory and olfactory alterations are reportedly rare, whereas speech or sleep disorders are common, as are facial nerve and trigeminal nerve symptoms (Brownlee et al., 2017). In some cases, otolaryngology symptoms may portend the relapsing (active) phase of the disease (Di Stadio et al., 2018, Nordio et al., 2018) and therefore * Corresponding author at: Otolaryngology department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy. E-mail address: ariannadistadio@hotmail.com (A. Di Stadio). 1 Equal contribution to the paper. Contents lists available at ScienceDirect Multiple Sclerosis and Related Disorders journal homepage: www.elsevier.com/locate/msard https://doi.org/10.1016/j.msard.2020.102660 Received 20 October 2020; Received in revised form 26 November 2020; Accepted 28 November 2020