Which bulbar symptom is commonly seen in bulbar onset ALS?

• A. Sialorrhea
• B. Fine motor tremor
• C. Proprioceptive loss
• D. Hearing loss

Answer: (A)

In bulbar onset ALS, the muscles involved in speech and swallowing are affected, leading to impaired saliva control. This causes sialorrhea (excess drooling) because the lips, tongue, and pharyngeal muscles can’t clear saliva effectively. The bulbar region controls these oromotor muscles, so drooling is a common early and persistent feature as swallowing becomes less efficient and saliva pools.

The other options don’t fit this bulbar picture: fine motor tremor is more about limb motor control and is not a hallmark bulbar symptom; proprioceptive loss isn’t typical in ALS, which is primarily a motor neuron disease; hearing loss is not associated with bulbar ALS since the auditory system isn’t directly affected by bulbar neuron degeneration.