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Mothersole KH, Ulualp SO, Johnson RF, Brown AF, Shah GB, Liu CC, Chorney SR. Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove. Int Arch Otorhinolaryngol 2024; 28:e101-e106. [PMID: 38322447 PMCID: PMC10843914 DOI: 10.1055/s-0043-1767800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established. Objective We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG. Methods Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms. Results Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA. Conclusions Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG.
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Affiliation(s)
- Kelsey H. Mothersole
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Seckin O. Ulualp
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Romaine F. Johnson
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Ashley F. Brown
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Gopi B. Shah
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Christopher C. Liu
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Stephen R. Chorney
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
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Farrell A, Raol N. Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia. Curr Opin Otolaryngol Head Neck Surg 2023; 31:412-418. [PMID: 37820272 DOI: 10.1097/moo.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Dysphagia affects at least 1% of the pediatric population. This prevalence further increases in patients who are born prematurely or who have underlying neuromuscular or cardiopulmonary disorders. A multidisciplinary team approach, including an Otolaryngologist, can help promote an expedited diagnosis and therapeutic regimen, ensuring that the patient receives adequate nutrition needed for growth and development. RECENT FINDINGS The development and growth of multidisciplinary aerodigestive clinics have improved outcomes in pediatric patients with dysphagia. If a structural concern is noted on examination, there remain a multitude of medical and surgical options to help improve patient outcomes and swallow. These treatment options are usually multimodality and specific interventions may be employed to target a specific and notable abnormality. SUMMARY Pediatric dysphagia is a complex concern. For the otolaryngologist, etiologies with surgical targets may include ankyloglossia, tonsillar hypertrophy, laryngomalacia, laryngo-esophageal cleft, vocal fold movement impairment, and cricopharyngeal achalasia. The development and formalization of a multidisciplinary approach has streamlined and broadened treatment options for these patients. An otolaryngologist is integral as part of the treatment team of these patients.
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Affiliation(s)
- Annie Farrell
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Chen CB. Nutritional and feeding challenges in aerodigestive patients. Curr Opin Pediatr 2023; 35:561-565. [PMID: 37489246 DOI: 10.1097/mop.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE OF REVIEW Aerodigestive disorders encompass conditions that affect both the airway and gastrointestinal tract. These include conditions such as acquired and congenital defects of the airway and esophagus as well as neuromuscular disorders. Patients often suffer from dysphagia, aspiration, and respiratory disorders. This article will provide a review of current practices in the management of feeding disorders, oropharyngeal dysphagia, and nutritional support in the aerodigestive population. RECENT FINDINGS Oral aversion, aspiration, and feeding-tube dependence are all commonly encountered problems in the aerodigestive population. Intensive inpatient and outpatient programs along with use of appetite stimulants and psychotropic medications may help to improve feeding-related disorders. Aspiration affects many patients and requires close monitoring of clinical symptoms along with routine assessment with video fluoroscopy. Developments in blenderized feeds and formula supplementation have also provided new options for patients with feeding intolerance. SUMMARY Patients with aerodigestive disorders require complex medical care, and multidisciplinary teams are the most effective in addressing their medical needs. Advances in feeding, occupational, and pharmacologic therapy have allowed healthcare providers to better address the needs of these patients.
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Affiliation(s)
- Charles B Chen
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St., 65201, Columbia, Missouri, USA
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Stack TJ, Carrasco MC, Shah J, Zdanski CJ, Roberts J. Interarytenoid injection outcomes in pediatric feeding disorders. Laryngoscope Investig Otolaryngol 2023; 8:1421-1427. [PMID: 37899882 PMCID: PMC10601555 DOI: 10.1002/lio2.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Type 1 laryngeal clefts (LC1) and deep interarytenoid grooves contribute to pediatric feeding disorders. Management of these defects remains heterogeneous among surgeons and interarytenoid injection augmentation (IIA) is not always offered as a treatment option. This study evaluated IIA outcomes among a pediatric patient cohort comprised mostly of those with deep interarytenoid grooves. Methods A single-institution retrospective chart review featured children under the age of 5 years presenting for aspiration, dysphagia, or choking. Over the period of 7 years (January 2014-October 2021), 39 met inclusion criteria and had sufficient follow-up data. Descriptive statistics and subgroup analyses were performed. Results Of the 39 included patients, 76.92% had clinical improvement post-injection, with the mean time to follow-up being 47 days. Within the deep interarytenoid groove group, improvement rates were 82.76%. Bronchoscopy findings revealed 29 (74.36%) patients with a DIG, 3 (7.69%) with LC1, 3 (7.69%) with no anatomic abnormality, and 4 (10.26%) with vocal cord paralysis. There were no adverse events. There were no associations with the outcomes based on subgroup analysis and logistic regression. Conclusions IIA is an effective and safe treatment for pediatric feeding disorders. No covariates were associated with symptom improvement. Within the deep interarytenoid groove diagnosis subgroup, IIA effectively improved symptoms. Further investigations are needed to explore predictors of success with IIA in this population. Level of Evidence VI.
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Affiliation(s)
- Taylor J. Stack
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Joel Shah
- Liberty University College of Osteopathic MedicineLynchburgVirginiaUSA
| | - Carlton J. Zdanski
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jason Roberts
- Asheville Ear Nose & ThroatAshevilleNorth CarolinaUSA
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Wineski RE, Beltran-Ale G, Simpson R, Evarts M, Stein JS, Rosen P, Rogers JA, Leonard MV, Dimmitt R, Soong A, Kassel R, Harris WT, Wiatrak B, Smith NJ. Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity. Int J Pediatr Otorhinolaryngol 2023; 171:111657. [PMID: 37441989 DOI: 10.1016/j.ijporl.2023.111657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION We previously reported that endoscopic repair of a Type 1 Laryngeal Cleft (LC1) or Deep Interarytenoid Groove (DIG) improves swallowing function postoperatively. However, caregivers often ask about the timeline to resolution of the need for thickening. This study re-examines this cohort to answer this important caregiver-centered question. METHODS We reassessed a 3-year retrospective, single-center dataset of children with dysphagia found to have a LC-1 or DIG on endoscopic exam. The primary outcome was rate of complete resolution of dysphagia at 2, 6, and 12 months after endoscopic intervention. A sub-group analysis was made based on severity of dysphagia prior to intervention and by type of endoscopic repair. RESULTS Thirty-nine patients with mean age 1.35 years that had a LC-1 or DIG met criteria for inclusion. Rate of complete dysphagia resolution increased over time. Those with mild dysphagia (flow-reducing nipple and/or IDDSI consistency 1 or 2) had brisker resolution than those with moderate dysphagia (IDDSI consistency 3 or 4) at 2 months (67% vs 5%, p < 0.01) and at 6 months (80% vs 18%, p < 0.01) after endoscopic repair. There was no difference in dysphagia resolution between patients grouped by type of endoscopic repair. CONCLUSION Addressing an interarytenoid defect in patients will not result in immediate, complete dysphagia resolution in most patients. However, patients that only require a flow-reducing nipple and/or thickening to an IDDSI consistency 1 or 2 have brisker resolution of the need for thickening than those that require an IDSSI consistency 3 or 4 prior to intervention. These results inform pre-operative discussions of the timeline to resolution based upon severity of dysphagia and help manage caregiver expectations.
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Affiliation(s)
- R E Wineski
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - G Beltran-Ale
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA.
| | - R Simpson
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA
| | - M Evarts
- Pediatric Otolaryngology Head and Neck Surgery Associates, St. Petersburg, FL, USA
| | - J S Stein
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - P Rosen
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - J A Rogers
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - M V Leonard
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - R Dimmitt
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Soong
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - R Kassel
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - W T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA
| | - B Wiatrak
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - N J Smith
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
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Jiang ZY, Gatcliffe C, Mai T, Huang Z. Aerodigestive Approach to Pediatric Chronic Cough. Otolaryngol Clin North Am 2022; 55:1233-1242. [DOI: 10.1016/j.otc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wineski RE, Panico E, Karas A, Rosen P, Van Diver B, Norwood TG, Grayson JW, Beltran-Ale G, Dimmitt R, Kassel R, Rogers A, Leonard M, Chapman A, Boehm L, Wiatrak B, Harris WT, Smith N. Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients. Int J Pediatr Otorhinolaryngol 2021; 150:110874. [PMID: 34392101 DOI: 10.1016/j.ijporl.2021.110874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients. METHODS A 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05. RESULTS 449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05). CONCLUSION In pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.
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Affiliation(s)
- R E Wineski
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - E Panico
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Karas
- Department of Otorhinolaryngology- Head and Neck Surgery, Rush University School of Medicine, Chicago, IL, USA
| | - P Rosen
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - B Van Diver
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - T G Norwood
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - J W Grayson
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - G Beltran-Ale
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - R Dimmitt
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - R Kassel
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Rogers
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - M Leonard
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - A Chapman
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - L Boehm
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - B Wiatrak
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - W T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - N Smith
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
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Martha VV, Vontela S, Calder AN, Martha RR, Sataloff RT. Laryngeal cleft: A literature review. Am J Otolaryngol 2021; 42:103072. [PMID: 33957543 DOI: 10.1016/j.amjoto.2021.103072] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Laryngeal cleft is a congenital condition in which an opening in the posterior laryngotracheal wall allows food and liquid to pass from the esophageal lumen to the airway and causes aspiration. The severity of a laryngeal cleft is measured using the Benjamin-Inglis system, and can be managed conservatively or with a variety of surgical options With increased awareness, higher suspicion among primary physicians, advanced technology and improved intensive neonatal care services, more babies with laryngeal clefts survive in the modern era. Therefore, the focus has shifted from infant survival to treatment of laryngeal clefts and the challenging, complex medical conditions they create. OBJECTIVE To understand current laryngeal cleft management and post-operative outcomes. METHODS Literature review of laryngeal cleft studies from 2010 to 2021. RESULTS A total of 1033 patients were included. Based on 415 cases for whom sufficient classification data were available, the predominate symptom for patients with type I, III, and IV clefts is swallowing dysfunction, while the predominant symptoms for patients with type II clefts are stridor and aspiration. A wide variety of comorbidities involving several major organs has been reported with laryngeal clefts, which tend to impact clinical outcomes negatively. Approximately 19% of type I clefts have been treated conservatively successfully, but the majority was treated surgically. Most studies that used injection laryngoplasty for type I clefts reported highly successful repairs without complications or delays in additional procedures. Ninety-eight percent all type II clefts were treated with endoscopic repair; 87% of patients with type III clefts received endoscopic repair; and 66% of patients with type IV clefts underwent open surgery. Approximately 62% of resolved cases were reported within 12 months, while 50.87% of failed cases were reported within 6 weeks. CONCLUSIONS There are multiple treatment approaches, each of which may be applicable depending on factors such as laryngeal cleft type, severity of presentation, and comorbidities. Conservative approaches appear to be most useful for type I clefts or in patients with mild symptoms, while surgical management can be considered for any type of laryngeal cleft. The benefit of injection laryngoplasty, endoscopic repair and open surgery can also vary, but injection laryngoplasty and endoscopic repair are used most commonly. Open surgery should be to be considered if patients present with severe cleft types or if it is unsafe to perform other surgical techniques. Familiarity with this literature review should help clinicians understand clinical characteristics, direct medical management, and guide successful resolution of laryngeal clefts.
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Park M, Kim S, Kim E, Kim GE, Jung JH, Kim SY, Kim MJ, Kim DH, Park S, Ho IG, Kim SK, Hwang S, Shin KH, Lee H, Lee B, Lee H, Park M, Koh H, Sohn MH, Rha DW, Kim KW. Multidisciplinary aerodigestive program at a children's hospital: A protocol for a prospective observational study. PLoS One 2021; 16:e0259208. [PMID: 34705883 PMCID: PMC8550601 DOI: 10.1371/journal.pone.0259208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Children with complex chronic multisystemic diseases frequently require care from multiple pediatric subspecialists. The aerodigestive program is a multidisciplinary program that diagnoses and treats pediatric patients with complex multi-systematic problems affecting airway, breathing, feeding, swallowing, or growth. The aim of this study is to present the protocol of the aerodigestive program of a children's hospital. METHODS AND DESIGN This study is a prospective study to evaluate and compare the overall improvement of patients' objective and subjective conditions before and after the AeroDigestive Team (ADT) program. Among children from 1 month to 18 years of age, patients with complex problems of the airway, breathing, feeding, swallowing, or growth meeting at least two parameters of the inclusion criteria were enrolled. The overall process included referral based on the inclusion criteria, enrollment of ADT program with informed consents, interview and questionnaire for assessing patients' medical condition, prescheduling appointment, multi-specialists' evaluation, monthly team meetings, wrap-up discussion with the patients and family, therapeutic intervention, and follow-up at 6 months with the assessment of outcome measures. The outcome was evaluated objectively and subjectively. The objective outcome measure was divided into surgical or medical intervention, assessment of changes in medical condition, and follow-up study. Both caregiver interviews and questionnaires using a scoring system were used as subjective outcome measures before and after the ADT program. Children were scheduled to be followed-up at 6 months after the interventions or ADT meeting. DISCUSSION The aerodigestive program is expected to provide comprehensive and multidisciplinary management of children with complex airway and digestive tract disorders.
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Affiliation(s)
- Mireu Park
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eunyoung Kim
- Department of Nursing, Severance Children Hospital, Yonsei University Health System, Seoul, Korea
| | - Ga Eun Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hwa Jung
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sowon Park
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Geol Ho
- Department of Pediatric Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ki Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sangwon Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong Hun Shin
- Department of Nutrition Care, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Hosun Lee
- Department of Nutrition Care, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Bobae Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeyeon Lee
- Department of Pediatric Occupational Therapy, Severance Rehabilitation hospital, Yonsei University Health System, Seoul, Korea
| | - Minhwa Park
- Department of Pediatric Occupational Therapy, Severance Rehabilitation hospital, Yonsei University Health System, Seoul, Korea
| | - Hong Koh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Reddy P, Byun YJ, Downs J, Nguyen SA, White DR. Presentation and management of type 1 laryngeal clefts: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2020; 138:110370. [PMID: 33152963 DOI: 10.1016/j.ijporl.2020.110370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate outcomes of injection laryngoplasty (IL) and endoscopic surgical repair for the treatment of type 1 laryngeal clefts (LC1) and to determine the most common presentations of LC1. METHODS Primary studies were searched for in PubMed, Scopus, OVID, and Cochrane Library using search terms laryngeal cleft and laryngotracheoesophageal cleft for articles published from database inception through August 2019. The search identified all articles pertaining to the symptomatology and management of LC1. Meta-analysis was performed on presenting symptoms and improvement of clinical symptoms and swallow function. RESULTS Twenty-four studies, comprising 713 patients with a mean age of 33.7 months (range 0-168 months), were included. The most common presenting symptoms were aspiration (80%, CI [55%-96%]), dysphagia (61%, CI [47%-74%]), and choking (57%, CI [37%-76%]). Gastroesophageal reflux disease (GERD) was the most common comorbidity (68%, CI [51%-83%]) and premature birth comprised 27% [21%-32%] of the patients. Overall, 38% of patients received IL as a primary therapy. Prior to injection, 91% [87%-94%] of patients aspirated on swallow evaluations, and 62% [55%-68%] aspirated post-injection. At an average follow-up time of 6.8 months, 90% [70%-100%] of parents reported symptom improvement. An additional 54% of patients underwent endoscopic surgical repair as primary treatment. The rate of aspiration decreased from 73% [43%-94%] to 28% [13%-46%] after repair. At a mean follow-up of 14.2 months, 80% [67%-91%] reported symptom improvement. CONCLUSION A high level of clinical suspicion is necessary to detect LC1 since its most common presenting symptoms overlap with other diseases commonly found in this patient population. Both IL and formal surgical repair were effective in managing LC1.
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Affiliation(s)
- Priyanka Reddy
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Young Jae Byun
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jaye Downs
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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11
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Weinstock MS, McCoy JL, Cangilla K, Shaffer AD, Maguire RC, Tobey ABJ, Simons JP, Padia RK. Predictive Utility of the Penetration-Aspiration Scale in Inter-Arytenoid Injection Augmentation. Laryngoscope 2020; 131:E1707-E1713. [PMID: 33009827 DOI: 10.1002/lary.29142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the utility of preoperative penetration-aspiration scale (PAS) scores and clinical findings on modified barium swallow (MBS) in predicting advancement of diet after interarytenoid injection augmentation (IAIA). STUDY DESIGN Retrospective review. METHODS In this retrospective cohort study, 372 consecutive patients who underwent IAIA for pharyngeal dysphagia between 2009 and 2019 were initially identified. Patients were excluded from the study if they had insufficient preop MBS, no postop MBS within 3 months of injection, supraglottoplasty, or underlying neurological condition. Ninety-three patients were included in the study. Pre- and postoperative PAS scores were recorded, as were pre and postop diets. PAS scores were calculated by a single pediatric speech and language pathologist. RESULTS Average PAS score on MBS was 5.87 (standard deviation [SD] 2.74); median (range) = 8 (1-8). Postop average was 4.29 (SD 3.02); median (range) = 2 (1-8), P < .001. Those with worse preop PAS scores had increased odds of improvement in diet (odds ratio 1.24, 95% confidence interval [CI] 1.02-1.49, P = .029). An improvement in PAS score of 3.0 or greater predicted an improvement in diet with a sensitivity of 76.7% and a specificity of 85.7%. CONCLUSIONS PAS score on MBS can be a useful tool when assessing pediatric patients who may be candidates for IAIA. Prospectively comparing PAS score in patients post-IAIA to patients solely undergoing diet modification can help to better objectively assess differences in outcomes and understand the full utility of PAS score. LEVEL OF EVIDENCE Level III (Individual Cohort Study) Laryngoscope, 131:E1707-E1713, 2021.
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Affiliation(s)
- Michael S Weinstock
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jennifer L McCoy
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Kristin Cangilla
- Department of Speech and Language Pathology, Feeding and Swallowing Center, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Raymond C Maguire
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Allison B J Tobey
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jeffrey P Simons
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Reema K Padia
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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12
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Timashpolsky A, Schild SD, Ballard DP, Leventer SP, Rosenfeld RM, Plum AW. Management of Type 1 Laryngeal Clefts: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:489-500. [PMID: 32807006 DOI: 10.1177/0194599820947742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Endoscopic surgical management or injection laryngoplasty of type 1 laryngeal clefts in pediatric patients is used in those who do not respond to conservative treatment. This study compares conservative treatment, endoscopic surgical repair, and injection laryngoplasty for the management of type 1 laryngeal clefts. DATA SOURCES PubMed, Web of Science, and Embase. REVIEW METHODS This systematic review included studies of patients with type 1 laryngeal clefts who were managed with conservative treatment, injection laryngoplasty, or endoscopic repair, and all studies reported postintervention outcomes. Two independent investigators assessed study eligibility, rated the quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data. RESULTS Of the 1209 studies identified, 27 met inclusion criteria. There were 543 patients with type 1 laryngeal clefts represented in the studies, with outcomes reported for 537. Conservative therapy had a 52% (95% CI, 37%-66%; I2 = 63%) success rate at improving symptoms, while endoscopic repair had a significantly higher percentage resolution of symptoms (70%; 95% CI, 59%-79%; I2 = 62%, P < .001) as compared with conservative treatment (51%; 95% CI, 36%-65%; I2 = 62%) or injection laryngoplasty (36%; 95% CI, 20%-57%; I2 = 70%). The quality scores of the studies ranged from 7 to 12 out of 16. CONCLUSION Our systematic review demonstrated significant improvement and resolution of symptoms for patients with type 1 laryngeal clefts treated with endoscopic repair as compared with other modalities. More prospective and controlled studies comparing treatment strategies with validated instruments to measure outcomes are necessary to determine their efficacy in the management of type 1 laryngeal clefts.
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Affiliation(s)
- Alisa Timashpolsky
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Sam D Schild
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Daniel P Ballard
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Sarah P Leventer
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Richard M Rosenfeld
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Ann W Plum
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
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13
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Li KL, Fang CH, Ferastraoaru D, Akbar NA, Jerschow E, Abuzeid WM. Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary Rhinology and Allergy Clinic. Ann Otol Rhinol Laryngol 2020; 129:699-706. [PMID: 32059621 DOI: 10.1177/0003489420905859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.
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Affiliation(s)
- Kevin L Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denisa Ferastraoaru
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nadeem A Akbar
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elina Jerschow
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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14
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Miller AL, Caloway C, Hersh CJ, Hartnick CJ. Long-term swallowing outcomes following type 1 laryngeal cleft injection. Int J Pediatr Otorhinolaryngol 2020; 128:109731. [PMID: 31648159 DOI: 10.1016/j.ijporl.2019.109731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Interarytenoid injection augmentation (IIA) during initial diagnostic endoscopy for aspiration and dysphagia has been described as both a diagnostic and therapeutic technique in the evaluation of type 1 laryngeal cleft (LC-1). IIA is additionally hypothesized to be a temporizing measure that facilitates improvement of swallowing function and potentially obviates the need for future formal endoscopic suture repair of LC-1. However, long-term (>6 month) outcomes of IIA for LC-1 remain largely unknown. The objective of this study was to evaluate the effect of IIA on long-term swallowing outcomes and need for formal endoscopic suture repair in patients with LC-1. METHODS This is a retrospective cohort study of patients age ≤24 months with pharyngeal phase dysphagia on preoperative videofluoroscopic swallow study (VFSS) who underwent IIA for LC-1 during diagnostic laryngoscopy and bronchoscopy at a single tertiary care academic subspecialty hospital from June 2017 to May 2018. Included patients underwent VFSS within 30 days of IIA and had documented SLP follow up at 6 months or more post-procedure. Exclusion criteria included prior cleft repair, gastrostomy tube dependence, additional procedures at the time of IIA, or lack of documented follow up. A total of 34 patients underwent LC-1 during study period with 24 included in final analyses. The primary outcome measure was improvement in safely swallowed consistency at 6 months or greater following injection. Secondary outcomes included need for formal suture LC-1 repair following IIA and comparison of 30-day and long-term swallowing function. RESULTS Median [range] age at injection was 15.3 [10.3-19.1] months and 50% were female (n = 12). Improvement was noted in 12 (50%) patients within 30 days of IIA, with 11 of 12 demonstrating sustained improvement at long-term follow up (10.3 [9.3-14.0] months). Among all patients, 15 of 24 (63%) demonstrated improvement compared to preoperative baseline. Six of 24 (25%) required formal suture repair of LC-1. CONCLUSIONS IIA is a safe procedure that may result in both immediate and long-term improvement in dysphagia in select patients with LC-1. Additional studies are required to determine impact of IIA on pulmonary complications and hospital utilization and as well as patient- and caregiver-related outcome measures.
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Affiliation(s)
- Ashley L Miller
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Christen Caloway
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
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15
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Wick EH, Johnson K, Demarre K, Faherty A, Parikh S, Horn DL. Reliability and Construct Validity of the Penetration-Aspiration Scale for Quantifying Pediatric Outcomes after Interarytenoid Augmentation. Otolaryngol Head Neck Surg 2019; 161:862-869. [PMID: 31426703 DOI: 10.1177/0194599819856299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the reliability and construct validity of the Penetration-Aspiration Scale in children. STUDY DESIGN This was a retrospective cohort study of pre- and postoperative video modified barium swallow studies from children who underwent interarytenoid injection augmentation for unexplained persistent pharyngeal dysphagia. Two pediatric speech and language pathologists reviewed each study twice in a blinded and randomized fashion. SETTING Tertiary academic pediatric hospital. SUBJECTS AND METHODS Thirty children were identified with adequate pre- and postoperative modified barium swallow studies within 4 weeks of intervention. Children were separated into clinical outcome groups based on ability to advance to thinner diet consistencies postoperatively. Construct validity was assessed with a mixed linear model to test the hypothesis that only the clinically improved group would receive better Penetration-Aspiration Scale scores after surgery. Reliability was assessed by calculating chance-corrected agreement between raters (interrater) and raters' repeat evaluations (intrarater). RESULTS Inter- and intrarater reliabilities (Cohen's κ) were both excellent. Results of the mixed model revealed a significant interaction between outcome group and pre- and postoperative time interval. As hypothesized, this involved a significant improvement in Penetration-Aspiration Scale score only in the improved group. CONCLUSIONS These findings suggest that the Penetration-Aspiration Scale is a reliable and valid measure of clinical response to interarytenoid injection augmentation in children.
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Affiliation(s)
- Elizabeth H Wick
- Department of Otolaryngology, Barnes-Jewish Hospital-Washington University in St Louis, St Louis, Missouri, USA
| | - Kaalan Johnson
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kim Demarre
- Department of Speech and Language Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Amy Faherty
- Department of Speech and Language Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay Parikh
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - David L Horn
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
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16
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Basharat U, Schraff S, Stevens LM, Clarke PY, Kang P, Woodward J, Schroeder SR, Rao A, Page N, Williams DI. Deep interarytenoid notch in young children managed with systematic thickener wean and injection laryngoplasty. Int J Pediatr Otorhinolaryngol 2019; 118:115-119. [PMID: 30611096 DOI: 10.1016/j.ijporl.2018.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/22/2018] [Accepted: 12/23/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. METHODS We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1-3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. RESULTS Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). CONCLUSIONS These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.
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Affiliation(s)
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, AZ, USA
| | - Lindsay M Stevens
- Department of Rehabilitation, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Pamela Y Clarke
- Department of Rehabilitation, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Paul Kang
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA
| | - Jim Woodward
- Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Shauna R Schroeder
- Department of Gastroenterology, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Aparna Rao
- Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Nathan Page
- Department of Otolaryngology, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dana I Williams
- Department of Gastroenterology, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
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17
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Padia R, Coppess S, Horn DL, Parikh SR, Hoang J, Faherty A, DeMarre K, Johnson K. Pediatric dysphagia: Is interarytenoid mucosal height significant? Laryngoscope 2019; 129:2588-2593. [PMID: 30671968 DOI: 10.1002/lary.27535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS). METHODS A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%). RESULTS There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%). CONCLUSION There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology. LEVEL OF EVIDENCE 4. Laryngoscope, 129:2588-2593, 2019.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Steven Coppess
- Seattle Children's Hospital, the University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - David L Horn
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Jennifer Hoang
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Amy Faherty
- the Speech and Language Services, Department of Rehabilitation Services, Seattle, Washington, U.S.A
| | - Kimberley DeMarre
- the Speech and Language Services, Department of Rehabilitation Services, Seattle, Washington, U.S.A
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
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18
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Miller AL, Hersh CJ, Johnson KE, Hartnick CJ. Short-term swallowing outcomes following type 1 laryngeal cleft injection. Int J Pediatr Otorhinolaryngol 2019; 116:159-163. [PMID: 30554689 DOI: 10.1016/j.ijporl.2018.10.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Interarytenoid injection augmentation at the time of initial diagnostic endoscopy for aspiration and dysphagia may result in near-immediate improvement in swallowing function, potentially obviating the need for future formal endoscopic repair of type 1 laryngeal cleft. Interarytenoid injection augmentation may also address physiologic aspiration. Early treatment of type 1 laryngeal cleft may allow for expedited liberalization of feedings. The objective of this study was to evaluate the effect of interarytenoid injection augmentation (IIA) for type 1 laryngeal clefts (LC-1) on short-term swallowing function assessed by videofluoroscopic swallowing study (VFSS). METHODS This was a retrospective cohort study of patients age ≤24 months with dysphagia on preoperative VFSS who underwent IIA with calcium hydroxyapatite for LC-1 during direct laryngoscopy and bronchoscopy from June to October 2017 at a tertiary care academic subspecialty hospital. Exclusion criteria included prior endoscopic or open LC repair (n = 1), gastrostomy tube dependence (n = 1), additional procedures at the time of IIA (supraglottoplasty, frenulectomy, n = 1). Children without postoperative VFSS within 30 days of injection were excluded (n = 2). Fifteen children met inclusion criteria for analysis. The primary endpoint was improvement in safely swallowed consistency as defined by recommendation to liberalize diet by at least a half-consistency (e.g. half-honey to nectar thick liquid). Secondary endpoints included clinical assessment of dysphagia and postoperative respiratory events. RESULTS Median [range] age at injection was 15.2 [7.7-24.3] months and 67% of patients were female (n = 10). The majority (13/15) of patients were full-term and 80% of patients (n = 12) had documented gastroesophageal reflux disease (GERD). Median time from injection to VFSS was 16 [9-29] days. Improvement in safely swallowed consistency was noted in 60% (n = 9) of patients. Aspiration completely resolved in two patients. Swallow function was unchanged in 40% of patients (n = 6); no patients experienced worsening dysphagia. No respiratory complications were documented during inpatient observation. CONCLUSION IIA is a safe procedure that may result in immediate improvement in dysphagia in select patients with LC-1. IIA does not address neurologic, developmental, or other anatomic etiologies of dysphagia. Additional studies are required to determine long-term efficacy of IIA on dysphagia and pulmonary complications, as well as the patient- and caregiver-related outcome measures.
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Affiliation(s)
- Ashley L Miller
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA, USA
| | - Cheryl J Hersh
- Massachusetts Eye and Ear, Department of Otolaryngology, Boston, MA, USA; Massachusetts General Hospital for Children, Boston, MA, USA
| | - Kaalan E Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, USA; Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's, Seattle, WA, USA
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19
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Coppess S, Padia R, Horn D, Parikh SR, Inglis A, Bly R, Dahl J, Dudley D, Johnson K. Standardizing Laryngeal Cleft Evaluations: Reliability of the Interarytenoid Assessment Protocol. Otolaryngol Head Neck Surg 2018; 160:533-539. [DOI: 10.1177/0194599818806283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective While the Benjamin-Inglis classification system is widely used to categorize laryngeal clefts, it does not clearly differentiate a type 1 cleft from normal anatomy, and there is no widely accepted or validated protocol for systematically evaluating interarytenoid mucosal height. We sought to propose the interarytenoid assessment protocol as a method to standardize the description of the interarytenoid anatomy and to test its reliability. Study Design Retrospective review of endoscopic videos. Setting Pediatric academic center. Subjects and Methods The interarytenoid assessment protocol comprises 4 steps for evaluation of the interarytenoid region relative to known anatomic landmarks in the supraglottis, glottis, and subglottis. Thirty consecutively selected videos of the protocol were reviewed by 4 otolaryngologists. The raters were blinded to identifying information, and the video order was randomized for each review. We assessed protocol completion times and calculated Cohen’s linear-weighted κ coefficient between blinded expert raters and with the operating surgeon to evaluate interrater/intrarater reliability. Results Median age was 4.9 years (59 months; range, 1 month to 20 years). Median completion time was 144 seconds. Interrater and intrarater reliability showed substantial agreement (interrater κ = 0.71 [95% confidence interval (CI), 0.55-0.87]; intrarater mean κ = 0.70 [95% CI, 0.59-0.92/rater 1, 0.47-0.85/rater 2]; P < .001). Comparing raters to the operating surgeon demonstrated substantial agreement (mean κ = 0.62; 95% CI, 0.31-0.79/rater 1, 0.48-0.89/rater 2; P < .001). Conclusion The interarytenoid assessment protocol appears reliable in describing interarytenoid anatomy. Rapid completion times and substantial interrater/intrarater reliability were demonstrated. Incorporation of this protocol may provide important steps toward improved standardization in the anatomic description of the interarytenoid region in pediatric dysphagia.
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Affiliation(s)
- Steven Coppess
- University of Washington School of Medicine, University of Washington, Seattle, Washington, USA
| | - Reema Padia
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - David Horn
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Sanjay R. Parikh
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Andrew Inglis
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Randall Bly
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - John Dahl
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Daniel Dudley
- University of Washington School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
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