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Miller AL, Miller CK, Fei L, Sun Q, Willging JP, de Alarcon A, Pentiuk SP. Predictive Value of Laryngeal Penetration to Aspiration in a Cohort of Pediatric Patients. Dysphagia 2024; 39:33-42. [PMID: 37243730 DOI: 10.1007/s00455-023-10589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
Videofluoroscopic swallow studies (VFSS) provide dynamic assessment of the phases of swallowing under fluoroscopic visualization and allow for identification of abnormalities in the process, such as laryngeal penetration and aspiration. While penetration and aspiration both reflect degrees of swallowing dysfunction, the predictive potential of penetration for subsequent aspiration is not fully elucidated in the pediatric population. As a result, management strategies for penetration vary widely. Some providers may interpret any depth or frequency of penetration as a proxy for aspiration and implement various therapeutic interventions (e.g., modification of liquid viscosity) to eliminate penetration episodes. Some may recommend enteral feeding given the presumed risk of aspiration with penetration, even when aspiration is not identified during the study. In contrast, other providers may advise continued oral feeding without modification even when some degree of laryngeal penetration is identified. We hypothesized that the depth of penetration is associated with the likelihood of aspiration. Identification of predictive factors for aspiration following laryngeal penetration events has significant implications for selection of appropriate interventions. We performed a retrospective cross-sectional analysis of a random sample of 97 patients who underwent VFSS in a single tertiary care center over a 6 month period. Demographic variables including primary diagnosis and comorbidities were analyzed. We examined the association between aspiration and degrees of laryngeal penetration (presence or absence, depth, frequency) across diagnostic categories. Infrequent and shallow penetration events of any type of viscosity were less likely to be associated with aspiration event(s) during the same clinical encounter regardless of diagnosis. In contrast, children with consistent deep penetration of thickened liquids invariably demonstrated aspiration during the same study. Our findings show that shallow, intermittent laryngeal penetration of any viscosity type on VFSS was not consistent with clinical aspiration. These results provide further evidence that penetration-aspiration is not a uniform clinical entity and that nuanced interpretation of videofluoroscopic swallowing findings is necessary to guide appropriate therapeutic interventions.
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Affiliation(s)
- Ashley L Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Claire Kane Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Division of Speech and Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Qin Sun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Paul Willging
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alessandro de Alarcon
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott P Pentiuk
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Aras I, Yalcin A, Gode S, Aras A, Sezgin B, Durusoy D, Eyigor S. Evaluation of Swallowing Function in Relation to Oropharyngeal Dysphagia in Patients with Operated Unilateral Cleft Lip and Palate. J Craniofac Surg 2023; 34:e576-e580. [PMID: 37280736 DOI: 10.1097/scs.0000000000009405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/11/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To determine the occurrence of oropharyngeal dysphagia (OD) signs and symptoms in patients with operated unilateral cleft lip and palate (CLP). MATERIALS AND METHODS This prospective study was conducted on 15 adolescents with operated unilateral CLP (CLP group) and 15 non-cleft volunteers (control group). Initially, the Eating Assessment Tool-10 (EAT-10) questionnaire was administered to subjects. OD signs and symptoms such as coughing, the sensation of choking, globus sensation, the need to clear the throat, nasal regurgitation, difficulties of bolus control multiple swallowing were evaluated by patient complaints and physical examination of swallowing function. Also, the Functional Outcome Swallowing Scale was used to determine the severity of the OD. Fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and crackers was performed. RESULTS The prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (range, 6.7 to 26.7%), and nonsignificant differences were observed between the groups for these parameters as well as for EAT-10 scores. According to the Functional Outcome Swallowing Scale findings, 11 of 15 patients with CLP were asymptomatic. Fiberoptic endoscopic evaluation of swallowing indicated that post-swallow pharyngeal wall residues with yogurt were significant in the CLP group with a prevalence of 53% ( P < 0.05), whereas differences between the groups in terms of cracker and water residues were nonsignificant ( P > 0.05). CONCLUSION OD in patients with repaired CLP was manifested mainly in the form of pharyngeal residue. However, it did not appear to cause significant increases in patient complaints compared with healthy individuals.
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Affiliation(s)
- Isil Aras
- School of Orthodontics Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, FL
| | | | - Sercan Gode
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Aynur Aras
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | | | | | - Sibel Eyigor
- Physical Medicine and Rehabilitation Department, Ege University School of Medicine, Izmir, Turkey
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Yalcin A, Aras I, Gode S, Durusoy D, Sezgin B, Eyigor S, Aras A. Evaluation of swallowing in transverse maxillary deficiency patients before and after rapid maxillary expansion. Angle Orthod 2023; 93:552-557. [PMID: 37083753 PMCID: PMC10575642 DOI: 10.2319/101222-703.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/01/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES To evaluate swallowing function in relation to oropharyngeal dysphagia (OD) in adolescents who had transverse maxillary deficiency with posterior crossbite and high-arched palate, before, and after rapid maxillary expansion (RME). MATERIALS AND METHODS Twenty patients (mean age: 13.0 ± 3.1) with bilateral posterior crossbite and high-arched palate (RME group: RMEG) and 20 volunteers (mean age: 13.4 ± 2.6) with Class I crowding without posterior crossbite or high-arched palate (control group: CG) were recruited. OD signs and symptoms were evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaire, patient complaints, and physical examination of swallowing function before (T1) and 7 months after (T2) RME. Additionally, fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and cracker was performed. In CG, evaluation of swallowing was performed only once, corresponding to T1 of RMEG. RESULTS Prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (5%-15%), and nonsignificant differences were observed between CG and RMEG at T1 for these parameters as well as for EAT-10 scores. Total post-swallow pharyngeal residue with yogurt was significantly different between CG and RMEG at T1, with a prevalence of 60% in RMEG (P < .05). There was no significant difference regarding residue with yogurt between T1 and T2 in RMEG (P > .05). CONCLUSION Patients with a maxillary transverse deficiency were affected by pharyngeal residue as indicated by FEES, but it did not appear to improve in short-term follow-up in patients treated with RME.
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Affiliation(s)
| | - Isil Aras
- Corresponding author: Isil Aras, DDS, MSc, PhD, School of Orthodontics, Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, 5491 Dolphin Point, Jacksonville, FL 32211, USA (e-mail: )
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Krug K, Hübl N, Freitag N, Schramm D. Safety, feasibility and diagnostic value of Clinical Swallow Examination and FEES in children between 0 and 24 months. Early Hum Dev 2023; 179:105732. [PMID: 36863223 DOI: 10.1016/j.earlhumdev.2023.105732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Clinical Swallowing Examination (CSE) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are relevant diagnostic methods in pediatric dysphagia. Satisfactory and comprehensive healthcare is still not part of the standard diagnostic process. AIMS The purpose of this article is to evaluate the safety, feasibility, and diagnostic value of CSE and FEES in children 0-24 months of age. STUDY DESIGN A retrospective cross-sectional study which was conducted at the pediatric clinic of the University Hospital Düsseldorf, Germany, between 2013 and 2021. SUBJECTS A total of 79 infants and toddlers with suspected dysphagia were included. OUTCOME MEASURES Analyses of the cohort and FEES pathologies were performed. Dropout criterion, complications and change of diet were recorded. Chi-square identified associations between clinical symptoms and FEES results. RESULTS All FEES examinations were performed without complications and with a completion rate of 93.7 %. Anatomical abnormalities in the laryngeal region were diagnosed in 33 children. Wet voice was significantly associated with premature spillage (p = .028). CONCLUSIONS CSE and FEES are important and uncomplicated examinations for children with suspected dysphagia between 0 and 24 months. They are equally helpful for differential diagnosis of feeding disorders and anatomical abnormalities. The results underline the added value of combining both examinations and their importance for individual nutritional management. History taking and CSE are mandatory as they reflect the everyday eating situation. This study adds essential knowledge to the diagnostic work-up of dysphagic infants and toddlers. Standardizing the examinations and validating dysphagia scales are future tasks.
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Affiliation(s)
- Katrin Krug
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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Miller CK, Reynolds J, Kelchner LN, Scarborough D, Langmore S, Gosa M. Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Pediatric Populations: Part 2. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:55-82. [PMID: 36538506 DOI: 10.1044/2022_ajslp-22-00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This is Part 2 of a two-part tutorial series establishing clinical guidelines pertaining to the administration of fiberoptic endoscopic evaluation of swallowing (FEES) developed by representatives of the American Board of Swallowing and Swallowing Disorders, all of whom are members of Special Interest Group 13. Whereas Part 1 focused on use of FEES with adults and included general information common to using FEES in any population, the purpose of this tutorial is to provide clinicians with updated best practice clinical guidelines for performing, interpreting, and documenting outcomes when using FEES with the pediatric population. This document has two main sections. The first section discusses the history of pediatric FEES, needed knowledge and skill pertaining to all elements of performing and interpreting the examination including detailed information related to indications and contraindications, developmental anatomical and physiological changes across childhood, preparing for and conducting the examination, medical collaboration, and patient safety. The second section provides detailed guidelines for clinicians who require training for use of FEES with the pediatric population. CONCLUSIONS This first of its kind tutorial offers guidelines for clinicians who perform, interpret, and/or want to train to perform FEES in the pediatric population. Important clinical distinctions exist when using FEES with the pediatric population versus with the adult population. Developmental changes, pediatric medical frailty, provider-parent/caregiver interaction, collaboration with physician colleagues, and patient safety are representative of key areas highlighted in this document.
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Affiliation(s)
- Claire Kane Miller
- Aerodigestive and Esophageal Center, Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, OH
| | - Jenny Reynolds
- Neonatal Intensive Care Unit, Baylor University Medical Center, Dallas, TX
| | - Lisa N Kelchner
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Donna Scarborough
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
| | - Susan Langmore
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
| | - Memorie Gosa
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa
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Frakking TT, Chang AB, Carty C, Newing J, Weir KA, Schwerin B, So S. Using an Automated Speech Recognition Approach to Differentiate Between Normal and Aspirating Swallowing Sounds Recorded from Digital Cervical Auscultation in Children. Dysphagia 2022; 37:1482-1492. [PMID: 35092488 PMCID: PMC9643257 DOI: 10.1007/s00455-022-10410-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Use of machine learning to accurately detect aspirating swallowing sounds in children is an evolving field. Previously reported classifiers for the detection of aspirating swallowing sounds in children have reported sensitivities between 79 and 89%. This study aimed to investigate the accuracy of using an automatic speaker recognition approach to differentiate between normal and aspirating swallowing sounds recorded from digital cervical auscultation in children. We analysed 106 normal swallows from 23 healthy children (median 13 months; 52.1% male) and 18 aspirating swallows from 18 children (median 10.5 months; 61.1% male) who underwent concurrent videofluoroscopic swallow studies with digital cervical auscultation. All swallowing sounds were on thin fluids. A support vector machine classifier with a polynomial kernel was trained on feature vectors that comprised the mean and standard deviation of spectral subband centroids extracted from each swallowing sound in the training set. The trained support vector machine was then used to classify swallowing sounds in the test set. We found high accuracy in the differentiation of aspirating and normal swallowing sounds with 98% overall accuracy. Sensitivity for the detection of aspiration and normal swallowing sounds were 89% and 100%, respectively. There were consistent differences in time, power spectral density and spectral subband centroid features between aspirating and normal swallowing sounds in children. This study provides preliminary research evidence that aspirating and normal swallowing sounds in children can be differentiated accurately using machine learning techniques.
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Affiliation(s)
- Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD, 4510, Australia.
- Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD, 4029, Australia.
- Speech Pathology Department, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD, 4510, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, Australia
| | - Jade Newing
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD, 4215, Australia
| | - Kelly A Weir
- Menzies Health Institute QLD & School of Health Sciences & Social Work, Griffith University, Gold Coast Campus, 1 Parklands Avenue, Southport, QLD, 4222, Australia
- Allied Health Research, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Belinda Schwerin
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD, 4215, Australia
| | - Stephen So
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD, 4215, Australia
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Smith MM, Buck LS. Update on the diagnosis and management of pediatric laryngotracheal stenosis. Expert Rev Respir Med 2022; 16:1035-1041. [DOI: 10.1080/17476348.2022.2145947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew M Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Lauren S Buck
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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Schindler A, Baijens LWJ, Geneid A, Pizzorni N. Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES. Eur Arch Otorhinolaryngol 2022; 279:2727-2742. [PMID: 34779927 PMCID: PMC8591442 DOI: 10.1007/s00405-021-07161-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Oropharyngeal dysphagia (OD) is a common phenomenon in otorhinolaryngology and phoniatrics. As both sub-disciplines have a strong tradition and clinical experience in endoscopic assessment of the upper aerodigestive tract, the implementation of fiberoptic endoscopic evaluation of swallowing (FEES) was an almost self-evident evolution. This review aims to provide an update on FEES and the role of phoniatricians and otorhinolaryngologists using FEES in Europe. METHODS A narrative review of the literature was performed by experts in the field of FEES both in the clinical context and in the field of scientific research. RESULTS FEES is the first-choice OD assessment technique for both phoniatricians and otorhinolaryngologists. FEES is becoming increasingly popular because of its usefulness, safety, low costs, wide applicability, and feasibility in different clinical settings. FEES can be performed by health professionals of varying disciplines, once adequate knowledge and skills are acquired. FEES aims to determine OD nature and severity and can provide diagnostic information regarding the underlying etiology. The direct effect of therapeutic interventions can be evaluated using FEES, contributing to design the OD management plan. Standardization of FEES protocols and metrics is still lacking. Technological innovation regarding image resolution, frame rate frequency, endoscopic light source specifications, and endoscopic rotation range has contributed to an increased diagnostic accuracy. CONCLUSION The rising number of phoniatricians and otorhinolaryngologists performing FEES contributes to the early detection and treatment of OD in an aging European population. Nevertheless, a multidisciplinary approach together with other disciplines is crucial for the success of OD management.
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Affiliation(s)
- Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", Milan University, UOS Foniatria, ASST Fatebenefratelli-Sacco, Ospedale Sacco, Via GB Grassi 74, 20154, Milano, Italy.
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology-GROW, Maastricht University, Maastricht, The Netherlands
| | - Ahmed Geneid
- Department of Otorhinolaryngology and Phoniatrics-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", Milan University, UOS Foniatria, ASST Fatebenefratelli-Sacco, Ospedale Sacco, Via GB Grassi 74, 20154, Milano, Italy
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Zang J, Kiehn S, Flügel T, Koseki JC, Nießen A, Kim SH, Pflug C, Nienstedt JC. Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research. Dysphagia 2022; 37:1822-1838. [PMID: 35430715 PMCID: PMC9643173 DOI: 10.1007/s00455-022-10446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date. OBJECTIVE This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome. METHODS Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form. RESULTS In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared. DISCUSSION None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Evaluating dysphagia in infants with congenital heart disease using Fiberoptic Endoscopic Evaluation of Swallowing. Int J Pediatr Otorhinolaryngol 2022; 152:111004. [PMID: 34902666 DOI: 10.1016/j.ijporl.2021.111004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/05/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Dysphagia is common in infants with congenital heart disease (CHD). However, there is minimal published data regarding its management outside of the perioperative period. The objective of this study is to describe the role of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in the diagnosis and management of dysphagia in infants with CHD. METHODS Infants with CHD who underwent FEES exam for evaluation of swallowing dysfunction between February 2015 and February 2021 at a university-based, tertiary care urban pediatric hospital were studied. Demographic data, presenting symptoms, medical history, and dysphagia history were examined. The validated Dysphagia Outcome and Severity Scale (DOSS) was used to standardize and compare dysphagia severity. RESULTS 62 FEES exams were performed on 48 patients. All 48 patients were diagnosed with dysphagia and had a mean dysphagia severity score (DOSS) of 2.68. Patients with wet laryngeal congestion on presentation had worse mean DOSS score and were more likely to demonstrate aspiration on FEES exam (p < 0.01). There was no significant difference in mean DOSS or presence of aspiration when comparing infants who had cardiothoracic surgery, vocal cord paralysis, or lower respiratory tract illness with those who had not (p > 0.05). CONCLUSION A FEES exam is an effective and well-tolerated procedure for evaluating swallowing dysfunction in pediatric patients with CHD and its use reduces radiation exposure for this vulnerable population. Wet laryngeal congestion was found to be predictive of more severe dysphagia and aspiration. There is no significant association between severity of dysphagia or aspiration on FEES exam and history of cardiac surgery, vocal cord paralysis, or lower respiratory tract illness.
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Pavithran J, Puthiyottil IV, Kumar M, Nikitha AV, Vidyadharan S, Bhaskaran R, Chandrababu Jaya A, Thankappan K, Subramania I, Sundaram KR. Exploring the utility of fibreoptic endoscopic evaluation of swallowing in young children- A comparison with videofluoroscopy. Int J Pediatr Otorhinolaryngol 2020; 138:110339. [PMID: 32911239 DOI: 10.1016/j.ijporl.2020.110339] [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: 07/22/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. STUDY DESIGN Prospective, observational. METHODOLOGY Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used. RESULTS FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). CONCLUSION FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.
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Affiliation(s)
- Jayanthy Pavithran
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Indu Vadakke Puthiyottil
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Madhumita Kumar
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Anju Viswambharan Nikitha
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Sivakumar Vidyadharan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India.
| | - Arya Chandrababu Jaya
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Iyer Subramania
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - K R Sundaram
- Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India.
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Miller CK, Schroeder JW, Langmore S. Fiberoptic Endoscopic Evaluation of Swallowing Across the Age Spectrum. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:967-978. [PMID: 32650653 DOI: 10.1044/2019_ajslp-19-00072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Fiberoptic endoscopic evaluation of swallowing (FEES) is a widely used instrumental procedure used to assess swallowing function in persons of all ages, from infants to older adults. In this article, the history of FEES in adults, the protocol, the scoring system, and the interpretation of abnormal findings are summarized. The use of FEES to guide treatment in adults is also covered briefly. Following this review in adults, the use of FEES in infants and children is presented, including the anatomical-physiological assessment and the assessment of swallowing of food and liquid. Interpretation of findings and therapeutic applications are discussed. Conclusion FEES is a valuable part of the clinical protocol for evaluation and management of dysphagia across the life span. It provides a mechanism for in-depth analysis of swallowing structures and function during intake of liquid and food boluses. Future developments include standardized training content to ensure clinical competency and the development of standardized examination and interpretation protocols.
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Affiliation(s)
- Claire Kane Miller
- Aerodigestive and Esophageal Center, Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, OH
| | - James W Schroeder
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, IL
- Departments of Otolaryngology-Head and Neck Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Susan Langmore
- Department of Otolaryngology, Boston University School of Medicine, MA
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Frakking TT, Chang AB, David M, Orbell‐Smith J, Weir KA. Clinical feeding examination with cervical auscultation for detecting oropharyngeal aspiration: A systematic review of the evidence. Clin Otolaryngol 2019; 44:927-934. [DOI: 10.1111/coa.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 05/16/2019] [Accepted: 07/07/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Thuy T. Frakking
- Speech Pathology Department & Research Development Unit, Metro North Hospital & Health Service, Queensland Health Caboolture Hospital Caboolture QLD Australia
- School of Health and Rehabilitation Sciences The University of Queensland St Lucia QLD Australia
| | - Anne B. Chang
- Department of Respiratory Medicine Queensland Children's Hospital QLD Australia
- Child Health Division, Menzies School of Health Research Charles Darwin University Casuarina NT Australia
- Centre for Children's Health Research Queensland University of Technology QLD Australia
| | - Michael David
- School of Medicine and Public Health The University of Newcastle Gosford NSW Australia
| | - Jane Orbell‐Smith
- Library Services, Metro North Hospital & Health Service Caboolture Hospital Caboolture QLD Australia
| | - Kelly A. Weir
- School of Allied Health Sciences, Menzies Health Institute Queensland Griffith University Brisbane QLD Australia
- Clinical Governance, Education & Research Gold Coast University Hospital Southport QLD Australia
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Armstrong ES, Reynolds J, Carroll S, Sturdivant C, Suterwala MS. Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol 2019; 39:1249-1256. [PMID: 31332272 DOI: 10.1038/s41372-019-0438-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of videofluoroscopy (VFSS) and endoscopy (FEES) in detecting laryngeal penetration and tracheal aspiration in bottle-fed young infants in the NICU. STUDY DESIGN VFSS and FEES findings of 22 infants were compared to each other and to a composite reference standard in this prospective study. Sensitivity, specificity, positive and negative predictive values were calculated for each assessment. RESULT Agreement between VFSS and FEES was high (92%) for aspiration and moderate (56%) for penetration, with FEES detecting more instances of penetration. Compared to the composite reference standard, FEES had greater sensitivity and a higher negative predictive value for penetration than VFSS. Because of the low prevalence of aspiration, diagnostic accuracy could not be determined for aspiration for either assessment. CONCLUSION FEES appears to be more accurate in detecting penetration in this population, and both assessments are valuable tools in a comprehensive feeding and swallowing evaluation.
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Affiliation(s)
- Erika S Armstrong
- Department of Communication Sciences and Oral Health, Texas Woman's University, Denton, TX, USA
| | - Jenny Reynolds
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Sandra Carroll
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Chrysty Sturdivant
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Mustafa S Suterwala
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA.
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Dysphagia characteristics in Huntington's disease patients: insights from the Fiberoptic Endoscopic Evaluation of Swallowing and the Swallowing Disturbances Questionnaire. CNS Spectr 2019; 24:413-418. [PMID: 30198457 DOI: 10.1017/s1092852918001037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a neurodegenerative disease characterized by increasing dysphagia as the disease progresses. Specific characteristics of the HD dysphagia are not well defined. OBJECTIVE To characterize the swallowing disturbances of HD patients, to evaluate the feasibility of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in assessing dysphagia in HD patients, and to discern the relation between FEES findings and patients' self-report on dysphagia symptoms and swallowing related quality of life (SWAL-QOL). METHOD A retrospective case series in a tertiary referral center. All recruited HD patients underwent Bed Side Swallowing Evaluation (BSE), FEES, the Unified Huntington's Disease Rating Scale (UHDRS), and the Montreal Cognitive Assessment (MoCA). All completed the Swallowing Disturbances Questionnaire (SDQ) and the SWAL-QOL questionnaire. RESULTS Fourteen HD patients were recruited. All were able to complete the FEES study. The FEES demonstrated delayed swallowing reflex, solid food residues, and pre/post swallowing spillage in most patients (50%, 53.5%, 83.3%, and 87.5%, respectively). The mean SDQ score was 13.2. Significant correlations were found between the SWAL-QOL fear of eating score; the SDQ oral, pharyngeal, and total scores; and the FEES parameters of pureed and solid food bolus flow time. Significant correlations were also found between the total UHDRS score, the volitional cough score, and the SWAL-QOL disease burden score. CONCLUSION HD patients exhibit prominent unique oropharyngeal dysphagia features that may serve as a marker of disease progression. The FEES and the SDQ are valuable tools for detecting these features in HD patients with swallowing disturbance.
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Effect of aspiration on the lungs in children: a comparison using chest computed tomography findings. BMC Pediatr 2019; 19:162. [PMID: 31117982 PMCID: PMC6529997 DOI: 10.1186/s12887-019-1531-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 05/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Detecting and addressing aspiration early in children with dysphagia, such as those with cerebral palsy, is important for preventing aspiration pneumonia. The current gold standards for assessing aspiration are swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing (FEES) and videofluorographic swallowing study; however, the relationship between aspiration of secretion vs aspiration of foodstuff and pulmonary injury is unclear. To clarify this relationship, we examined the correlations between pneumonia findings from chest computed tomography (CT) and the presence or absence of aspiration detected by FEES. Methods Eighty-five children (11 years 2 months ±7 years 2 months) underwent FEES and chest CT. Based on the FEES findings, the participants were divided into groups: with and without food aspiration, and with and without saliva aspiration. Correlations between chest CT findings of pneumonia and the presence or absence of each type of aspiration were then examined. Results No significant correlations were observed between food aspiration and chest CT findings of pneumonia, whereas saliva aspiration and chest CT findings of pneumonia were significantly correlated. In addition, saliva aspiration was significantly associated with bronchial wall thickening (p < 0.01) and atelectasis (p < 0.05). Conclusions Our findings in children suggest that: (1) the presence or absence of food aspiration detected by FEES evaluation has little correlation with pneumonia, and (2) the presence or absence of saliva aspiration may be an indicator of aspiration pneumonia risk.
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Abstract
INTRODUCTION Laryngotracheal stenosis comprises a broad spectrum of congenital and acquired conditions that commonly cause pediatric airway obstruction. Although the majority of these conditions were historically managed with endoscopic dilations, the introduction of operative procedures such as laryngotracheoplasty, cricotracheal resection, and slide tracheoplasty changed the treatment paradigm. The gradual evolution of endoscopic technology enabled surgeons to perform certain procedures endoscopically that were previously only able to be performed in an open fashion. Areas covered: This review highlights the important aspects of the diagnosis, workup, and surgical treatment of pediatric laryngotracheal stenosis. Important articles describing research and techniques within pediatric airway reconstruction are summarized and included in the review. Expert commentary: The importance of the multidisciplinary concept of treating laryngotracheal stenosis is evidenced by the establishment of aerodigestive centers internationally. In order to continue successfully treating complex cases of laryngotracheal stenosis, further airway research is needed. The application and feasibility of tracheal transplantation and replacement is likely the next frontier in the treatment of laryngotracheal stenosis.
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Affiliation(s)
- Matthew M Smith
- a Division of Pediatric Otolaryngology-Head and Neck Surgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Otolaryngology-Head and Neck Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Robin T Cotton
- a Division of Pediatric Otolaryngology-Head and Neck Surgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Otolaryngology-Head and Neck Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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Vetter-Laracy S, Osona B, Roca A, Peña-Zarza JA, Gil JA, Figuerola J. Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES). Pediatr Pulmonol 2018; 53:437-442. [PMID: 29356410 DOI: 10.1002/ppul.23946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Swallowing disorders which lead to aspiration are common in premature infants with a postmenstrual age (PMA) of >36 weeks. Aspiration is often silent and the unique symptom is desaturation during feeding. The aim of this study was 1) to determine the number of prematures with desaturations during feeding due to aspiration, using Fiberoptic Endoscopic Evaluation of Swallowing (FEES); 2) to relate clinical factors and FEES findings to aspiration; and 3) to describe type and efficacy of suggested treatments. METHODS A retrospective review of 62 ex-premature babies with a median PMA of 40 weeks which underwent FEES due to persistent feeding desaturations. Aspiration was related to other FEES findings and to clinical and demographic data. The efficacy of the treatment was evaluated during the FEES and by comparing recorded desaturations during feeding 7 days before and after FEES. RESULTS A total of 44 (71%) infants were diagnosed with aspiration and/or penetration. No relation was found to demographic or clinical data. The accumulation of saliva and residues post-swallowing were related to aspiration (P < 0.01). In 77.3% of the infants, use of a thickener seemed to reduce aspiration during FEES and was suggested as a treatment. 13.6% of infants received anti-reflux treatment after FEES and 9.1% required gastrostomy. CONCLUSIONS Aspiration is very frequent in premature infants who present desaturations during feeding and FEES is a useful method for diagnosing and suggesting treatments.
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Affiliation(s)
- Susanne Vetter-Laracy
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Borja Osona
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Antonia Roca
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Jose A Peña-Zarza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Jose A Gil
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Joan Figuerola
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
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Torres-Silva CA. Chronic Pulmonary Aspiration in Children: Diagnosis and Management. Curr Probl Pediatr Adolesc Health Care 2018; 48:74-81. [PMID: 29571544 DOI: 10.1016/j.cppeds.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic pulmonary aspiration (CPA) is a common cause of morbidity in children with complex aerodigestive disorders. CPA can be caused by swallowing dysfunction, anatomic, or dynamic abnormalities of the airways, and/or other circumstances that overcome the child's natural capacity to protect the airway. Diagnostic evaluation for suspected aspiration aims to characterize the swallowing function, identify the etiology of aspiration, including anatomic and/or dynamic abnormalities causing aspiration, and evaluate for the development of aspiration sequelae (e.g., bronchiectasis). CPA management approach should be guided by the recognized risk factors and co-morbidities, and directed to decrease the events of aspiration, improve clearance of aspirated material, and limit the development of aspiration sequelae (e.g., chronic inflammation and recurrent infections). This article presents a practical approach for the diagnosis and management of chronic pulmonary aspiration (CPA) in children.
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Affiliation(s)
- Cherie A Torres-Silva
- Division of Pulmonary Medicine at Cincinnati Childrens Hospital Medical Center, Cincinnati, OH.
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20
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Suterwala MS, Reynolds J, Carroll S, Sturdivant C, Armstrong ES. Using fiberoptic endoscopic evaluation of swallowing to detect laryngeal penetration and aspiration in infants in the neonatal intensive care unit. J Perinatol 2017; 37:404-408. [PMID: 28055025 DOI: 10.1038/jp.2016.239] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the safety of fiberoptic endoscopic evaluation of swallowing (FEES) and the reliability of both FEES and a videofluoroscopic swallowing study (VFSS) in identifying laryngeal penetration and tracheal aspiration in infants under 3 months old in the neonatal intensive care unit (NICU). STUDY DESIGN Twenty-five infants at least 37 weeks postmenstrual age suspected of aspirating were assessed with FEES and VFSS. Complications, autonomic instability and vital signs before endoscope insertion and following FEES were documented. Blinded video recordings were coded by two reviewers to determine reliability. RESULTS We found no major complications or significant differences between FEES prefeeding and postfeeding vital signs, including respiratory rate, heart rate or oxygen saturation. FEES interrater reliability was 80% for both penetration and aspiration, compared with 87 and 90%, respectively, for VFSS. CONCLUSION FEES is safe and reliable in assessing laryngeal penetration and tracheal aspiration in NICU infants.
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Affiliation(s)
- M S Suterwala
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA
| | - J Reynolds
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - S Carroll
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - C Sturdivant
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - E S Armstrong
- Department of Communication Sciences and Disorders, Texas Woman's University, Denton, TX, USA
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21
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Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia 2017; 32:27-38. [DOI: 10.1007/s00455-016-9775-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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22
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Bourin PF, Puech M, Woisard V. Pediatric Aspect of Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fuller JC, Sinha S, Caruso PA, Hersh CJ, Butler WE, Krishnamoorthy KS, Hartnick CJ. Chiari malformations: An important cause of pediatric aspiration. Int J Pediatr Otorhinolaryngol 2016; 88:124-8. [PMID: 27497399 DOI: 10.1016/j.ijporl.2016.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 11/16/2022]
Abstract
Chronic aspiration poses a major health risk to the pediatric population. We describe four cases in which work up for chronic aspiration with a brain MRI revealed a Chiari I malformation, a poorly described etiology of pediatric aspiration. All patients had at least one non-specific neurologic symptom but had swallow studies more characteristic of an anatomic than a neurologic etiology. Patients were referred to neurosurgery and underwent posterior fossa decompression with symptom improvement. A high index of suspicion for Chiari malformation should be maintained when the standard work up for aspiration is non-diagnostic, particularly when non-specific neurologic symptoms are present.
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Affiliation(s)
- Jennifer C Fuller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA.
| | - Sumi Sinha
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
| | - Paul A Caruso
- Department of Radiology, Massachuesetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
| | - Cheryl J Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts Eye and Ear Infirmary - Massachusetts General Hospital for Children, 243 Charles St., Boston, MA 02114, USA
| | - William E Butler
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | | | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
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Abstract
Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. Ongoing innovations in neonatal care have gradually led to the salvage of premature and medically fragile infants in whom laryngeal pathology is often more severe, and in whom stenosis often involves not only the subglottis, but also the supraglottis or glottis-causing significant morbidity and mortality. The primary objective of intervention in these children is decannulation or preventing the need for tracheotomy. The aim of this article is to present a more detailed description of both congenital and acquired SGS, highlighting the essentials of diagnostic assessment and familiarizing the reader with contemporary management approaches.
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Affiliation(s)
- Niall D Jefferson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-30309
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-30309
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-30309; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Fiberoptic Endoscopic Evaluation of Swallowing: A Multidisciplinary Alternative for Assessment of Infants With Dysphagia in the Neonatal Intensive Care Unit. Adv Neonatal Care 2016; 16:37-43. [PMID: 26709466 DOI: 10.1097/anc.0000000000000245] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The standard procedure to assess an infant in the neonatal intensive care unit (NICU) who is suspected of aspirating on oral feedings is a videofluoroscopic swallowing study (VFSS). The VFSS has been used for more than 30 years to assess dysphagia and is considered the gold standard. However, there are challenges to the VFSS, including radiation exposure, transport to radiology, usage of barium, limited positioning options, and cost. An alternative approach is fiberoptic endoscopic evaluation of swallowing (FEES), which uses a flexible endoscope passed transnasally into the pharynx to assess anatomy, movement/sensation of structures, swallow function, and response to therapeutic interventions. Fiberoptic endoscopic evaluation of swallowing has been established as a valid tool for evaluating dysphagia and utilized as an alternative or supplement to the VFSS in both adults and children. PURPOSE This article provides an overview of the current challenges in the NICU with assessing aspiration and introduces a multidisciplinary FEES program for bottle and breastfeeding. METHODS/SEARCH STRATEGY A review of the literature of dysphagia, VFSS, and FEES in the adult, pediatric, infant, and neonatal populations was performed. Clinical competency standards were researched and then implemented through an internal process of validation. Finally, a best practice protocol was designed as it relates to FEES in the NICU. FINDINGS/RESULTS Fiberoptic endoscopic evaluation of swallowing is a safe alternative to the VFSS. It can be utilized at the infant's bedside in a NICU for the diagnosis and treatment of swallowing disorders by allowing the clinician the ability to replicate a more accurate feeding experience, therefore, determining a safe feeding plan. IMPLICATIONS FOR PRACTICE Competency and training are essential to establishing a multidisciplinary FEES program in the NICU. IMPLICATIONS FOR RESEARCH Further research is needed to compare the efficacy and validity of FEES versus VFSS for infants in the NICU. Furthermore, evaluating the efficacy of FEES during breastfeeding is warranted.
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Baudon JJ, Renault F, Flores-Guevara R, Vazquez MP. Outcomes of Neonatal Bulbar Weakness. Pediatrics 2016; 137:peds.2015-3004. [PMID: 26659817 DOI: 10.1542/peds.2015-3004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Neonatal bulbar weakness (BW) has various etiologies and a broad prognostic range. We aimed to report outcomes in a large series of children with neonatal BW and explore the association of orofacial electrodiagnostic data with outcome. METHODS We retrospectively reviewed the files of children who presented with facial, lingual, laryngeal, or pharyngeal weakness at birth and who underwent electrodiagnostic studies combining conventional needle electromyography (EMG) of orofacial muscles, blink responses, and EMG during bottle-feeding. Outcome measures included the need for prolonged respiratory assistance and enteral feeding, as well as sensorimotor and cognitive impairments. RESULTS Of 175 patients, 73% had developmental disorders, 25% suffered from acquired brain damage, and 2% had no apparent underlying disorders. Motor or mental impairment was observed in 71%; death occurred in 16%. Outcomes were not significantly different when comparing developmental disorders versus acquired brain damage or neurogenic versus normal detection EMG. Abnormal blink responses were associated with higher frequencies of respiratory assistance (P = .03), gastrostomy (P = .025), and death (P = .009); moderate or severe oropharyngeal incoordinations were associated with higher frequencies of respiratory assistance (P = .006), prolonged enteral feeding (P < .0001), and gastrostomy (P = .0002). CONCLUSIONS Orofacial electrodiagnostic studies provide supplementary information to help the pediatrician anticipate the management and prognosis of young infants with BW.
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Affiliation(s)
- Jean-Jacques Baudon
- Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Francis Renault
- Clinical Neurophysiology Unit, Hôpital Armand-Trousseau, Assistance Publique - Hôpitaux de Paris, Paris, France;
| | - Roberto Flores-Guevara
- Clinical Neurophysiology Unit, Hôpital Armand-Trousseau, Assistance Publique - Hôpitaux de Paris, Paris, France; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Marie-Paule Vazquez
- Faculté de Médecine René Descartes, Université Paris 5, Paris, France; and Department of Maxillofacial Surgery, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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Willette S, Molinaro LH, Thompson DM, Schroeder JW. Fiberoptic examination of swallowing in the breastfeeding infant. Laryngoscope 2015; 126:1681-6. [PMID: 26372024 DOI: 10.1002/lary.25641] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Fiberoptic endoscopic evaluation of swallowing (FEES) is the only instrumental exam that can be used to assess swallowing in a breastfeeding infant. There is minimal data on its efficacy and safety in this patient population. Analyze the common indications for, findings of, and safety of FEES exam in breastfeeding infants. STUDY DESIGN Case series. METHODS Consecutive 10 months old or younger breastfed infants undergoing a FEES exam between June 1, 2012, and August 1, 2014, at a university-based, tertiary care urban children's hospital were studied. Common indications for and findings of FEES, as well as complications of the procedure, were determined. RESULTS Twenty-four FEES were reviewed on 23 patients. There were 14 males (58%). The average age was 14 weeks, and two children were premature. Common indications for FEES were feeding difficulties (52%), noisy breathing with/without feeding (28%), and cyanosis (16%). Of the patients who participated in active breastfeeding during the exam, a functional swallow was identified in 12.5%. The remaining patients demonstrated dysphagia characterized by laryngeal penetration (83%) and/or direct aspiration (50%). The most common findings were laryngeal edema (29%), anterior displacement of glottis structures (14%), and cobblestoning (11%). There was no morbidity directly associated with the procedure. No cyanosis or respiratory distress occurred during or immediately after the procedure. CONCLUSION Performing FEES exams on breastfeeding infants is safe and effective. There is no other instrumental evaluation of swallowing to assess dysphagia in this population. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1681-1686, 2016.
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Affiliation(s)
- Susan Willette
- Department of Speech Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Laura Hinkes Molinaro
- Department of Speech Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Dana M Thompson
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago.,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - James W Schroeder
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago.,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Simons JP, Greenberg LL, Mehta DK, Fabio A, Maguire RC, Mandell DL. Laryngomalacia and swallowing function in children. Laryngoscope 2015; 126:478-84. [PMID: 26152504 DOI: 10.1002/lary.25440] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS 1) To determine the prevalence of dysphagia in children with laryngomalacia, 2) To ascertain whether severity of laryngomalacia influences the presence of swallowing dysfunction, and 3) To examine whether patients with medical comorbidities and laryngomalacia have a higher prevalence of swallowing dysfunction. STUDY DESIGN Retrospective cohort study. METHODS All patients seen in the aerodigestive center at our institution between January 2007 and December 2012 with the diagnosis of laryngomalacia were included. Swallowing function was assessed by symptoms, clinical swallowing evaluations (CSE) performed by speech pathologists, modified barium swallow (MBS) studies, and fiberoptic endoscopic evaluations of swallowing (FEES). RESULTS There were 324 patients with laryngomalacia identified (41.4% female, 58.6% male). Severity of laryngomalacia was categorized in 279 patients, with 62.7% mild, 28.7% moderate, and 8.6% severe. Gastroesophageal reflux disease (GERD) was diagnosed in 69.8% of patients. Other medical comorbidities included Down syndrome (3.1%), neurological impairment (6.5%), and congenital heart disease (0.9%). Symptoms of dysphagia or feeding difficulty were present in 163/324 (50.3%), and failure to thrive was present in 31/324 patients (9.6%). At least one abnormal swallowing assessment was present in 97/120 (80.8%) patients presenting with subjective dysphagia and 43/65 (66.2%) patients without subjective dysphagia. A total of 140/185 (75.7%) patients had at least one abnormal baseline swallowing assessment. There was no significant relationship between severity of laryngomalacia and presence of abnormal swallowing function based on symptoms, CSE, MBS, or FEES. However, patients with greater severity were more likely to have failure to thrive. There was not a significant association between the presence of swallowing dysfunction or disease severity and medical comorbidities such as Down syndrome, neurological impairment, or congenital heart disease. However, GERD was more likely to be present in patients with moderate and severe laryngomalacia than in patients with mild disease. CONCLUSIONS Swallowing dysfunction is common in children with laryngomalacia regardless of disease severity or other medical comorbidities. Swallowing studies are frequently abnormal in laryngomalacia patients presenting both with and without subjective symptoms of dysphagia. Dysphagia assessment should be considered as part of the evaluation of infants with laryngomalacia. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jeffrey P Simons
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Laura L Greenberg
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Deepak K Mehta
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Anthony Fabio
- Epidemiology Data Center, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Raymond C Maguire
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - David L Mandell
- Center for Pediatric ENT-Head and Neck Surgery, Boynton Beach, Florida, U.S.A
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Abdulmassih EMDS, Teive HAG, Santos RS. The evaluation of swallowing in patients with spinocerebellar ataxia and oropharyngeal dysphagia: A comparison study of videofluoroscopic and sonar doppler. Int Arch Otorhinolaryngol 2015; 17:66-73. [PMID: 26038680 PMCID: PMC4440452 DOI: 10.7162/s1809-97772013000100012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/25/2012] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Spinocerebellar ataxia (SCA) is a degenerative disease that can cause loss of coordination of voluntary muscle movement such as that required for swallowing. AIMS The purposes of this cross-sectional and comparative case study were: (1) to assess the severity of dysphagia through a videofluoroscopic swallow study, and (2) to compare differences in frequency, intensity, and duration of sound waves produced during swallowing in normal and SCA patients by using sonar Doppler. METHOD During swallow evaluation using videofluoroscopy, a sonar Doppler transducer was placed on the right side of the neck, at the lateral edge of the trachea, just below the cricoid cartilage to capture the sounds of swallowing in 30 SCA patients and 30 controls. RESULT The prevalence in the dynamic evaluation of swallowing videofluoroscopy was by changes in the oral phase of swallowing. The analysis of variance of the averages found in each variable - frequency, intensity and duration of swallowing - shows there was a significant correlation when compared to the healthy individual curve. CONCLUSION The study demonstrates the prevalence of oral dysphagia observed in dynamic videofluoroscopic swallow evaluation. In patients with SCA, the mean initial frequency (IF), initial intensity (II), and final intensity (FI) were higher and the time (T) and peak frequency (PF) were lower, demonstrating a pattern of cricopharyngeal opening very close to that found in normal populations.
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Affiliation(s)
- Edna Márcia da Silva Abdulmassih
- Speech Therapist Speech Therapy Specialist Hospital PUC PR Master in Communication Disorders UTP PR Doctoral Student in Internal Medicine UFPR
| | | | - Rosane Sampaio Santos
- Speech Therapist Master in Communication Disorders UTP PR Doctoral Student in Internal Medicine UFPR
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Lagos HNC, Santos RS, Abdulmassih EMDS, Gallinea LF, Langone M. Characterization of swallowing sounds with the use of sonar Doppler in full-term and preterm newborns. Int Arch Otorhinolaryngol 2013; 17:383-6. [PMID: 25992041 PMCID: PMC4399192 DOI: 10.1055/s-0033-1353369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/11/2013] [Indexed: 11/24/2022] Open
Abstract
Introduction Technological advances have provided a large variety of instruments to view the swallowing event, aiding in the evaluation, diagnosis, and monitoring of disturbances. These advances include electromyography of the surface, dynamic video fluoroscopy, and most recently sonar Doppler. Objective To characterize swallowing sounds in typical children through the use of sonar Doppler. Method Thirty newborns participated in this prospective study. All newborns received breast milk through either their mother's breasts or bottles during data collection. The newborns were placed in either right lateral or left lateral positions when given breast milk through their mother's breasts and in a sitting position when given a bottle. There were five variables measured: initial frequency of sound wave (FoI), frequency of the first peak of the sound wave (FoP1), frequency of the second peak of the sound wave (FoP2), initial intensity and final sound wave (II and IF), and swallowing length (T), the time elapsed from the beginning until the end of the analyzed acoustic signal measured by the audio signal, in seconds. Results The values obtained in the initial frequency of the babies had a mean of 850 Hz. In terms of frequency of first peak, only three presented with a subtle peak, which was due to the elevated larynx position. Conclusion The use of sonar Doppler as a complementary exam for clinical evaluations is of upmost importance because it is nonintrusive and painless, and it is not necessary to place patients in a special room or expose them to radiation.
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Affiliation(s)
- Hellen Nataly Correia Lagos
- Department of Internal Medicine, Federal University of Paraná (UFPR), Curitiba/PR, Brazil
- Department of Orofacial Motricity: Dysphagia, Scope Hospital, University Tuiuti of Paraná (UTP), Curitiba/PR, Brazil
| | - Rosane Sampaio Santos
- Department of Internal Medicine, Federal University of Paraná (UFPR), Curitiba/PR, Brazil
- Department of Speech Pathology, University Tuiuti of Paraná (UTP), Curitiba/PR, Brazil
| | - Edna Marcia da Silva Abdulmassih
- Department of Internal Medicine, Federal University of Paraná (UFPR), Curitiba/PR, Brazil
- Department of Speech Therapy, Pathology Specialist Hospital Speech, The Pontifical Catholic University of Paraná (PUC), Curitiba/PR, Brazil
| | - Liliane Friedrich Gallinea
- Department of Orofacial Motricity: Dysphagia, Scope Hospital, University Tuiuti of Paraná (UTP), Curitiba/PR, Brazil
- Department of Child and Adolescent, Federal University of Paraná (UFPR), Curitiba/PR, Brazil
| | - Mariangela Langone
- Department of Orofacial Motricity: Dysphagia, Scope Hospital, University Tuiuti of Paraná (UTP), Curitiba/PR, Brazil
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Weir K, McMahon S, Chang AB. Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev 2012; 2012:CD005303. [PMID: 22972084 PMCID: PMC7389607 DOI: 10.1002/14651858.cd005303.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals. OBJECTIVES Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in May 2102. SELECTION CRITERIA All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported. MAIN RESULTS No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration. AUTHORS' CONCLUSIONS There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.
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Affiliation(s)
- Kelly Weir
- Paediatrics and Child Health, University of Queensland, Herston, Queensland, Australia.
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Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation. Ann Thorac Surg 2012; 94:1257-61. [PMID: 22421593 DOI: 10.1016/j.athoracsur.2012.01.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/03/2012] [Accepted: 01/06/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the incidence of vocal cord (VC) and swallowing dysfunction in infants after the Norwood operation and to examine the relationship between laryngopharyngeal dysfunction and postoperative outcomes. METHODS We conducted a retrospective review of 63 infants who underwent routine postoperative fiberoptic endoscopic evaluation of swallowing function and vocal cords after a Norwood operation at our institution during a recent 6-year period (2003-2009). RESULTS The overall incidence of VC dysfunction after the Norwood operation was 58.7%. After a modification of the aortic arch dissection technique in 2007, the incidence of VC dysfunction decreased significantly from 79.5% in 2003 through 2006 to 25% in 2007 through 2009 (p<0.001). The incidence of swallowing dysfunction also decreased from 23.1% in 2003 through 2006 to 4.2% in 2007 through 2009 (p=0.07). Swallowing dysfunction was more common in patients with VC dysfunction (21.6%) as compared with patients without VC dysfunction (7.7%; p=0.18). Patients with VC dysfunction were more often discharged home on tube-only feeding regimens compared with infants without VC dysfunction (46% versus 26.9%). In infants with both VC and swallowing dysfunction, 75% were discharged exclusively to have tube feeding. Median hospital length of stay tended to be longer in infants with swallowing dysfunction (31 days) than in infants without swallowing dysfunction (23 days; p=0.16). CONCLUSIONS Vocal cord and swallowing dysfunction are common in infants after the Norwood operation and may increase the need for tube feeding regimens. Modification of surgical techniques for dissection and mobilization of the aorta can significantly reduce the incidence of these adverse outcomes.
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Pediatric Aspect of Dysphagia. Dysphagia 2012. [DOI: 10.1007/174_2012_583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sitton M, Arvedson J, Visotcky A, Braun N, Kerschner J, Tarima S, Brown D. Fiberoptic Endoscopic Evaluation of Swallowing in children: feeding outcomes related to diagnostic groups and endoscopic findings. Int J Pediatr Otorhinolaryngol 2011; 75:1024-31. [PMID: 21663978 DOI: 10.1016/j.ijporl.2011.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 05/06/2011] [Accepted: 05/07/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is used as an adjunct to assess swallowing function in children with complex feeding disorders. We report the feeding outcomes of patients who underwent FEES to determine whether associations exist between clinical diagnoses or FEES findings and feeding outcomes. METHODS Retrospective review of children who underwent FEES for dysphagia or aspiration from 2003 to 2009. The clinical diagnoses and initial FEES findings were compared to follow up feeding status for associations. RESULTS 79 patients were included (44 males and 35 females). The change from initial to final status: total oral feeding (42-67%), NPO ± minimal tastes (39-21%) and oral feeding with tube feeding (19-12%). Of the clinical diagnoses, tonsillar hypertrophy was associated with ultimately obtaining total oral feeding status (p = 0.046) while the inability to obtain total oral feeding status was associated with neurologic (p < 0.001). The initial FEES findings showed no significant associations with long-term feeding status. CONCLUSION Many children overcome their dysphagia but those with neurologic disorders are less likely to achieve total oral feeding status. In children with dysphagia evaluated by FEES, the long-term feeding status is not significantly associated with the initial FEES findings.
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Affiliation(s)
- Matthew Sitton
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, WI, United States.
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Marques IL, Prado-Oliveira R, Leirião VHV, Jorge JC, De Souza L. Clinical and Fiberoptic Endoscopic Evaluation of Swallowing in Robin Sequence Treated with Nasopharyngeal Intubation: The Importance of Feeding Facilitating Techniques. Cleft Palate Craniofac J 2010; 47:523-9. [DOI: 10.1597/09-002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate oral feeding capacity, the swallowing process, and risk for aspiration, both clinically and during fiberoptic endoscopic evaluation of swallowing, in infants with isolated Robin sequence treated exclusively with nasopharyngeal intubation and feeding facilitating techniques. Design Longitudinal and prospective study. Setting Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, Brazil. Patients Eleven infants with isolated Robin sequence, under 2 months of age, treated with nasopharyngeal intubation. Interventions Feeding facilitating techniques were applied in all infants throughout the study period. The infants were evaluated clinically and through fiberoptic endoscopic evaluation of swallowing at first, second, and, if necessary, third week of hospitalization (T1, T2, T3). The mean volume of ingested milk was registered during clinical evaluation, and events were registered during feeding. Results The respiratory status of all infants was improved after nasopharyngeal intubation; 72% of them presented risk for aspiration during fiberoptic endoscopic evaluation of swallowing at T1. This risk was less frequent when thickened milk was given to the infants and at subsequent evaluations (T2 and T3). Conclusions Nasopharyngeal intubation aids in stabilizing the airway in isolated Robin sequence, but it does not relate directly to feeding. The risk for aspiration was present in most of the infants, mainly during the first week of hospitalization, and improved within a few weeks, after the use of feeding facilitating techniques.
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Affiliation(s)
- Ilza Lazarini Marques
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP), Bauru, São Paulo, Brazil
| | - Rosana Prado-Oliveira
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP), Bauru, São Paulo, Brazil
| | - Vera Helena Valente Leirião
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP), Bauru, São Paulo, Brazil
| | - José Carlos Jorge
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP), Bauru, São Paulo, Brazil
| | - Luiz De Souza
- Faculdade de Medicina de Ribeiráo Preto, Universidade de São Paulo, Ribeiráo Preto, São Paulo, Brazil
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Geddes DT, Chadwick LM, Kent JC, Garbin CP, Hartmann PE. Ultrasound imaging of infant swallowing during breast-feeding. Dysphagia 2009; 25:183-91. [PMID: 19626366 DOI: 10.1007/s00455-009-9241-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 06/20/2009] [Indexed: 10/20/2022]
Abstract
Coordination of infants' suck-swallow-breathing patterns is integral to safe and efficient feeding. However, assessment of these patterns is difficult and often invasive, particularly in breast-fed infants less than 4 months of age. The aims of this study were to develop an ultrasound approach to visualize swallowing in term breast-feeding infants and to determine the accuracy of ultrasound imaging of swallowing compared to respiratory inductive plethysmography (RIP). On ultrasound, the breast milk bolus was observed as a predominantly echogenic area moving inferiorly. Of the 388 swallows detected with ultrasound, 379 correlated with the swallow apneas detected by RIP (R(2) = 0.98). The mean duration of the swallow was 0.63 +/- 0.06 s. Ultrasound imaging is a noninvasive accurate method for detection of swallowing by visualization of movement of the milk bolus through the pharyngeal area of a breast-feeding infant. These techniques may potentially provide useful information for infants experiencing breast-feeding difficulties.
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Affiliation(s)
- Donna T Geddes
- Biomedical, Biomolecular and Chemical Sciences, School of Biomedical and Chemical Sciences, Faculty of Life and Physical Sciences, The University of Western Australia, Perth, Western Australia, Australia.
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Suiter DM, Leder SB, Karas DE. The 3-ounce (90-cc) water swallow challenge: A screening test for children with suspected oropharyngeal dysphagia. Otolaryngol Head Neck Surg 2009; 140:187-90. [DOI: 10.1016/j.otohns.2008.11.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 11/27/2022]
Abstract
Objectives: To investigate the clinical utility of the 3-ounce (90-cc) water swallow challenge alone to determine both aspiration status and oral feeding recommendations in children. Design: Cross-sectional evaluation of a diagnostic test with a consecutive, referral-based sample. Setting: Urban, tertiary care, teaching hospital. Participants: Fifty-six children (age range 2–18 years; mean 13 years) referred for swallowing evaluations. Outcome Measures: Aspiration status during fiberoptic endoscopic evaluation of swallowing (FEES) was the objective criterion standard with which results from the 3-ounce water swallow challenge were compared. Results: Twenty-two (39.3%) participants passed and 34 (60.7%) failed the 3-ounce challenge. Sensitivity for predicting aspiration status during FEES = 100.0 percent, specificity = 51.2 percent, and false-positive rate = 48.4 percent. Sensitivity for identifying individuals who were deemed safe for oral intake based on FEES results = 100.0 percent, specificity = 44.0 percent, and false-positive rate = 56.0 percent. Conclusions: If the 3-ounce water swallow challenge is passed, not only thin liquids but diet recommendations with puree and solid food consistencies can be made without the need for further instrumental dysphagia assessment. Significance: The 3-ounce water swallow challenge has been shown to be a clinically useful screening test for oropharyngeal dysphagia in children.
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Affiliation(s)
- Debra M. Suiter
- From the School of Audiology and Speech-Language Pathology, the University of Memphis (Dr Suiter), and the Yale University School of Medicine (Drs Leder and Karas)
| | - Steven B. Leder
- From the School of Audiology and Speech-Language Pathology, the University of Memphis (Dr Suiter), and the Yale University School of Medicine (Drs Leder and Karas)
| | - David E. Karas
- From the School of Audiology and Speech-Language Pathology, the University of Memphis (Dr Suiter), and the Yale University School of Medicine (Drs Leder and Karas)
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Leder SB, Murray JT. Fiberoptic endoscopic evaluation of swallowing. Phys Med Rehabil Clin N Am 2008; 19:787-801, viii-ix. [PMID: 18940641 DOI: 10.1016/j.pmr.2008.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fiberoptic endoscopic evaluation of swallowing is a technique that allows for the assessment of pharyngeal dysphagia and the implementation of rehabilitation interventions with the goal of promoting safe and efficient swallowing. An overview of the equipment needed for the laryngoscopic evaluation, how to conduct the examination, what can be visualized endoscopically, diagnostic parameters, the implementation of therapeutic strategies, and suggestions for future research are discussed herein.
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Affiliation(s)
- Steven B Leder
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, PO Box 208041, New Haven, CT 06520-8041, USA.
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Postma GN, McGuirt WF, Butler SG, Rees CJ, Crandall HL, Tansavatdi K. Laryngopharyngeal Abnormalities in Hospitalized Patients With Dysphagia. Laryngoscope 2007; 117:1720-2. [PMID: 17690603 DOI: 10.1097/mlg.0b013e31811ff906] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES). STUDY DESIGN Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video-recorded by a speech-language pathologist (SLP). METHODS Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings. RESULTS Sixty-one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy-six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty-five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated. CONCLUSIONS Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow-up of mucosal and neuromuscular findings that do not respond to medical management.
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Affiliation(s)
- Gregory N Postma
- Department of Otolaryngology, Center for Voice and Swallowing Disorders, Medical College of Georgia, Augusta, Georgia, USA.
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Boseley ME, Ashland J, Hartnick CJ. The utility of the fiberoptic endoscopic evaluation of swallowing (FEES) in diagnosing and treating children with Type I laryngeal clefts. Int J Pediatr Otorhinolaryngol 2006; 70:339-43. [PMID: 16125795 DOI: 10.1016/j.ijporl.2005.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 06/24/2005] [Indexed: 10/25/2022]
Abstract
This case series of three young children with type I laryngeal clefts is presented to demonstrate the utility of fiberoptic endoscopic evaluation of swallowing (FEES) in managing these patients. FEES revealed laryngeal penetration in a posterior to anterior direction in two patients and penetration from lateral to medial in the third patient. The type of laryngeal penetration helped in making the diagnosis of a type I cleft in two children and helped establish a safe feeding regiment in the third child. Patients with type I laryngeal clefts are often misdiagnosed, most likely resulting from the complex presentation of signs/symptoms and the difficulty of detecting small clefts with currently available tests. The pattern of laryngeal aspiration seen with FEES can help in diagnosis and management in this patient population.
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Affiliation(s)
- Mark E Boseley
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, 02114-3914, USA.
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Weir K, McMahon S, Chang AB. Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev 2005:CD005303. [PMID: 16235398 DOI: 10.1002/14651858.cd005303.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals. OBJECTIVES Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in January 2005. SELECTION CRITERIA All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported. MAIN RESULTS No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration. AUTHORS' CONCLUSIONS There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.
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Affiliation(s)
- K Weir
- University of Queensland, Paediatrics and Child Health, Herston, Queensland, Australia.
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Rogers B, Arvedson J. Assessment of infant oral sensorimotor and swallowing function. ACTA ACUST UNITED AC 2005; 11:74-82. [PMID: 15856438 DOI: 10.1002/mrdd.20055] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The development of feeding and swallowing is the result of a complex interface between the developing nervous system, various physiological systems, and the environment. The purpose of this article is to review the neurobiology, development, and assessment of feeding and swallowing during early infancy. In recent years, there have been exciting advances in our understanding of the physiology and neurological control of feeding and swallowing. These advances may prove useful in furthering our understanding of the pathophysiology of dysphagia in infancy. Progress in developing standardized, reliable, and valid measures of oral sensorimotor and swallowing function in infancy has been slow. However, there have been significant advances in the instrumental analysis of feeding and swallowing disorders in infancy, including manometric analyses of sucking and swallowing, measures of respiration during feeding, videofluoroscopic swallow evaluations, ultrasonography, and flexible endoscopic examination of swallowing. Further efforts are needed to develop clinical evaluative measures of dysphagia in infancy.
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Affiliation(s)
- Brian Rogers
- Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, Oregon 97207, USA.
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Abstract
Dysphagia is a common finding in infants and children with neuromuscular disabilities. Dysphagia may be developmental, as in the preterm infant, transient, chronic, or progressive. The evaluation of dysphagia must take into account the age of the patient and typical development of feeding and swallowing for that age. The typical abilities seen in neonatal, early infancy, later infancy and early childhood periods vary in sensorimotor skills and feeding efficiency. In addition to knowing the substrate of expected skills by age, knowledge of the neurophysiology of feeding and swallowing is essential to diagnosis. Each physiologic phase of deglutition: oral, pharyngeal, and esophageal can present with symptoms of dysphagia that can guide investigation. Common symptoms of dysphagia include generalized feeding difficulty such as poor efficiency, food refusal and failure to thrive. Specific symptoms include tongue thrust, choking, cough, and oxygen desaturation. The possibility of dysphagia can be identified through a thorough feeding history. Examination initially includes the infant's muscle tone and posture in the head, neck and body. Anomalies of structures of the head and neck must be identified and examined for their effect on function. Next, examination of oral structures for reflexes, tongue movements, and symmetry will identify neurologic abnormalities. Observation of feeding is essential and will reveal signs of dysphagia. Aspiration in the infant can present without specific signs. Respiratory abnormalities or Gastroesophageal reflux can be identified during history or examination. Investigation of dysphagia most commonly includes videofluoroscopy, endoscopy, and ultrasonography. The management of dysphagia requires an individualized approach and will include neurologic, respiratory, nutritional and possibly gastrointestinal management. Six broad areas are identified that must be considered in the management of dysphagia in infants and children. They include: normalization of posture and positioning, adaptation of foods and feeding equipment, oromotor therapy, feeding therapy, nutritional support and management of associated disorders. A team of professionals will assist the parent and child in achieving pleasant feedings to foster appropriate growth and development.
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Affiliation(s)
- Anna Dusick
- Section of Developmental Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Schwarz SM. Feeding Disorders in Children With Developmental Disabilities. INFANTS & YOUNG CHILDREN 2003; 16:317-330. [DOI: 10.1097/00001163-200310000-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
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Abstract
OBJECTIVES/HYPOTHESIS Approximately 8 million people in the United States report some degree of dysphagia annually; as the population continues to age, this will become a greater problem. A comprehensibly performed and interpreted fiberoptic endoscopic evaluation of swallowing provides invaluable information for the evaluation and management of individuals with dysphagia or aspiration, or both. STUDY DESIGN Review. METHODS The state-of-the-art technique, interpretation, predictive value, and safety of fiberoptic endoscopic evaluation of swallowing was reviewed.
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Affiliation(s)
- Susan G Hiss
- Center for Voice Disorders of Wake Forest University and Department of Otolarynology, School of Medicine, Winston-Salem, North Carolina 27157, USA
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Abstract
Feeding disorders are common in infants and children. Multiple interacting behavioral, anatomic, and functional factors all can impact on the feeding process, making the evaluation and treatment of pediatric disorders complex and challenging. Knowledge of the normal process of feeding and swallowing, a careful history, observation of the patient during a feeding session, and selected tests usually provide an understanding of the underlying cause of feeding difficulties. Treatment of underlying pathology and careful balancing of the risks and benefits of oral feeding underlie the selection of an optimal management strategy.
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Affiliation(s)
- Colin D Rudolph
- Department of Pediatrics, Medical College of Wisconsin, Section of Pediatric Gastroenterology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
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