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Liu Y, Wang X, Wang LB, Sun XR. Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Infants With Congenital Laryngeal Developmental Anomalies. J Voice 2023:S0892-1997(23)00204-7. [PMID: 37806900 DOI: 10.1016/j.jvoice.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To evaluate the correlation between clinical characteristics and radionuclide salivagram findings in infants with congenital laryngeal developmental anomalies, and determine the clinical characteristics that could predict the positive results of radionuclide salivagram. METHODS 151 hospitalized infants with congenital laryngeal developmental anomalies were retrospectively included to assess the correlation between positive radionuclide salivagram results and clinical features, and a multivariate logistic regression model was constructed to identify significant correlates that jointly predict positive radionuclide salivagram results. RESULTS Positive radionuclide salivagram results were significantly associated with fever, neurological diseases, congenital syndromes, and positive pathogenetic test results in univariate analysis. Positive radionuclide salivagram were significantly associated with fever (odds ratio [OR] = 3.494; 95% confidence interval [CI] 1.414-8.630; P = 0.007), neurological diseases (OR = 3.296; 95% CI 1.335-8.138; P = 0.010), and congenital syndromes (OR = 5.069, 95% CI 1.696-15.154; P = 0.004) in a multivariable logistic regression analysis. CONCLUSION Fever, concurrent neurological diseases, and concurrent congenital syndromes were discovered as clinical factors that could predict positive radionuclide salivagram results and salivary aspiration should be highly suspected in infants with these clinical factors of congenital laryngeal developmental anomalies.
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Affiliation(s)
- Yun Liu
- Department of Pneumology, Xi'an Children's Hospital, Xi'an, Shaanxi, China
| | - Xue Wang
- Department of Pneumology, Xi'an Children's Hospital, Xi'an, Shaanxi, China
| | - Li-Bo Wang
- Department of Pneumology, Children's Hospital of Fudan University, Shanghai, China.
| | - Xin-Rong Sun
- Department of Pneumology, Xi'an Children's Hospital, Xi'an, Shaanxi, China.
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2
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Nguyen J, Ongkasuwan J, Anand G, Lambert EM. Combined laryngeal cleft injection laryngoplasty and salivary botulinum toxin for saliva aspiration. Laryngoscope Investig Otolaryngol 2022; 7:1194-1199. [PMID: 36000049 PMCID: PMC9392396 DOI: 10.1002/lio2.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Children with type I laryngeal clefts and sialorrhea can have posterior drooling, aspiration of oral secretions, and respiratory complications. Laryngeal cleft injection laryngoplasty (LCIL) and salivary botulinum injections (Sal-Bot) have been used separately for short-term treatment of type I laryngeal clefts and sialorrhea. Our goal was to evaluate combined LCIL and Sal-Bot and create recommendations for further treatment based on response to initial treatment. Methods Retrospective chart review of nine patients who underwent direct laryngoscopy and bronchoscopy with combined LCIL and Sal-Bot from 2012 to 2019. Charts were reviewed for patient characteristics, response to treatment, and pre and post-op hospitalizations. Subsequent procedures were performed depending on efficacy of initial treatments. Results Nine patients were identified. All had pre-existing neurologic conditions, gastrostomy tubes, and a history of coughing and choking on secretions. Only one patient was able to feed orally (purees). 1 U/kg of botulinum toxin per gland was injected into each parotid and submandibular gland. The average units of botulinum toxin injected was 67 U. The mean laryngeal cleft injection volume was 0.35 cc. Subsequent treatment was based on timing of symptomatic improvement and individual patient factors. Five patients had respiratory-related hospitalizations in year preceding the procedures (median 1.5, range 1-10). Three (60%) had a reduction in respiratory-related hospitalization 1 year post procedure (median 1, range 1-3). One patient died during the follow up period due to continued chronic respiratory failure. Conclusions This is the first study of combined laryngeal cleft injection laryngoplasty and botulinum toxin injections for patients with posterior laryngeal penetration and aspiration of oropharyngeal secretions. We highlight strategies for choosing subsequent procedures based on response to initial treatment. Level of Evidence 4.
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Affiliation(s)
- Justin Nguyen
- Department of Otolaryngology: Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Julina Ongkasuwan
- Department of Otolaryngology: Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
- Division of Pediatric Otolaryngology, Department of SurgeryTexas Children's HospitalHoustonTexasUSA
| | - Grace Anand
- Division of Pediatric Otolaryngology, Department of SurgeryTexas Children's HospitalHoustonTexasUSA
| | - Elton M. Lambert
- Department of Otolaryngology: Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
- Division of Pediatric Otolaryngology, Department of SurgeryTexas Children's HospitalHoustonTexasUSA
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3
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Shao F, Zhao X, Toyama H, Ichihara T, Zhuang H, Zhao R, Kung BT, Ng KS, Zhang Z, Wu H. Semi-quantitative assessment optimized the grading of pulmonary aspiration on salivagram in children. Ann Nucl Med 2021; 35:321-327. [PMID: 33555558 DOI: 10.1007/s12149-020-01564-6] [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: 09/27/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Salivagram is one of the imaging modalities to detect pulmonary aspiration in children. This study aims to optimize the classification of pulmonary aspiration detected by salivagram with a semi-quantitative analytical method. METHODS This is a retrospective study involving 737 patients (471 males, 266 females; aged 1 month to 8 years; mean age 5.3 months, median age 3.0 months old) with suspected pulmonary aspiration, who had salivagram done between January 2018 and June 2019. Positive cases were divided into 10 groups (Grade 1, R2, L2, R2L2, R3, L3, R3L2, R2L3, R3L3, and 4) according to the scintigraphic findings. Aspiration index was determined as the ratio of the count in the respiratory tract to the total count in the image field of view and compared among different groups using the receiver operating characteristics (ROC) curve analysis. RESULTS A total of 180 cases had positive scintigraphic findings of various grades of aspiration (24.4%, 180/737). There is a high consistency among the two independent nuclear medicine physicians involved in the study, in determining both the disease gradings (κ = 0.919;95% CI: 0.915-0.923) and aspiration index (ICC = 0.994;95% CI: 0.993-0.996). There is no significant difference (p > 0.05) in aspiration index among the gradings in "mild" group (grade 1, R2, L2, L2R2), and "moderate" group (grade R3, R3L2, R3L3). After dividing the different grades into "mild", "moderate" and "severe" groups, the aspiration index of "mild" group is 4.40 ± 2.01, that of "moderate" group is 16.43 ± 8.20, and that of "severe" group is 46.94 ± 14.81. Difference in groups was statistically significant (p < 0.0001). In ROC curve analysis, AUC of "mild" and "moderate" groups is 0.970 and that of "moderate" and "severe" groups is 0.943; the cut-off value with highest diagnostic efficiency is 6.75 between "mild" and "moderate" groups and 38.00 between "moderate" and "severe" groups. CONCLUSIONS We introduced a semi-quantitative analytical method in pulmonary aspiration on salivagram, to optimize and supplement to the current classification of pulmonary aspiration.
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Affiliation(s)
- Fuqiang Shao
- Department of Nuclear Medicine, Zigong First People's Hospital, Zigong, Sichuan, 643000, People's Republic of China
| | - Xiaofei Zhao
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China
- Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Takashi Ichihara
- Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hongming Zhuang
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruifang Zhao
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China
| | - Boom Ting Kung
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Kowloon, Hong Kong, People's Republic of China
| | - Kwok Sing Ng
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Kowloon, Hong Kong, People's Republic of China
| | - Ziwei Zhang
- Department of Nuclear Medicine, Zigong First People's Hospital, Zigong, Sichuan, 643000, People's Republic of China
| | - Ha Wu
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China.
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4
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Fogarty MJ, Brandenburg JE, Sieck GC. Diaphragm neuromuscular transmission failure in a mouse model of an early-onset neuromotor disorder. J Appl Physiol (1985) 2020; 130:708-720. [PMID: 33382958 DOI: 10.1152/japplphysiol.00864.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The spa transgenic mouse displays spasticity and hypertonia that develops during the early postnatal period, with motor impairments that are remarkably similar to symptoms of human cerebral palsy. Previously, we observed that spa mice have fewer phrenic motor neurons innervating the diaphragm muscle (DIAm). We hypothesize that spa mice exhibit increased susceptibility to neuromuscular transmission failure (NMTF) due to an expanded innervation ratio. We retrogradely labeled phrenic motor neurons with rhodamine and imaged them in horizontal sections (70 µm) using confocal microscopy. Phrenic nerve-DIAm strip preparations from wild type and spa mice were stretched to optimal length, and force was evoked by phrenic nerve stimulation at 10, 40, or 75 Hz in 330-ms duration trains repeated each second (33% duty cycle) across a 120-s period. To assess NMTF, force evoked by phrenic nerve stimulation was compared to force evoked by direct DIAm stimulation superimposed every 15 s. Total DIAm fiber number was estimated in hematoxylin and eosin-stained strips. Compared to wild type, spa mice had over twofold greater NMTF during the first stimulus train that persisted throughout the 120 s period of repetitive activation. In both wild type and spa mice, NMTF was stimulation-frequency dependent. There was no difference in neuromuscular junction morphology or the total number of DIAm fibers between wild type and spa mice, however, there was an increase innervation ratio (39%) in spa mice. We conclude that early-onset developmental neuromotor disorders impair the efficacy of DIAm neuromuscular transmission, likely to contribute to respiratory complications.NEW & NOTEWORTHY Individuals with motor control deficits, including cerebral palsy (CP) often have respiratory impairments. Glycine-receptor mutant spa mice have early-onset hypertonia, and limb motor impairments, similar to individuals with CP. We hypothesized that in the diaphragm of spa mice, disruption of glycinergic inputs to MNs would result in increased phrenic-DIAm neuromuscular transmission failure. Pathophysiologic abnormalities in neuromuscular transmission may contribute to respiratory dysfunction in conditions where early developmental MN loss or motor control deficits are apparent.
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Affiliation(s)
- Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gary C Sieck
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Abstract
OBJECTIVE The aim of this study was to analyse the potential effect of indwelling nasogastric tubes (NGTs) on the positive rate of pulmonary aspiration in the salivagram of paediatric patients. METHODS This retrospective study evaluated 290 children suffering from respiratory tract infection with clinical suspicion of pulmonary aspiration (104 cases with NGT and 186 cases without NGT). Among them, 216 had good past health, while 74 had history of oropharyngeal diseases or brain injuries. Tc-DTPA salivagrams were performed to determine whether the risk of pulmonary aspiration was different between patients with and without NGT. RESULTS The positive rates of aspiration in salivagram were 32.3% (60/186) and 29.8% (31/104) in the patients without and with NGT, respectively. The positive rates of the two groups had not statistically significant difference [risk ratio (RR) = 0.924; 95% confidence interval (CI): 0.644-1.326; P = 0.666]. Subgroup analyses showed that the patients with good past health had the positive rates of 24.4% (19/78) with NGT and 25.4 % (35/138) without NGT. The two groups had no statistically significant difference (RR = 0.960; 95% CI: 0.592-1.559; P = 0.870). For the patients with underlying diseases, the positive rates were 46.2% (12/26) with NGT and 52.1% (25/48) without NGT. These two groups also demonstrated no statistically significant difference (RR = 0.886; 95% CI: 0.540-1.455; P = 0.626). CONCLUSION The positive rate of pulmonary aspiration was relatively high in patients with respiratory tract infection who have underlying diseases but NGT feeding did not affect salivagram accuracy.
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6
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Use of Static Imaging as a Substitute for Conventional Dynamic Imaging for Salivagrams in Children. Clin Nucl Med 2019; 44:532-534. [DOI: 10.1097/rlu.0000000000002595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Ho MJ, Ciritsis A, Manoliu A, Stieltjes B, Marcon M, Andreisek G, Kuhn FP. Diffusion Tensor Imaging of the Brachial Plexus: A Comparison between Readout-segmented and Conventional Single-shot Echo-planar Imaging. Magn Reson Med Sci 2018; 18:150-157. [PMID: 30416178 PMCID: PMC6460122 DOI: 10.2463/mrms.mp.2018-0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Diffusion tensor imaging (DTI) adds functional information to morphological magnetic resonance neurography (MRN) in the assessment of the brachial nerve plexus. To determine the most appropriate pulse sequence in scan times suited for diagnostic imaging in clinical routine, we compared image quality between simultaneous multi-slice readout-segmented (rs-DTI) and conventional single-shot (ss-DTI) echo-planar imaging techniques. Methods: Institutional Review Board (IRB) approved study including 10 healthy volunteers. The supraclavicular brachial plexus, covering the nerve roots and trunks from C5 to C7, was imaged on both sides with rs-DTI and ss-DTI. Both sequences were acquired in scan times <7 min with b-values of 900 s/mm2 and with isotropic spatial resolution. Results: In rs-DTI image, the overall quality was significantly better and distortion artifacts were significantly lower (P = 0.001–0.002 and P = 0.001–0.002, respectively) for both readers. In ss-DTI, a trend toward lower degree of ghosting and motion artifacts was elicited (reader 1, P = 0.121; reader 2, P = 0.264). No significant differences between the two DTI techniques were found for signal-to-noise ratios (SNR), contrast-to-noise ratios (CNR) and fractional anisotropy (FA) (P ≥ 0.475, P ≥ 0.624, and P ≥ 0.169, respectively). Interreader agreement for all examined parameters and all sequences ranged from intraclass correlation coefficient (ICC) 0.064 to 0.905 and Kappa 0.40 to 0.851. Conclusion: Incomparable acquisition times rs-DTI showed higher image quality and less distortion artifacts than ss-DTI. The trend toward a higher degree of ghosting and motion artifacts in rs-DTI did not deteriorate image quality to a significant degree. Thus, rs-DTI should be considered for functional MRN of the brachial plexus.
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Affiliation(s)
- Michael J Ho
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich.,Department of Neuroradiology, University Hospital Freiburg
| | - Alexander Ciritsis
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich
| | | | - Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich
| | | | - Felix Pierre Kuhn
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich
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8
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Pulmonary aspiration only increases the risk of right-sided pneumonia in children. Nucl Med Commun 2018; 39:505-510. [DOI: 10.1097/mnm.0000000000000836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Kim GE, Sung IY, Ko EJ, Choi KH, Kim JS. Comparison of Videofluoroscopic Swallowing Study and Radionuclide Salivagram for Aspiration Pneumonia in Children With Swallowing Difficulty. Ann Rehabil Med 2018; 42:52-58. [PMID: 29560324 PMCID: PMC5852229 DOI: 10.5535/arm.2018.42.1.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To determine whether the use of both videofluoroscopic swallowing study (VFSS) and radionuclide salivagram was beneficial for detecting aspiration-induced pneumonia in children with swallowing difficulty. Methods From 2001 to 2016, children who underwent both VFSS and salivagram consecutively for suspected aspiration or dysphagia were included in the study. Demographic data, findings of VFSS and salivagram, and medical records were reviewed. Results Aspiration pneumonia (AP) was present in 34 out of 110 children; 48 showed positive aspiration findings in VFSS and 33 showed positive aspiration findings in salivagram. Among the 62 children who were negative of aspiration in VFSS, 12 (19.4%) showed positive aspiration findings in salivagram. Four out of 12 children were diagnosed with AP. The aspiration findings in both VFSS and salivagram were significantly related to AP. However, the aspiration findings in the two tests were weakly consistent. Even if one test showed negative aspiration, it was helpful to additionally detect AP using another test, which showed positive aspiration finding. If aspiration findings were positive in only one of the two tests, the probability of AP was 38.5%, whereas if they were positive in both tests, the probability increased to 66.7%. If the aspiration findings were negative in both tests, AP did not occur with a probability of 90%. Conclusion Salivagram is a valuable tool for monitoring of aspiration in children with swallowing difficulties. It could be helpful in assessment of children at a high risk of AP, even if the VFSS showed negative aspiration findings. Thus, testing for AP using both VFSS and salivagram is desirable.
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Affiliation(s)
- Go Eun Kim
- Department of Rehabilitation Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - In Young Sung
- Department of Rehabilitation Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Abstract
Meckel scintigraphy with Tc-pertechnetate was performed in a 5-year-old boy to determine whether a Meckel diverticulum containing ectopic gastric mucosa caused bleeding. The images did not reveal focal activity characteristic of a Meckel diverticulum. Unexpectedly, activity in the tracheobronchial tree was visualized, consistent with aspiration of the radioactive saliva.
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11
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Up-to-date review of nuclear medicine applications in pediatric thoracic imaging. Eur J Radiol 2017; 95:418-427. [DOI: 10.1016/j.ejrad.2016.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/02/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022]
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12
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Image characteristics and classification of salivagram in the diagnosis of pulmonary aspiration in children. Nucl Med Commun 2017; 38:617-622. [DOI: 10.1097/mnm.0000000000000688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Bar-Sever Z. Scintigraphic Evaluation of Gastroesophageal Reflux and Pulmonary Aspiration in Children. Semin Nucl Med 2017; 47:275-285. [PMID: 28417856 DOI: 10.1053/j.semnuclmed.2016.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gastroesophageal reflux (GER) and pulmonary aspiration are encountered in children of all ages. Signs, symptoms, and complications vary from mild and transient to severe life-threatening conditions. This review will present relevant clinical information on these conditions as well as common diagnostic procedures. The role of scintigraphic techniques used in the evaluation of these conditions will be discussed in detail including protocols and performance in comparison to other diagnostic methods.
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Affiliation(s)
- Zvi Bar-Sever
- Department of nuclear medicine, Schneider Children's Medical Center, Petah Tikva, Israel.
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14
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Abstract
Key points Educational aims Children with neurocognitive impairment often present with chronic or recurrent respiratory problemshttp://ow.ly/uqiG306pE9B
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Affiliation(s)
- Marijke Proesmans
- Dept of Pediatric Pulmonology, Katholieke Universiteit Leuven, Leuven, Belgium
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15
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Mahoney L, Rosen R. Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia-Tracheoesophageal Fistula Patient. Front Pediatr 2017; 5:127. [PMID: 28620597 PMCID: PMC5449447 DOI: 10.3389/fped.2017.00127] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/12/2017] [Indexed: 11/24/2022] Open
Abstract
Feeding difficulties such as dysphagia, coughing, choking, or vomiting during meals, slow eating, oral aversion, food refusal, and stressful mealtimes are common in children with repaired esophageal atresia (EA) and the reasons for this are often multifactorial. The aim of this review is to describe the possible underlying mechanisms contributing to feeding difficulties in patients with EA and approaches to management. Underlying mechanisms for these feeding difficulties include esophageal dysphagia, oropharyngeal dysphagia and aspiration, and aversions related to prolonged gastrostomy tube feeding. The initial diagnostic evaluation for feeding difficulties in a patient with EA may involve an esophagram, videofluoroscopic imaging or fiberoptic endoscopic evaluation during swallowing, upper endoscopy with biopsies, pH-impedance testing, and/or esophageal motility studies. The main goal of management is to reduce the factors contributing to feeding difficulties and may include reducing esophageal stasis, maximizing reflux therapies, treating underlying lung disease, dilating strictures, and altering feeding methods, routes, or schedules.
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Affiliation(s)
- Lisa Mahoney
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, United States
| | - Rachel Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, United States
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16
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Hou P, Deng H, Wu Z, Liu H, Liu N, Zheng Z, Chen P. Detection of salivary aspiration using radionuclide salivagram SPECT/CT in patients with COPD exacerbation: a preliminary study. J Thorac Dis 2016; 8:2730-2737. [PMID: 27867548 DOI: 10.21037/jtd.2016.09.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this prospective study was to assess the utility of radionuclide salivagram for detecting salivary aspiration in AECOPD patients and to evaluate the adding value of SPECT/CT to planar imaging. METHODS 52 consecutive AECOPD patients underwent radionuclide salivagram SPECT/CT and water swallow test between April 2012 and March 2014. All images were interpreted independently by two experienced nuclear medicine physicians. Final diagnosis was made by consensus of two readers. The radionuclide salivagram and water swallow test results were compared using kappa values. The relationship between radionuclide salivagram results and exacerbation frequency was evaluated with the Person χ2 test. RESULTS Salivary aspiration was diagnosed by radionuclide salivagram in 17 of 52 patients. Aspiration into the right main bronchus and branch was seen in 8 patients, bilateral main bronchi in 6 patients, and left lung field in 3 patients. SPECT/CT provided more accurate information on the extent and location of salivary aspiration, in 11 cases, SPECT/CT demonstrated aspiration of pulmonary segment bronchus and the following areas. Moreover, SPECT/CT revealed salivary aspiration corresponding to aspiration pneumonia in 8 cases. There was general agreement between the radionuclide salivagram and water swallow test results (Kappa =0.712; 95% CI, 0.504-0.920; P<0.001). The incidence of frequent exacerbations was greater among subjects with positive salivagram than among those with negative salivagram results (RR =3.43; 95% CI, 1.90-6.19; P<0.001). CONCLUSIONS Radionuclide salivagram is an objective method for detecting salivary aspiration in AECOPD patients. Moreover, SPECT/CT can identify more precise location of salivary aspiration and suggest a possible role for saliva in the pathophysiology of aspiration pneumonia.
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Affiliation(s)
- Peng Hou
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Huaifu Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Zhida Wu
- Department of Respiratory Diseases, The First People's Hospital of Shunde, Shunde 528300, China
| | - Haiping Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Ni Liu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Zeguang Zheng
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Ping Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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17
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Mahoney L, Rosen R. Feeding Difficulties in Children with Esophageal Atresia. Paediatr Respir Rev 2016; 19:21-7. [PMID: 26164203 PMCID: PMC4690793 DOI: 10.1016/j.prrv.2015.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 01/03/2023]
Abstract
The current available literature evaluating feeding difficulties in children with esophageal atresia was reviewed. The published literature was searched through PubMed using a pre-defined search strategy. Feeding difficulties are commonly encountered in children and adults with repaired esophageal atresia [EA]. The mechanism for abnormal feeding includes both esophageal and oropharyngeal dysphagia. Esophageal dysphagia is commonly reported in patients with EA and causes include dysmotility, anatomic lesions, esophageal outlet obstruction and esophageal inflammation. Endoscopic evaluation, esophageal manometry and esophograms can be useful studies to evaluate for causes of esophageal dysphagia. Oropharyngeal dysfunction and aspiration are also important mechanisms for feeding difficulties in patients with EA. These patients often present with respiratory symptoms. Videofluoroscopic swallow study, salivagram, fiberoptic endoscopic evaluation of swallowing and high-resolution manometry can all be helpful tools to identify aspiration. Once diagnosed, management goals include reduction of aspiration during swallowing, reducing full column reflux into the oropharynx and continuation of oral feeding to maintain skills. We review specific strategies which can be used to reduce aspiration of gastric contents, including thickening feeds, changing feeding schedule, switching formula, trialing transpyloric feeds and fundoplication.
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Affiliation(s)
| | - Rachel Rosen
- Corresponding author. Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, 300 Longwood Ave, Boston MA, 02115
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Radionuclide Salivagram and Gastroesophageal Reflux Scintigraphy in Pediatric Patients: Targeting Different Types of Pulmonary Aspiration. Clin Nucl Med 2016; 40:559-63. [PMID: 26018695 DOI: 10.1097/rlu.0000000000000815] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Both gastroesophageal reflux (GER) scintigraphy and radionuclide salivagram are commonly used in the detection of pulmonary aspiration in pediatric patients. This investigation is to compare the diagnostic value of these 2 imaging methods. METHODS This retrospective study included 4186 pediatric patients (aged 1 week to 16 years; mean age, 28 months) who underwent a GER scintigraphy and/or radionuclide salivagram. Detection rate of pulmonary aspiration by the 2 imaging techniques was compared. RESULTS The detection rate for pulmonary aspiration in patients undergoing both procedures was 1.9% (5 of 266) for GER scintigraphy and 22.2% (59 of 266) for radionuclide salivagram. Fifty-six of 59 patients with proven aspiration on radionuclide salivagram demonstrated no such findings on GER scintigraphy, whereas 2 of 5 patients with proven aspiration on GER scintigraphy demonstrated no such findings on radionuclide salivagram. In patients who underwent only 1 procedure (either GER scintigraphy or salivagram), the detection rate for pulmonary aspiration was 0.4% (15 of 3551) for GER scintigraphy and 20.3% (75 of 369) for radionuclide salivagram. CONCLUSIONS Radionuclide salivagram showed a much higher detection rate for pulmonary aspiration compared with GER scintigraphy. However, this may be related to a significantly higher prevalence of antegrade versus retrograde aspiration in our study population. Our results also suggest that not all episodes of retrograde aspiration can be detected by a radionuclide salivagram, and the requested scan should be tailored to the type of suspected aspiration.
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Abu-Hasan M, Elmallah M, Neal D, Brookes J. Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:115-119. [PMID: 26697264 DOI: 10.1089/ped.2014.0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Chronic pulmonary aspiration is a common cause of chronic respiratory symptoms in children. However, there is no gold standard diagnostic test for aspiration. In this study, we explore the diagnostic value of measuring salivary amylase in bronchoalveolar lavage (BAL) fluid as a marker of chronic aspiration in children with different chronic respiratory illnesses. Methods: Measurements of salivary amylase in BAL fluid were routinely done in patients undergoing flexible bronchoscopy. Patients' demographic and clinical data were extracted from records and reviewed by one of the investigators. Patients were classified into three different groups based on the reviewer's assessment of risk for aspiration. BAL amylase measurements were masked from the reviewer. Multiple regression analysis was used to determine the effect of the patients' clinical variables on BAL amylase. Results: Sixty-four patients (median age 2 years; range 0-14 years) were included. Indications for bronchoscopy included chronic cough (n=20), chronic wheezing (n=27), Cystic Fibrosis (n=6), recurrent pneumonia (n=5), and lung infiltrate in immunocompromised patients (n=6). Young age, history of excessive drooling, and wet cough were predictive of high BAL amylase. Thirteen patients were considered at no risk of aspiration, 41 patients were at low risk, and 10 patients were at high risk based on clinical symptoms and other diagnostic tests. No significant differences in BAL amylase levels were found between the three groups. However, when high and low risk groups were combined and compared to the no risk group, there was a significantly higher BAL amylase level in the combined at risk groups (1,722 vs. 307 U/L; p=0.03). Receiver operator curve analysis demonstrated that amylase cutoff value of 250 U/L differentiates between the two risk groups with sensitivity of 66.7% and specificity of 69.2%. Conclusion: Salivary amylase level in BAL can help identify children at risk for chronic pulmonary aspiration.
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Affiliation(s)
- Mutasim Abu-Hasan
- Division of Pediatric Pulmonary and Allergy, University of Florida , Gainesville, Florida
| | - Mai Elmallah
- Division of Pediatric Pulmonary and Allergy, University of Florida , Gainesville, Florida
| | - Dan Neal
- Department of Neurosurgery, College of Medicine, University of Florida , Gainesville, Florida
| | - James Brookes
- Pediatric Otolaryngology-Head and Neck Surgery, Alberta Children's Hospital , Calgary, Alberta, Canada
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