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Wineski RE, Beltran-Ale G, Simpson R, Evarts M, Stein JS, Rosen P, Rogers JA, Leonard MV, Dimmitt R, Soong A, Kassel R, Harris WT, Wiatrak B, Smith NJ. Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity. Int J Pediatr Otorhinolaryngol 2023; 171:111657. [PMID: 37441989 DOI: 10.1016/j.ijporl.2023.111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION We previously reported that endoscopic repair of a Type 1 Laryngeal Cleft (LC1) or Deep Interarytenoid Groove (DIG) improves swallowing function postoperatively. However, caregivers often ask about the timeline to resolution of the need for thickening. This study re-examines this cohort to answer this important caregiver-centered question. METHODS We reassessed a 3-year retrospective, single-center dataset of children with dysphagia found to have a LC-1 or DIG on endoscopic exam. The primary outcome was rate of complete resolution of dysphagia at 2, 6, and 12 months after endoscopic intervention. A sub-group analysis was made based on severity of dysphagia prior to intervention and by type of endoscopic repair. RESULTS Thirty-nine patients with mean age 1.35 years that had a LC-1 or DIG met criteria for inclusion. Rate of complete dysphagia resolution increased over time. Those with mild dysphagia (flow-reducing nipple and/or IDDSI consistency 1 or 2) had brisker resolution than those with moderate dysphagia (IDDSI consistency 3 or 4) at 2 months (67% vs 5%, p < 0.01) and at 6 months (80% vs 18%, p < 0.01) after endoscopic repair. There was no difference in dysphagia resolution between patients grouped by type of endoscopic repair. CONCLUSION Addressing an interarytenoid defect in patients will not result in immediate, complete dysphagia resolution in most patients. However, patients that only require a flow-reducing nipple and/or thickening to an IDDSI consistency 1 or 2 have brisker resolution of the need for thickening than those that require an IDSSI consistency 3 or 4 prior to intervention. These results inform pre-operative discussions of the timeline to resolution based upon severity of dysphagia and help manage caregiver expectations.
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Affiliation(s)
- R E Wineski
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - G Beltran-Ale
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA.
| | - R Simpson
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA
| | - M Evarts
- Pediatric Otolaryngology Head and Neck Surgery Associates, St. Petersburg, FL, USA
| | - J S Stein
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - P Rosen
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - J A Rogers
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - M V Leonard
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - R Dimmitt
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Soong
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - R Kassel
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - W T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA
| | - B Wiatrak
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - N J Smith
- Aerodigestive Center, Children's of Alabama, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
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Perez A, Hays S, Gao Y, Soong A, Kleinhenz M, Leard L, Kukreja J, Venado A, Golden J, Shah R, Blanc P, Greenland J, Singer J. High Lung Allocation Scores Do Not Preclude Improvement in Health-Related Quality of Life after Lung Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Kolaitis N, Soong A, Gao Y, Shah R, Venado A, Hays S, Kukreja J, Golden J, Leard L, Greenland J, Kleinhenz M, Katz P, Blanc P, Singer J. Frailty is Associated with Greater Impairments in Health-Related Quality of Life after Lung Transplantation Than Before. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Singer JP, Katz PP, Soong A, Shrestha P, Huang D, Ho J, Mindo M, Greenland JR, Hays SR, Golden J, Kukreja J, Kleinhenz ME, Shah RJ, Blanc PD. Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study. Am J Transplant 2017; 17:1334-1345. [PMID: 27743488 PMCID: PMC6085872 DOI: 10.1111/ajt.14081] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/13/2016] [Accepted: 10/04/2016] [Indexed: 01/25/2023]
Abstract
Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study from 2010 to 2016, we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death. We also tested changes in LT-Valued Life Activities disability, BMI, allograft function, and 6-min walk test exercise capacity as predictors of HRQL change. Among 211 initial participants (92% of those eligible), LT improved HRQL by all 5 measures (p < 0.05) and all but SF12-Mental Health improved by threefold or greater than the minimally clinically important difference. Compared to younger participants, those aged ≥65 improved less in SF12-Physical and Mental Health (p < 0.01). Improvements in disability accounted for much of the HRQL improvement. In the LAS era, LT affords meaningful and durable HRQL improvements, mediated by amelioration of disability. Identifying factors limiting HRQL improvement in selected subgroups, especially those aged ≥65, are needed to maximize the net benefits of LT.
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Affiliation(s)
- J P Singer
- Department of Medicine, University of California, San Francisco, CA
| | - P P Katz
- Department of Medicine, University of California, San Francisco, CA
| | - A Soong
- Department of Medicine, University of California, San Francisco, CA
| | - P Shrestha
- Department of Medicine, University of California, San Francisco, CA
| | - D Huang
- Department of Medicine, University of California, San Francisco, CA
| | - J Ho
- Department of Medicine, University of California, San Francisco, CA
| | - M Mindo
- Department of Medicine, University of California, San Francisco, CA
| | - J R Greenland
- Department of Medicine, University of California, San Francisco, CA
| | - S R Hays
- Department of Medicine, University of California, San Francisco, CA
| | - J Golden
- Department of Medicine, University of California, San Francisco, CA
| | - J Kukreja
- Department of Surgery, University of California, San Francisco, CA
| | - M E Kleinhenz
- Department of Medicine, University of California, San Francisco, CA
| | - R J Shah
- Department of Medicine, University of California, San Francisco, CA
| | - P D Blanc
- Department of Medicine, University of California, San Francisco, CA
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Kolaitis N, Huang D, Soong A, Shrestha P, Golden J, Leard L, Shah R, Kleinhenz M, Greenland J, Katz P, Blanc P, Hays S, Kukreja J, Singer J. ECMO Prior to Lung Transplantation Does Not Impact Health-Related Quality of Life (HRQL) After Transplant. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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