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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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