Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients,International Journal of Pediatric Otorhinolaryngology

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Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients
International Journal of Pediatric Otorhinolaryngology ( IF 1.5 ) Pub Date : 2021-08-06 , DOI: 10.1016/j.ijporl.2021.110874
R E Wineski ₁ , E Panico ₁ , A Karas ₂ , P Rosen ₁ , B Van Diver ₁ , T G Norwood ₁ , J W Grayson ₁ , G Beltran-Ale ₃ , R Dimmitt ₄ , R Kassel ₄ , A Rogers ₅ , M Leonard ₅ , A Chapman ₆ , L Boehm ₆ , B Wiatrak ₇ , W T Harris ₃ , N Smith ₇

Affiliation

Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Department of Otorhinolaryngology- Head and Neck Surgery, Rush University School of Medicine, Chicago, IL, USA.
Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA.
Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA.
Children's of Alabama Aerodigestive Program, Birmingham, AL, USA.
Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA.

Introduction

The best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients.

Methods

A 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05.

Results

449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05).

Conclusion

In pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.

中文翻译：

小儿呼吸消化患者吞咽困难内镜治疗的最佳时机和技术

介绍

处理吞咽困难儿科呼吸消化患者杓间缺损[1 型喉裂 (LC-1) 或深杓间沟 (DIG)] 的最佳策略仍不确定。本研究在儿科患者中比较了杓间韧带增强术 (IAA) 与缝合修复或单独临床观察的益处。

方法

对接受内镜气道评估的吞咽困难儿童进行了一项为期 3 年的回顾性单中心分析。医师偏好指导治疗方案：CO2激光缝合修复、IAA（羧甲基纤维素或羟基磷灰石钙）或观察。主要结果是改善术后饮食。显着性假设为 p < 0.05。

结果

449 名患者接受了诊断性内窥镜检查。手术时的平均年龄 (±SD) 为 21 ± 13 个月，其中近四分之一 (28%) 的儿童≤12 个月。80 人 (18%) 有 LC-1 (n = 55) 或 DIG (n = 25)。其中，35 人 (42 %) 进行了缝合修复，22 人 (28 %) 进行了 IAA，23 人 (30 %) 仅进行了观察。与观察对照组相比，干预组的吸入总体有所改善（58 % vs. 9 %，p < 0.05），干预年龄观察到的益处没有变化。IAA 与缝合修复一样有效（59 % 对 55 %，p = 0.46）。在仅进行 DIG 的患者中，单独 IAA 干预显着改善了吞咽功能（66.6 % vs. 0 %，p < 0.05）。