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Nonselective laryngeal reinnervation (NSLR) shows comparable voice results to thyroplasty after one year without permanent implants. In the rare case of a second ipsilateral vocal fold paralysis after NSLR, we present the first recorded revision NSLR. Case report. A 51 year old woman with a history of right NSLR in 2017 for vocal fold paralysis after an anterior cervical diskectomy and fusion (ACDF) presented for re-evaluation prior to a revision of her ACDF. Ipsilateral revision was recommended to reduce the risk of bilateral vocal fold paralysis. Post-operatively, she was noted to have vocal fold immobility. Her maximum phonation time at that time was 9 s. Her voice was moderately breathy and moderately asthenic. Fundamental frequency (F0) was 211 Hz. Jitter was 2.868%, and shimmer 14.429%. Noise to harmonic ratio was 0.366. Cepstral peak prominence was 2.689. After being offered thyroplasty or revision reinnervation, she opted for revision reinnervation due to a strong preference for her reinnervated voice. She underwent a revision cross-neck NSLR with a commercial nerve graft in September 2022. One year later, her MPT was found to be 7.6 s, with mild breathiness and asthenia. F0 was 190 Hz. Jitter decreased to 2.42%, shimmer to 6.478%, and NHR to 0.165. Cepstral peak prominence increased to 4.427. VHI decreased from 35 pre-operatively to 7 post-operatively. We present the first case of a revision NSLR. Notable improvement has been found in objective voice measures and patient-reported outcomes post-operatively, demonstrating feasibility in similar patients. Laryngoscope, 2024.
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OBJECTIVE: The purpose of this study is to determine whether tracheostomy stomal maturation affects the risk of tracheocutaneous fistula (TCF) in children. METHODS: A retrospective chart review was conducted for all children who both underwent a tracheostomy and were decannulated between 2012 and 2021 at a tertiary children's hospital. Charts were analyzed for demographics, surgical technique, and development of a TCF. TCF was defined as a persistent fistula following 3 months after decannulation. RESULTS: 179 children met inclusion criteria. The median (interquartile range) age at tracheostomy was 1.5 (82.4) months, average (standard deviation [SD]) duration of tracheotomy was 20.0 (20.6) months, and length of follow-up after decannulation (range; SD) was 39.3 (4.4-110.0; 26.7) months. 107 patients (60.0%) underwent stomal maturation and 98 patients developed a TCF (54.7%). Younger age at tracheostomy placement was significantly associated with increased risk of TCF, mean (SD) age 28.4 (51.4) version 80.1 (77.5) months (p < 0.001). Increased duration of tracheostomy was significantly associated with increased risk of TCF, 27.5 (18.4) version 11.0 (18.2) months (p < 0.001). Stomal maturation was not significantly associated with the risk of TCF, including on multivariable analysis adjusting for age at tracheostomy and duration of tracheostomy (p = 0.089). CONCLUSION: Tracheostomy stomal maturation did not affect the risk of TCF in children, even after adjusting for age and duration of tracheostomy. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2941-2944, 2024.
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Fístula Cutánea , Enfermedades de la Tráquea , Traqueostomía , Traqueotomía , Humanos , Estudios Retrospectivos , Masculino , Femenino , Lactante , Preescolar , Fístula Cutánea/cirugía , Fístula Cutánea/etiología , Enfermedades de la Tráquea/cirugía , Enfermedades de la Tráquea/etiología , Traqueostomía/efectos adversos , Traqueotomía/métodos , Traqueotomía/efectos adversos , Niño , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Factores de Riesgo , Estomas Quirúrgicos/efectos adversosRESUMEN
OBJECTIVE: Pediatric nonselective laryngeal reinnervation (NSLR) has gained popularity in recent years; however, long-term outcomes have not been reported. METHODS: Patients greater than 1 year post reinnervation were recruited. Families were asked to report Pediatric Voice-Related Quality of Life (PVRQOL) and provide an audio recording of connected speech. PVRQOL and voice measures were compared with preoperative and early postoperative outcomes (<12 months) using analysis of variance (ANOVA) for repeated measures and post hoc tests for linear trend. RESULTS: Sixty-six patient families were contacted. Twelve patients responded with PVRQOL; six (50%) were female. Median age at surgery was 6.4 (range 1.9-15) and at follow-up 13.5 (range 10-18), with a median of 6.8 years (range 3-9.1) since surgery at follow-up. Mean preoperative PVRQOL was 68.1 (95% CI 52.3-84.0), early postoperative 86.5 (73.2-99.7), and long-term 90 (82.7-97.3). ANOVA showed no significant difference between values (p = 0.1228), but post hoc testing showed improving outcomes over time (p-for-trend 0.0304). PVRQOL was stable between early postoperative and long-term values (p = 0.3399). Four voice samples were adequate for analysis. Mean preoperative cepstral peak prominence (CPP) was 5.2 (95% CI 3.4-7.0), early postoperative 8.5 (5.5-11.5), and long-term 6.8 (2.77-10.89, p = 0.3340, p-for-trend 0.2988) Low-to-high spectral ratio was 22.3 preoperatively (14.0-30.5), 23.0 early postoperative (17.4-28.7), and 28.8 long-term (17.4-40.2, p = 0.1174, p-for-trend 0.0364). Cepstral spectral index of dysphonia (CSID) was 83.0 preoperatively (44.1-121.8), 39.4 early postoperative (20.4-58.3), and 45.53 long-term (-0.05-91.1, p = 0.4457, p-for-trend 0.1464). CONCLUSIONS: Years after NSLR, PVRQOL, low-to-high spectral ratio, and CSID show no evidence of degradation over time. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.
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INTRODUCTION: Vagal nerve stimulator (VNS) implantation is a vital therapy for epilepsy refractory to other treatments; however, it is associated with a very high rate of voice changes. Relatively few of these patients are evaluated for vocal fold motion impairments. In this series, we evaluate 5 such patients with a novel phenotype of forced abduction with VNS stimulation. METHODS: Retrospective case series. RESULTS: Five patients with a VNS implant who underwent operative direct or in-office rigid laryngoscopy and had vocal fold motion impairment associated with VNS activation are included. All 5 patients had vocal fold mobility with VNS off and a fixed with activation. All patients exhibited vocal fold abduction with VNS activation. Patient 2 has since undergone laryngeal reinnervation, which helped her intermittent dysphonia but left a small glottic gap. A type 1 thyroplasty corrected this gap and improved her voice further. Patient 3 has undergone laryngeal reinnervation for which early results show improvement in perceptual and patient reported outcomes. Patients 4 and 5 have both undergone laryngeal reinnervation with improvement in voice. CONCLUSION: Previous reported cases of stimulated immobility associated with VNS use describe only adduction of the vocal fold. This series expands the previous work showing the VNS activation can also cause stimulated immobility in an abducted position, for which reinnervation and other medialization procedures offer promising treatment.
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OBJECTIVES: Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a rare, costly condition linked to human papillomavirus. Standard of care is serial surgical debridement. Many adjunctive therapies have been trialed, with recent success with systemic bevacizumab. This paper examines healthcare spending associated with systemic bevacizumab use for JoRRP and compares it to healthcare spending for surgical care alone to determine whether bevacizumab has a financial benefit. METHODS: Five patients treated with systemic bevacizumab for JoRRP were identified at a single institution. Spending data was derived from the electronic medical record. Sensitivity analysis was performed using variation in spending and frequency of treatments. RESULTS: Patients had an average of 4.2 treatments per year prior to bevacizumab (95% confidence interval [CI] 1.4-7.0) and 1.1 after (0.2-2.0). Patients underwent an average of 9.2 bevacizumab treatments in their first year after initiation, 4.0 in the second, and 4.5 in their third. Mean payment per debridement was $3198 ($2856-3539), with mean total surgical payment per year of $17,966 ($11,673-24,259) prior to initiating bevacizumab. Mean payment on a single bevacizumab infusion visit was $6508 ($6063-6952). Mean total surgical and bevacizumab spending per year after bevacizumab initiation were $83,951 ($12,938-154,964). CONCLUSIONS: Accounting for variations in the number of treatments per year with bevacizumab after initiation, healthcare spending after bevacizumab initiation is similar to spending on surgery alone for JoRRP in patients with severe disease.
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OBJECTIVE: The purpose of the study is to compare the incidence of early postoperative tracheotomy stoma wound complications in pediatric patients using a silver-impregnated barrier dressing (Mepilex Ag) versus a standard absorbent foam dressing (standard Mepilex). METHODS: This is a prospective, non-blinded, randomized trial of pediatric patients undergoing tracheotomy at a tertiary care children's hospital. Patients were randomized to receive Mepilex Ag versus standard Mepilex tracheostoma dressings following tracheotomy. All patients received standard postoperative wound care and daily stomal examination. Wound related complications, breakdown, granulation, and infection were recorded for the first 7 days after surgery. A non-inferiority study design was used to test the hypothesis that the Mepilex group had a non-inferior wound complication rate (within 10% margin) compared to the Mepilex Ag group. RESULTS: Eighty-two patients were enrolled; 52 received Mepilex Ag, and 30 received standard Mepilex. There was no difference between the groups with respect to age, sex, race, surgical indication, or postoperative length of stay. Non-inferiority testing demonstrated that the Mepilex standard cohort had no more than 10% greater stomal wound complication rate than that of Mepilex Ag dressing group (p = 0.0108). CONCLUSION: Standard Mepilex was found to be non-inferior to Mepilex Ag in the prevention of tracheotomy stomal wound complications. Standard Mepilex may be used effectively in the postoperative period, potentially reducing costs to caregivers and the institution. Further work is needed to analyze additional factors that could contribute to poor postoperative stoma healing such as bacterial colonization. LEVEL OF EVIDENCE: Randomized Controlled Trial, Level 2 Laryngoscope, 2024.
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OBJECTIVE: To create, validate, and apply an aerodigestive provider assessment survey. METHODS: A survey assessing provider knowledge and current practice in the transition of patients with chronic aerodigestive disorders from pediatric to adult care was drafted by a multidisciplinary expert panel. Once agreement of the initial survey items was obtained, the survey was distributed to a national multidisciplinary panel of aerodigestive experts for review. Responses from the national panel were systematically quantified and a content validity index (CVI) was calculated. A final survey was developed and distributed to pediatric and adult aerodigestive providers. RESULTS: From the initial 22 items presented to the national panel, 20 of the initial questions were included in the final instrument. Two additional questions were developed as a result of feedback from the expert panel. All items included in the survey had an Item Content Validity Index (I-CVI) of >0.85. The average Scale CVI in proportion to the average proportion of relevance (S-CVI/Ave) for the tool was 0.88. The average Scale CVI in proportion to universal agreement (S-CVI/UA) was 0.52. The survey was then administered to pediatric and adult specialty providers at our institution. Twenty-two providers completed the final survey. CONCLUSION: The content validity index measurements from this newly developed survey suggest that it is a valid tool for assessing current knowledge and practice in care transitions among patients with complex aerodigestive needs. The survey developed in this project has been used to identify knowledge gaps and process issues that can be addressed to ease the transition of adolescents from pediatric specialty care into adult specialty care.
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Transición a la Atención de Adultos , Humanos , Encuestas y Cuestionarios , Adulto , Niño , Masculino , Femenino , Enfermedad Crónica/terapia , Encuestas de Atención de la Salud , Adolescente , Reproducibilidad de los Resultados , Estados UnidosRESUMEN
OBJECTIVES: This study aimed to systematically review the literature to determine outcomes following surgical treatment of pediatric vocal fold nodules. METHODS: Studies with patients ≤18 years with nodules who underwent surgery were reviewed for dysphonia improvement and recurrence in PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases, searched from inception to November 1, 2022 using PRISMA guidelines. Non-English studies and case reports were excluded. Two evaluators independently reviewed each abstract and article. Heterogeneity and bias across studies were evaluated and meta-analysis was performed. RESULTS: The literature search yielded 655 articles; 145 underwent full-text screening and eight were selected for systematic review and meta-analysis. There were 311 children with nodules, aged 2-18 years, with male-to-female ratio of 3.6:1. There were no surgical complications. Voice therapy was inconsistently reported. Follow-up time ranged from 1 month to 10 years. One study concluded that neither surgery nor voice therapy was effective, while five studies concluded that dysphonia improved with surgery. Voice grading by GRBAS, objective voice measures, and lesion size were improved following surgery, when reported. Meta-analysis of six studies demonstrated improvement in dysphonia in 90% of children post-operatively (95% CI: 74-99%). Meta-analysis of four studies showed that recurrence occurred in 19% of children (95% CI: 13-23%). CONCLUSION: This systematic review suggests possible post-operative improvement in dysphonia for pediatric patients with vocal fold nodules; however, study measures, methods, and surgery utilized were heterogeneous and results should be interpreted cautiously. In order to better understand surgical outcomes, future studies should include standardized definition of nodules and objective measures of voice.
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Disfonía , Enfermedades de la Laringe , Pólipos , Voz , Humanos , Niño , Masculino , Femenino , Disfonía/diagnóstico , Pliegues Vocales , Calidad de la Voz , Enfermedades de la Laringe/complicaciones , Pólipos/complicacionesRESUMEN
OBJECTIVE: To determine how often children with airway injury at the time of tracheostomy develop airway stenosis. STUDY DESIGN: A 7-year retrospective review of a prospectively maintained database of pediatric patients who underwent endotracheal intubation followed by tracheostomy with concurrent and follow-up direct laryngoscopy. SETTING: Tertiary care hospital. METHODS: Outcomes included glottic or subglottic injury and progression to stenosis. Univariate and multivariate analyses were performed via SPSS. RESULTS: Of the 222 patients (median age at surgery, 0.6 years; 54% male) who met study criteria, 46% had airway injury at the time of tracheostomy. Patients with congenital cardiovascular disease had 2.33-times increased risk of developing airway injury (P = .01). Patients with airway injury on initial direct laryngoscopy developed stenosis significantly more frequently than those without injury (30% vs 12%, P < .01). Risks factors for developing stenosis in children with airway injury include prematurity (P = .02), younger age at time of surgery (P < .01), endotracheal tube size (P < .01), Down syndrome (P = .03), and neonatal (P = .02) and/or congenital cardiovascular (P < .01) diagnosis. However, none of these variables were significant on multivariate analysis. CONCLUSIONS: Intubated patients with evidence of glottic or subglottic injury at the time of tracheotomy are more likely to develop airway stenosis than those without. Congenital heart disease was associated with twice the risk of developing airway injury, while progression to stenosis was associated with younger age, prematurity, and/or comorbid diagnoses.
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Glotis , Laringoestenosis , Recién Nacido , Humanos , Niño , Masculino , Lactante , Femenino , Constricción Patológica/cirugía , Glotis/cirugía , Laringoscopía/efectos adversos , Traqueostomía/efectos adversos , Traqueotomía/efectos adversos , Estudios Retrospectivos , Intubación Intratraqueal/efectos adversos , Laringoestenosis/cirugíaRESUMEN
OBJECTIVES: Type 1 thyroplasty is a vital component of treatment for vocal fold hypomobility, immobility, and atrophy. However, patients with other laryngeal symptoms, including chronic cough, can have concomitant vocal fold atrophy and glottic insufficiency on the exam. Previous work has demonstrated that injection laryngoplasty can assist with treating cough in patients with glottic insufficiency. However, the role of type 1 thyroplasty for cough has not been well described. METHODS: Case series of five patients treated by a fellowship-trained laryngologist at a tertiary voice center. RESULTS: Five patients underwent type 1 thyroplasty for chronic cough. All five patients had a chronic cough that was not responsive to medical management. One patient underwent a previous superior laryngeal nerve block, which was effective for three weeks. Prior to surgery, all patients had a trial injection laryngoplasty with temporary improvement in symptoms. Four of five patients underwent bilateral GoreTex type 1 thyroplasty; one underwent only unilateral thyroplasty due to subtle vocal fold hypomobility on that side. All patients had improvement in their cough, with follow-up periods ranging from one month to three years. CONCLUSION: There are limited therapeutic options for chronic cough refractory to medical therapy. For patients with vocal fold atrophy or glottic insufficiency, type 1 thyroplasty may offer a durable option to improve cough.
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OBJECTIVE: This retrospective case series examines the effect of traumatic unilateral aryepiglottic fold injury on swallowing and airway protection. It focuses on the longitudinal care of five pediatric patients to determine the dietary modifications required to maintain a safe, functional swallow. METHODS: Retrospective chart review of patients with a diagnosis of unilateral aryepiglottic fold injury was performed. Cases were clinically identified by pediatric otolaryngologists at a single quaternary care pediatric hospital upon operative endoscopic evaluation. Clinical swallow outcomes were measured with the Rosenbek Penetration Aspiration Scale. RESULTS: Average age at diagnosis was 10 months with mean follow-up of 30 months. Eighty percent of patients were female. All patients had right-sided aryepiglottic fold injuries. Four patients were intubated for an average of 3 months and a fifth patient had a traumatic intubation event. All currently take nutrition by mouth, albeit to varying degrees. Four patients adequately protect their airway from aspiration with all oral consistencies. Optimized delivery of thin liquids yielded a Rosenbek penetration aspiration scale (PAS) score of 1 in four patients and 4 in the remaining patient. Four patients required gastric tube placement during severe illness, and three remain partially dependent. Surgical correction was attempted for one patient without improvement. CONCLUSION: Based on a limited and somewhat heterogeneous case series, the data suggests that traumatic unilateral aryepiglottic fold injury does not prohibit oral intake in most cases. While the PAS score under optimized conditions is impressive, implications for a safely tolerated diet remain. There is sparse published literature upon this topic, and the longitudinal data presented may serve as a pilot study for future investigation by shedding light on the consequences of this airway injury.
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Trastornos de Deglución , Deglución , Humanos , Niño , Femenino , Lactante , Masculino , Trastornos de Deglución/cirugía , Estudios Retrospectivos , Proyectos Piloto , EpiglotisRESUMEN
OBJECTIVE: To explore patient-reported outcome measures of pediatric paradoxical vocal fold motion through a multi-institutional study of geographically diverse United States medical facilities to assess long-term management and outcomes. METHODS: Eligible participants >8 years of age diagnosed with PVFM over a 10-year period from 7 tertiary pediatric hospitals were invited to complete a survey addressing study objectives. RESULTS: 65 participants completed the survey, of whom 80% were female, 75% reported a 3.5 grade point average or better, and 75% identified as competitive athletes or extremely athletic individuals. Participants rated their perceived efficacy of 13 specific treatments. Only five treatments were considered effective by a majority of the participants who tried them. The treatments that participants tried most often were breathing exercises (89.2%), bronchodilator treatments (45%), and allergy medications (35.4%). 78.8% of participants reported receiving more than one treatment and 25% reported receiving a combination of bronchodilators, anticholinergics, and steroids. At the time of PVFM diagnosis, 38% of participants had no idea when their symptoms would completely resolve. 23.3% of participants did not experience symptom resolution until greater than 1 year after diagnosis. CONCLUSIONS: Traditional management tools such as breathing exercises and biofeedback treatments may not provide the long-term benefit that providers anticipate. In addition to these commonly used management strategies, highly efficacious techniques such as counseling and lifestyle management should be incorporated into the long-term management of patients whose symptoms are refractory to traditional care. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:970-976, 2023.
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Laringoscopios , Disfunción de los Pliegues Vocales , Humanos , Femenino , Niño , Masculino , Disfunción de los Pliegues Vocales/diagnóstico , Disfunción de los Pliegues Vocales/terapia , Biorretroalimentación Psicológica , Ejercicios Respiratorios , Medición de Resultados Informados por el Paciente , Pliegues VocalesRESUMEN
The North American Airway Collaborative (NoAAC) previously published a 3-year multi-institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re-enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision-making. Level of evidence: 2-prospective cohort study.
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Laringoestenosis , Humanos , Constricción Patológica , Estudios Prospectivos , Estudios Retrospectivos , Laringoestenosis/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVES: Implanted vagal nerve stimulators (VNS) are an accepted therapy for refractory seizures. However, VNS have been shown to affect vocal fold function, leading to voice complaints of hoarseness. We present a case of intermittent VNS-related vocal fold paralysis leading to dysphonia and dysphagia with aspiration in a pediatric patient. METHODS: This is a case report of a patient at a tertiary hospital evaluated in pediatric swallow and voice clinics. Patient and mother gave verbal consent to be included in this case report. RESULTS: Indirect laryngeal stroboscopy was performed demonstrating full vocal fold mobility with VNS off and left vocal fold paralysis in lateral position and glottic gap with VNS on. Voice measures were performed demonstrating decreased phonation time, lower pitch, and decreased intensity of voice with VNS on. Flexible endoscopic evaluation of swallowing demonstrated deep penetration alone with VNS off and deep penetration with concern for aspiration with VNS on. CONCLUSIONS: While the majority of cases of vocal fold movement impairment associated with VNS have been noted to have a medialized vocal fold with VNS activation, we describe a case of intermittent vocal fold lateralization associated with VNS activation with resultant voice changes and aspiration.
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Disfonía , Estimulación del Nervio Vago , Parálisis de los Pliegues Vocales , Niño , Disfonía/diagnóstico , Disfonía/etiología , Disfonía/terapia , Ronquera/etiología , Humanos , Fonación/fisiología , Estimulación del Nervio Vago/efectos adversos , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/terapia , Pliegues VocalesRESUMEN
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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OBJECTIVES: To evaluate videofluoroscopic swallow study (VFSS) findings in infants with dysphagia and without prior diagnoses, and to characterize the outcomes and any diagnoses that follow. METHODS: A chart review of all pediatric patients who received a VFSS at a tertiary children's hospital from November 2008 to March 2017 was performed. RESULTS: There were 106 infants (57 males and 49 females) with 108 VFSS. VFSS was normal in 18 (16.98%) infants. Regarding airway protection, 50 (47.17%) infants had laryngeal penetration, and 8 (7.55%) had tracheal aspiration; 3 (2.83%, 37.5% of all aspirators) exhibited silent aspiration. Of the 75 infants with minimum 2-year follow-up, 35 (46.67%) had no sequelae of disease and received no diagnoses. The most common diagnoses and pathologic sequelae were gastroesophageal reflux (n = 18, 24.00%), asthma (n = 8, 10.67%), laryngomalacia (n = 6, 8.00%), and tracheomalacia (n = 4, 5.33%), all consistent with United States pediatric data on prevalence. All infants (n = 51) with follow-up for dysphagia had resolution of symptoms within 9 months from VFSS order date. CONCLUSIONS: Otherwise healthy infants may show signs of dysphagia and not develop later illness. Parents can thus be counseled on the implications of dysphagia in a previously healthy infant. Our findings provide comparative statistics for future research in pediatric dysphagia.
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Trastornos de Deglución , Laringe , Niño , Deglución , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiología , Femenino , Fluoroscopía , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVES: Cerebral palsy (CP) in infants can affect global motor function and lead to swallowing difficulties. This study aims to characterize oral and pharyngeal swallowing dynamics in infancy of patients later diagnosed with CP and to determine if swallow study performance in early infancy is associated with later CP severity and characteristics. METHODS: This is a retrospective chart review of infants who underwent videofluoroscopic swallow studies (VFSS) between 6/2008 and 10/2018 at a tertiary children's hospital, and were later diagnosed with CP. Demographic data, CP characteristics and metrics, and VFSS findings were collected and analyzed. RESULTS: There were 66 patients included in this study. The average age at the time of VFSS was 4 months (range: 0.3-12 months), 42% of patients were female, and 50% of patients were born premature. In our sample, 86% of patients presented with oral dysphagia, and 76% with pharyngeal dysphagia. Laryngeal penetration in isolation was seen in 39% of patients, and tracheal aspiration was seen in 38% of patients. Of these tracheal aspiration events, 64% were silent. At the time of VFSS, 58% of patients had a nasogastric tube, 12% had a gastrostomy tube, and 3% had a prior hospitalization for pneumonia. Rates of penetration and aspiration in early infancy did not consistently correlate with prematurity, type of CP (spastic, non-spastic, or mixed), degree of paralysis (quadriplegic, hemiplegic, or diplegic), or severity of Gross Motor Function Classification System (GMFCS) score. CONCLUSION: While there was not a consistent correlation of swallowing dynamics in infancy with later gross motor categorizations of CP, the results of this retrospective review highlight the essential role of early clinical and videofluoroscopic swallowing evaluations to identify oral and pharyngeal swallowing dysfunction in this patient population.
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Parálisis Cerebral , Trastornos de Deglución , Parálisis Cerebral/complicaciones , Niño , Deglución , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiología , Femenino , Fluoroscopía/métodos , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
IMPORTANCE: Vocal fold motion impairment (VFMI) due to neuronal injury is a known complication following thoracic aortic repair that can impair pulmonary toilet function and post-operative recovery. OBJECTIVE: To demonstrate clinical outcomes of patients undergoing inpatient vocal fold medialization for VFMI after aortic surgery. DESIGN: A 15-year retrospective chart review (2005-2019) of 259 patients with postoperative VFMI after thoracic aortic surgery registry was conducted. Data included demographics, surgery characteristics, laryngology exam, and postoperative clinical outcomes. Medialization procedures consisted of type 1 thyroplasty and injection laryngoplasty. SETTING: Tertiary care hospital. PARTICIPANTS: Two hundred and fifty-nine patients (median age 61, 71% male) with VFMI post-thoracic aortic repair met inclusion criteria; inpatient vocal fold medialization was performed for 203 (78%) patients. One hundred and twenty-six. (49%) received type 1 thyroplasty and 77 (30%) received injection laryngoplasty procedures at a median 7 days (IQR 5-8 days) from extubation. MAIN OUTCOMES: Primary study outcome measurements consisted of median LOS, median ICU LOS, complications intra- and postoperatively, and pulmonary complications (post-medialization bronchoscopies, pneumonia, tracheostomy, etc.). RESULTS: Post-medialization bronchoscopy rates were significantly lower in the medialization (n = 11) versus the non-medialization group (n = 8) (5% vs 14%, P = .02) and significantly higher in the injection laryngoplasty group (n = 77) versus thyroplasty group (n = 126) (10% vs 2%, P = .02). Further analysis revealed no significant difference in overall LOS and pulmonary complications between the techniques. CONCLUSION: Inpatient thyroplasty and injection laryngoplasty are both effective vocal fold medialization techniques after extent I and II aortic repair. Thyroplasty may have a small pulmonary toilet advantage, as measured by need for post-medialization bronchoscopy, compared to injection laryngoplasty.
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Laringoplastia , Parálisis de los Pliegues Vocales , Femenino , Humanos , Pacientes Internos , Laringoplastia/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/cirugía , Pliegues Vocales/lesionesRESUMEN
OBJECTIVES/HYPOTHESIS: Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the dysphagia in this population and explore the associations between surgical complexity and vocal fold mobility with dysphagia and airway protection. STUDY DESIGN: Retrospective chart review. METHODS: This is a retrospective chart review of infants (age <12 months) who underwent congenital heart surgery between 7/2008 and 1/2018 and received a subsequent videofluoroscopic swallow study (VFSS). Demographic information, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category of each surgery, vocal fold mobility status, and VFSS findings were collected and analyzed. RESULTS: Three hundred and seventy-four patients were included in the study. Fifty-four percent of patients were male, 24% were premature, and the average age at the time of VFSS was 59 days. Sixty percent of patients had oral dysphagia and 64% of patients had pharyngeal dysphagia. Fifty-one percent of patients had laryngeal penetration and 45% had tracheal aspiration. Seventy-three percent of these aspirations were silent. There was no association between surgical complexity, as defined by the STAT category, and dysphagia or airway protection findings. Patients with VFMI after surgery were more likely to have silent aspiration (odds ratio = 1.94, P < .01), even when adjusting for other risk factors. CONCLUSION: Infants who undergo congenital heart surgery are at high risk for VFMI and aspiration across all five STAT categories. This study demonstrates the high prevalence of silent aspiration in this population and the need for thorough postoperative swallow evaluation. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:701-705, 2022.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Trastornos de Deglución/etiología , Cardiopatías Congénitas/cirugía , Disfunción de los Pliegues Vocales/etiología , Procedimientos Quirúrgicos Cardíacos/métodos , Trastornos de Deglución/diagnóstico por imagen , Femenino , Fluoroscopía , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Disfunción de los Pliegues Vocales/fisiopatología , Pliegues Vocales/fisiopatologíaRESUMEN
OBJECTIVES/HYPOTHESIS: To analyze tracheostomy-related complications in pediatric patients with scoliosis. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review of all patients with tracheostomy and scoliosis was performed at a single institution. The charts were reviewed for variables including difficulties with tracheostomy tube changes, poor positioning of tube, abnormal appearance of trachea, and emergency room visits and admissions for complications. Decannulation rates were also identified. RESULTS: About 102 patients met inclusion criteria, 96 (94.1%) had scoliosis involving the thoracic spine, and 4 had scoliosis involving the cervical spine; 13 (12.8%) patients had documented poor positioning on tracheoscopy; 31 patients (30.3%) had at least one emergency room visit or admission for complications, such as accidental decannulation or bleeding from the tracheostomy; 19 (18.6%) patients required at least one tube change due to poor positioning, with 7 (6.9%) requiring multiple changes; 18 (17.7%) had reported difficulties with home tube changes. Custom length tubes were required in 9 patients (8.8%). The level of scoliosis was not associated with any of these complications. Abnormalities of the trachea, such as tortuosity, obstructive granulomas, or tracheomalacia, were seen in 35 patients (34.3%) on bronchoscopy. Scoliosis repair was performed in 18 patients (17.65%), of which two achieved decannulation. Ten patients (9.8%) overall were decannulated. CONCLUSION: A portion of patients with scoliosis who are tracheostomy-dependent have anatomical abnormalities of the trachea and poor positioning of the tracheostomy tube. Decannulation rates are also lower in this population compared to the literature. Further work is required to elucidate if scoliosis predisposes patients toward tracheostomy-related complications. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:944-948, 2022.