Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis

Gasparin, Marisa; Schweiger, Cláudia; Manica, Denise; Maciel, Antonio Carlos; Kuhl, Gabriel; Levy, Deborah Salle; Maróstica, Paulo José Cauduro

doi:10.1002/ppul.23484

Cited by 20 publications

(11 citation statements)

References 33 publications

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“…Although the CFE does not involve radiation risk, it can only identify signs and symptoms during feeding. This is not ideal because more than 80% of pediatric aspiration is silent and therefore occurs without overt clinical signs 11, 20–22 . Choosing the most sensitive test is critical because inadequately treated aspiration can lead to a variety of poor outcomes including pulmonary injury, failure to thrive and oral aversion 1, 23–25 .…”

mentioning

confidence: 99%

Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Duncan

Mitchell

Larson

et al. 2018

The Journal of Pediatrics

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mentioning

confidence: 99%

Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Duncan

Mitchell

Larson

et al. 2018

The Journal of Pediatrics

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“…Determining the true prevalence of dysphagia in children with laryngomalacia is difficult due to the low sensitivity (<50%) of the bedside swallow evaluation in identifying dysphagia in this population due to high rates of silent aspiration. 3 Hence, many children with laryngomalacia likely go undiagnosed. In our study, 57% of the children with laryngomalacia who were tested with an MBSS showed evidence of aspiration or laryngeal penetration.…”

Section: Discussionmentioning

confidence: 99%

Laryngomalacia and Swallow Dysfunction

2019

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Objectives: Laryngomalacia is an established cause of stridor and sleep-disordered breathing in children. However, the relationship between laryngomalacia and dysphagia has not been well characterized. The objectives of this study were to (1) describe the patient characteristics, symptoms, and prevalence of dysphagia in children with laryngomalacia and (2) examine the effectiveness of supraglottoplasty in improving feeding. Methods: This was a retrospective study of patients with laryngomalacia who underwent a modified barium swallow study (MBSS) at a tertiary academic pediatric medical center between March 1, 2014, and March 1, 2018. Patients were excluded if they did not undergo a MBSS. Comorbidities, airway and feedings symptoms, MBSS results, and surgical history were recorded from each patient’s electronic medical record. Results: Forty-four children met inclusion/exclusion criteria. The median age at presentation was 96 days. There was a male predominance (66%). About one-third had a genetic or neuromuscular comorbidity. Most children had stridor (93%) and feeding difficulty (86%), while 50% had parent-reported poor weight gain. Fifty-seven percent of patients had evidence of penetration or aspiration on MBSS. All patients with a positive MBSS had dysphagia symptoms. Fifty-seven percent of patients underwent supraglottoplasty. Postoperatively, 92% reported improvement in dysphagia symptoms. Conclusion: Dysphagia is prevalent among a subset of children with laryngomalacia. Symptomatic children may benefit from a swallow evaluation to help determine the need for further intervention. Children who undergo supraglottoplasty for laryngomalacia have improved dysphagia at follow-up, though the amount of improvement directly attributable to surgery is unclear and warrants further investigation.

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“…We feel it is imperative to emphasize that the co-occurrence of downstream consequences with an anatomic concern is the key in decision-making, as many children have anatomic variants that do not cause functional issues. Anatomic targets for surgical intervention by the otolaryngologist may include ankyloglossia, adenotonsillar hypertrophy, laryngeal cleft, laryngomalacia, vocal fold movement impairment, and cricopharyngeal achalasia [4,22,[30][31][32][33][34].…”

Section: Surgical and Medical Managementmentioning

confidence: 99%

Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia

Farrell,

Raol

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Dysphagia affects at least 1% of the pediatric population. This prevalence further increases in patients who are born prematurely or who have underlying neuromuscular or cardiopulmonary disorders. A multidisciplinary team approach, including an Otolaryngologist, can help promote an expedited diagnosis and therapeutic regimen, ensuring that the patient receives adequate nutrition needed for growth and development. Recent findings The development and growth of multidisciplinary aerodigestive clinics have improved outcomes in pediatric patients with dysphagia. If a structural concern is noted on examination, there remain a multitude of medical and surgical options to help improve patient outcomes and swallow. These treatment options are usually multimodality and specific interventions may be employed to target a specific and notable abnormality. Summary Pediatric dysphagia is a complex concern. For the otolaryngologist, etiologies with surgical targets may include ankyloglossia, tonsillar hypertrophy, laryngomalacia, laryngo-esophageal cleft, vocal fold movement impairment, and cricopharyngeal achalasia. The development and formalization of a multidisciplinary approach has streamlined and broadened treatment options for these patients. An otolaryngologist is integral as part of the treatment team of these patients.

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Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis

Cited by 20 publications

References 33 publications

Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Laryngomalacia and Swallow Dysfunction

Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia

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