Clinical predictors of laryngotracheoesophageal clefts and tracheoesophageal fistulae in children with dysphagia

Mattos, Claudia; Phinizy, Pelton; Duffy, Kimberly L.; Sobol, Steven E.; Piccione, Joseph

doi:10.1002/ppul.25628

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…While LTEC is rare, 1 in 10,000-20,000 live births (19), the incidence of LTEC is higher (7.6%-22%) in children with aerodigestive issues such as a chronic cough (20)(21)(22). Mattos et al (23) showed that 1 percent of surgically assessed aspirating patients had a TEF, and 26% had an LTEC. Full-term children with OPD and tracheal aspiration were 3 times more likely to have LTEC than children born prematurely who also aspirate.…”

Section: Otolaryngology Perspectivementioning

confidence: 99%

“…Full‐term children with OPD and tracheal aspiration were 3 times more likely to have LTEC than children born prematurely who also aspirate. While OPD in preterm children is more likely to be functional than structural, LTEC was identified in 10% of them and must be considered (23). These data support the role of bronchoscopy in children with OPD with tracheal aspiration.…”

Section: Diagnostics Approaches To Opdmentioning

confidence: 99%

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Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

Krasaelap,

Duncan,

Sabe

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. Methods: The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia, one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. Conclusions: The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with oropharyngeal dysphagia.

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Section: Otolaryngology Perspectivementioning

confidence: 99%

Section: Diagnostics Approaches To Opdmentioning

confidence: 99%

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

Krasaelap,

Duncan,

Sabe

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Although suspected aspiration is a recognized indication for flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) in children, 2,3 there is considerable variability among diagnostic practices (including the exact role of FB) in these individuals. In children with unexplained oropharyngeal dysphagia at risk for aspiration, combined airway endoscopy, consisting of both FB and direct laryngoscopy and rigid bronchoscopy (DLB), is often performed to assess lower airway health and evaluate for anatomical causes of aspiration such as laryngotracheoesophageal clefts (LTEC) and tracheoesophageal fistulas (TEF) 4–6 . Prior work has characterized actionable DLB findings in children with dysphagia 7,8 ; however, similar research is lacking with regard to FB.…”

Section: Introductionmentioning

confidence: 99%

“…In children with unexplained oropharyngeal dysphagia at risk for aspiration, combined airway endoscopy, consisting of both FB and direct laryngoscopy and rigid bronchoscopy (DLB), is often performed to assess lower airway health and evaluate for anatomical causes of aspiration such as laryngotracheoesophageal clefts (LTEC) and tracheoesophageal fistulas (TEF). [4][5][6] Prior work has characterized actionable DLB findings in children with dysphagia 7,8 ; however, similar research is lacking with regard to FB. Put another way, in children undergoing combined airway endoscopy for dysphagia, when a major focus is anatomical laryngeal evaluation achieved through DLB, the clinical contribution imparted through FB has yet to be established.…”

mentioning

confidence: 99%

Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia

Simpson,

Ale,

Harris

2023

Pediatric Pulmonology

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IntroductionFlexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are frequently performed in children with known or suspected aspiration, however, the additive value of FB in conjunction with direct laryngoscopy and rigid bronchoscopy (DLB) has not been previously quantified. This study details the common endoscopic/cytological findings and associated management impact of FB and BAL in pediatric Aerodigestive patients undergoing combined airway evaluation (FB and DLB) for oropharyngeal dysphagia.Materials and MethodsA retrospective chart review was performed in children <3 years of age followed through a large Aerodigestive center undergoing outpatient, combined airway endoscopy for dysphagia. Patient and procedural characteristics, endoscopic and BAL findings, and management metrics were collected and analyzed. A secondary analysis evaluated the association between endoscopic findings and medication changes.ResultsNinety‐one procedures (median patient age, 15 months) were identified. All procedures included both FB and DLB, and just over half (52.7%) included esophagogastroduodenoscopy. Common endoscopic findings included bronchitis (73.6%), adenoidal hypertrophy (31.9%), and tracheomalacia (10.8%). BAL cytology frequently identified neutrophilic inflammation (mean 39.6% neutrophils [interquartile range 6.5%–71%)]. Cultured pathogens commonly included Streptococcus viridans (46.6%), Hemophilus influenzae (36.3%), Moraxella catarrhalis (30.1%), and Streptococcus pneumoniae (25.0%). FB and BAL results contributed to clinical decisions in 65 of 91 (71.4%) patients. Endoscopically‐diagnosed bronchitis (odds ratio [OR] 7.27, 95% confidence interval [CI] 2.4–21.99) and tracheomalacia (OR 5.79, 95% CI 1.20–27.85) were significantly associated with increased odds of medication adjustments following FB.ConclusionIn pediatric Aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia, FB and BAL are high‐yield and clinically impactful procedures.

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Laryngeal cleft repair – formal suture technique

Timashpolsky

Sobol²

2022

Operative Techniques in Otolaryngology-Head and Neck Surgery

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Clinical predictors of laryngotracheoesophageal clefts and tracheoesophageal fistulae in children with dysphagia

Cited by 3 publications

References 12 publications

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia

Laryngeal cleft repair – formal suture technique

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