Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre

Svystun, Orysya; Johannsen, Wendy; Persad, Rabin; Turner, Justine; Majaesic, Carina; El‐Hakim, Hamdy

doi:10.1016/j.ijporl.2017.05.024

Cited by 32 publications

(35 citation statements)

References 26 publications

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“…Laryngeal penetration occurs when material enters the laryngeal inlet but does not extend below the level of the vocal cords and can vary in terms of frequency and depth. Penetration can occur for a variety of reasons including anatomic abnormalities, laryngopharyngeal sensory deficits, and developmental/neurologic conditions, but is thought to primarily occur due to disrupted swallow function in which some amount of material from the oral cavity travels inappropriately to the laryngeal inlet instead of esophagus (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration

Duncan¹,

Larson²,

Davidson

et al. 2019

J. pediatr. gastroenterol. nutr.

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Objectives: To determine if children with laryngeal penetration on videofluoroscopic swallow study (VFSS) who received feeding interventions (thickened liquids, change in liquid flow rate and/or method of liquid delivery) had improved symptoms and decreased hospitalizations compared to those without intervention. Methods: We performed a retrospective cohort study of children under 2 years with laryngeal penetration on VFSS at our institution in 2015 to determine initial and follow-up VFSS findings, symptom improvement at follow-up, and hospitalization risk before and after VFSS. Proportions were compared with Fisher's exact test and hospitalizations with paired t-tests. Results: We evaluated 137 subjects with age 8.93±0.59 months who had laryngeal penetration without aspiration on VFSS. 55% had change in management, with 40% receiving thickening and 15% a change in flow rate. There was significant improvement in symptoms for children that had feeding intervention and this improvement was greatest with thickening (OR 41.8, 95% CI 12.34-141.69, p<0.001). On repeat VFSS, 26% had evidence of aspiration that was not captured on initial VFSS. Subjects had decreased total and pulmonary hospitalizations with feeding intervention and decreased pulmonary nights with thickening (p<0.05). Conclusions: Laryngeal penetration appears to be clinically significant in children with oropharyngeal dysphagia and interventions to decrease its occurrence are associated with improved outcomes including decreased symptoms of concern and hospitalization nights. Thickening or other feeding intervention should be considered for all symptomatic children with laryngeal penetration on swallow study.

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Section: Introductionmentioning

confidence: 99%

Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration

Duncan¹,

Larson²,

Davidson

et al. 2019

J. pediatr. gastroenterol. nutr.

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“…These symptoms typically include coughing, choking, eyes turning red, difficulty feeding or changes in color with feeding 4 . Little is known about the actual correlation between presenting symptoms and the risk of finding aspiration either by clinical feeding evaluation (CFE) or videofluoroscopic swallow study (VFSS) 4, 5 . The CFE typically consists of assessing feeding with one or more textures (eg, thin, nectar, honey thick or purees) using one or more methods of feeding (e.g.…”

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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“…The general outline of management followed in our multi-disciplinary clinic was described by Syystun et al [15]. Largely, where possible a trial of oral thickened liquid intake was undertaken for a period of three months until resolution of symptoms was achieved.…”

Section: Methodsmentioning

confidence: 99%

Injection augmentation and endoscopic repair of type 1 laryngeal clefts: Development of a management algorithm

Isaac

Svystun

Johannsen

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Objectives: To describe indications for injection augmentation (IA), endoscopic repair (ER) and conservative methods for the management of type 1 laryngeal cleft (LC1) and propose a management algorithm. We also aimed to compare success of IA and ER and determine independent predictors of treatment failure. Methods: Retrospective study of patients diagnosed with LC1 at a Pediatric Otolaryngology referral centre between 2004 and 2016. All had pre-operative instrumental swallowing evaluation (VFSS/FEES), and were managed with a combination of conservative measures, IA and/or ER. We collected demographics, symptoms, comorbidities, VFSS/ FEES results, and operative details. The primary outcome was symptom resolution by parental report. The secondary outcome was predictors of treatment failure. Results: 88 patients were included in the analysis, with mean age 26 ± 25 months. Most presented with choking events (68%) or recurrent pneumonias (48%). In total, there were 55 IA performed and 45 ER. Of the patients who received IA, 19 required subsequent ER. 95% had symptom improvement, 67% had complete resolution. IA had a 56% long-term success rate, whereas that for ER was 85%. Tube feeding at initial evaluation was an independent predictor of treatment failure (HR 11.33 [1.51-84.97], p = 0.018). Conclusions: LC1 can be effectively managed with a combination of IA and ER with favorable results. Failure to respond to IA does not preclude ER, and both have their role in management. Patients who are tube fed have a higher probability of treatment failure. We propose a management algorithm that includes reasoning for conservative approaches, and reduces exposure to general anesthesia.

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Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre

Cited by 32 publications

References 26 publications

Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration

Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration

Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Injection augmentation and endoscopic repair of type 1 laryngeal clefts: Development of a management algorithm

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