Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients

Wineski, R.E.; Panico, Emma; Karas, Anatoli F.; Rosen, Philip L.; Diver, B. Van; Norwood, Timothy G.; Grayson, Jessica W.; Beltran-Ale, G.; Dimmitt, Reed A.; Kassel, Rachel; Rogers, Alice; Leonard, Michael P.; Chapman, AL; Boehm, L.; Wiatrak, Brian J.; Harris, William T.; Smith, Nicholas

doi:10.1016/j.ijporl.2021.110874

Cited by 9 publications

(12 citation statements)

References 15 publications

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“…A laryngeal cleft can be characterized by the Benjamin-Inglis classification system: A type I cleft involves supraglottis and ends above the true vocal folds (least severe) while a type IV cleft extends into the thoracic trachea. A more recent subclassification of type I laryngeal clefts has been published to describe a deep interarytenoid groove (DIG), which is defined as an inter-arytenoid defect ending 0-3 mm above the true vocal cords [1,[21][22][23][24].…”

Section: Endoscopic Evaluations Under Anesthesiamentioning

confidence: 99%

“…If there is a concern for a laryngeal cleft, several different management options are present. For a type I laryngeal cleft or DIG, surgical options include suture approximation or injection augmentation of the interarytenoid space [1,38]. Though no universally accepted system exists, an interarytenoid assessment protocol involving four standard steps for evaluating interarytenoid height has been studied and shown to be reliable and consistent [22].…”

Section: Surgical and Medical Managementmentioning

confidence: 99%

“…Dysphagia, or difficulty swallowing, is reported to occur in 1% of children, resulting in approximately 500 000 new diagnoses annually; however, the true incidence may be underestimated based on lack of screening via diagnostic swallow evaluations [1,2]. This prevalence increases greatly in patients who are born prematurely or who have underlying neuromuscular or cardiopulmonary disorders [3,4].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Endoscopic Evaluations Under Anesthesiamentioning

confidence: 99%

Section: Surgical and Medical Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Spontaneous breathing can be maintained, which allows for examination of the dynamic status of the airway. The sedated status allows for surgical interventions such as biopsy, laryngeal cleft injection or suturing, epiglottopexy, balloon dilation, vocal cord injection, and laryngotracheal reconstruction[ 9 , 10 ].…”

Section: Aerodigestive Program Servicesmentioning

confidence: 99%

Making the case for multidisciplinary pediatric aerodigestive programs

Kanotra¹,

Weiner²,

Rahhal³

2022

WJG

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Multidisciplinary pediatric aerodigestive centers have been proposed to address the needs of children with complex multi-system problems affecting the respiratory and upper gastrointestinal tracts. The setup of a multidisciplinary service allows for the complex coordination needed between different subspecialties. This allows for rapid communication and family-centered decision making and agreement on further diagnostic and/or therapeutic next steps such as offering triple endoscopy when indicated. Triple endoscopy entails performing rigid upper airway assessment, flexible bronchoscopy and upper gastrointestinal endoscopy and has been linked to reduced time to diagnosis/treatment, reduced costs and anesthesia exposure. This review summarizes the available literature on the structure and benefits of multidisciplinary pediatric aerodigestive services.

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“…Management of IIA remains underutilized for LC1 and little is known about its utilization or efficacy in DIG treatment. In past studies, these two anatomic defects have been grouped into one category due to poor differentiating diagnostic standards 17 . Importantly, treatment standards for LC1s, upon which DIG management is adapted, continue to be developed 2 .…”

Section: Introductionmentioning

confidence: 99%

Interarytenoid injection outcomes in pediatric feeding disorders

Stack-Pyle

Carrasco²,

Shah

et al. 2023

Laryngoscope Investig Oto

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ObjectivesType 1 laryngeal clefts (LC1) and deep interarytenoid grooves contribute to pediatric feeding disorders. Management of these defects remains heterogeneous among surgeons and interarytenoid injection augmentation (IIA) is not always offered as a treatment option. This study evaluated IIA outcomes among a pediatric patient cohort comprised mostly of those with deep interarytenoid grooves.MethodsA single‐institution retrospective chart review featured children under the age of 5 years presenting for aspiration, dysphagia, or choking. Over the period of 7 years (January 2014–October 2021), 39 met inclusion criteria and had sufficient follow‐up data. Descriptive statistics and subgroup analyses were performed.ResultsOf the 39 included patients, 76.92% had clinical improvement post‐injection, with the mean time to follow‐up being 47 days. Within the deep interarytenoid groove group, improvement rates were 82.76%. Bronchoscopy findings revealed 29 (74.36%) patients with a DIG, 3 (7.69%) with LC1, 3 (7.69%) with no anatomic abnormality, and 4 (10.26%) with vocal cord paralysis. There were no adverse events. There were no associations with the outcomes based on subgroup analysis and logistic regression.ConclusionsIIA is an effective and safe treatment for pediatric feeding disorders. No covariates were associated with symptom improvement. Within the deep interarytenoid groove diagnosis subgroup, IIA effectively improved symptoms. Further investigations are needed to explore predictors of success with IIA in this population.Level of EvidenceVI.

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Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients

Cited by 9 publications

References 15 publications

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

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

Making the case for multidisciplinary pediatric aerodigestive programs

Interarytenoid injection outcomes in pediatric feeding disorders

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