Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity

Wineski, R.E.; Ale, G.J. Beltran; Simpson, Ryne; Evarts, Marissa; Stein, Joel; Rosen, Philip L.; Rogers, John A.; Leonard, Michael P.; Dimmitt, Reed A.; Soong, Allison; Kassel, Rachel; Harris, William T.; Wiatrak, Brian J.; Smith, Nathan J.

doi:10.1016/j.ijporl.2023.111657

International Journal of Pediatric Otorhinolaryngology

2023

DOI: 10.1016/j.ijporl.2023.111657

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Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity

R.E. Wineski

G.J. Beltran Ale

Ryne Simpson

et al.

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Cited by 2 publications

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“…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.…”

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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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confidence: 99%

Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia

Simpson,

Ale,

Harris

2023

Pediatric Pulmonology

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Efficacy and Complications of Interarytenoid Injection for Dysphagia in Infants 1‐Year‐Old and Under

House,

Scheffler,

Gerber

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThe objective of this study was to assess the efficacy and complication rates of interarytenoid injection augmentation (IAIA) for the treatment of dysphagia in patients 1 year of age and under and to determine if concurrent feeding therapy (FT) affects outcome.Study DesignRetrospective case series.SettingTertiary pediatric hospital.MethodsRetrospective review of patients 13 months of age and younger with dysphagia treated by IAIA over a 4‐year period. The efficacy of IAIA was determined by comparing perioperative videofluoroscopic swallow studies (VFSS) and Dysphagia Outcome and Severity Scale (DOSS) scores. Complication rates and utilization of concomitant FT were determined by evaluating postoperative admission and follow‐up records.ResultsSixty‐five patients met inclusion criteria (median age 8 months, interquartile range [IQR]: 7‐11). Sixty‐seven percent of patients improved on postoperative VFSS scores (median improvement in aspiration of 2 thickness levels, IQR 0‐3, P < .0001), and 56% improved in DOSS scores (median increase of 1, IQR: 0‐1.5, P < .0001). Ninety‐two percent of patients were discharged home on the day of surgery. The 30‐day relevant readmission rate was 5%. No patients had intraoperative complications or severe complications at follow‐up. No statistical difference in aspiration or DOSS was noted in the concomitant FT cohort due to a lack of sample size.ConclusionThis study demonstrates that IAIA in children under 13 months old shows comparable rates of success and complications to older patients reported in the literature. No patients had long‐term complications and most were discharged home on the day of surgery. More studies are needed to determine the effect of concomitant FT on IAIA.

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Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity

Cited by 2 publications

References 14 publications

Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia

Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia

Efficacy and Complications of Interarytenoid Injection for Dysphagia in Infants 1‐Year‐Old and Under

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