Eelam Adil1, Hasan Al Shemari2, Amy Kacprowicz2, Jennifer Perez2, Kara Larson2, Kayla Hernandez2, Kosuke Kawai3, Julia Cowenhoven2, David Urion4, Reza Rahbar1. 1. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts. 2. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts. 3. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts4Clinical Research Center, Boston Children's Hospital. Boston, Massachusetts. 4. Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Abstract
IMPORTANCE: Chronic airway aspiration is a challenging problem for physicians and caregivers and can cause significant pulmonary morbidity in pediatric patients. Our knowledge regarding the causes and optimal management of these patients is in its infancy. OBJECTIVE: To review our experience with the evaluation and management of pediatric patients with documented aspiration and normal upper airway anatomy. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective medical record review, we studied pediatric patients for airway disorders at a pediatric tertiary referral center who were diagnosed as having aspiration on modified barium swallow study during a 10-year period (June 1, 2002, through September 31, 2012). INTERVENTIONS: Direct laryngoscopy and bronchoscopy performed with the patient under general anesthesia. MAIN OUTCOMES AND MEASURES: Demographics, comorbidities, management, and swallowing outcomes were analyzed. RESULTS: Forty-six patients met the inclusion criteria. The mean age at presentation was 1.56 years, and there was a male to female ratio of approximately 2:1. Eight patients (17%) were syndromic, 16 (35%) had developmental delay, and 12 (26%) had congenital heart disease. Fifteen patients (33%) underwent brain magnetic resonance imaging, and none had a brainstem or posterior fossa lesion that accounted for their aspiration. Patients were subdivided according to the consistency of the fluids that they aspirated: 25 (54%) aspirated thin liquids, 15 (33%) aspirated thickened liquids, and 6 (13%) aspirated purees. Of these patients, 21 (84%), 12 (80%), and 3 (50%) had resolution of their swallowing dysfunction with feeding and swallowing therapy, respectively. A total of 3 patients (7%) required a tracheostomy for their refractory aspiration. CONCLUSIONS AND RELEVANCE: We recommend feeding and swallowing therapy for children with normal upper airway anatomy. Brain magnetic resonance imaging should be considered for patients with suspected brainstem or posterior fossa lesion based on neurologic examination findings. Most patients who aspirate thin and thickened liquids will have resolution of their swallowing dysfunction within 1 year of beginning therapy.
IMPORTANCE: Chronic airway aspiration is a challenging problem for physicians and caregivers and can cause significant pulmonary morbidity in pediatric patients. Our knowledge regarding the causes and optimal management of these patients is in its infancy. OBJECTIVE: To review our experience with the evaluation and management of pediatric patients with documented aspiration and normal upper airway anatomy. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective medical record review, we studied pediatric patients for airway disorders at a pediatric tertiary referral center who were diagnosed as having aspiration on modified barium swallow study during a 10-year period (June 1, 2002, through September 31, 2012). INTERVENTIONS: Direct laryngoscopy and bronchoscopy performed with the patient under general anesthesia. MAIN OUTCOMES AND MEASURES: Demographics, comorbidities, management, and swallowing outcomes were analyzed. RESULTS: Forty-six patients met the inclusion criteria. The mean age at presentation was 1.56 years, and there was a male to female ratio of approximately 2:1. Eight patients (17%) were syndromic, 16 (35%) had developmental delay, and 12 (26%) had congenital heart disease. Fifteen patients (33%) underwent brain magnetic resonance imaging, and none had a brainstem or posterior fossa lesion that accounted for their aspiration. Patients were subdivided according to the consistency of the fluids that they aspirated: 25 (54%) aspirated thin liquids, 15 (33%) aspirated thickened liquids, and 6 (13%) aspirated purees. Of these patients, 21 (84%), 12 (80%), and 3 (50%) had resolution of their swallowing dysfunction with feeding and swallowing therapy, respectively. A total of 3 patients (7%) required a tracheostomy for their refractory aspiration. CONCLUSIONS AND RELEVANCE: We recommend feeding and swallowing therapy for children with normal upper airway anatomy. Brain magnetic resonance imaging should be considered for patients with suspected brainstem or posterior fossa lesion based on neurologic examination findings. Most patients who aspirate thin and thickened liquids will have resolution of their swallowing dysfunction within 1 year of beginning therapy.
Authors: Daniel R Duncan; Paul D Mitchell; Kara Larson; Maireade E McSweeney; Rachel L Rosen Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-12-01 Impact factor: 6.223
Authors: Nikolaus E Wolter; Kayla Hernandez; Alexandria L Irace; Kathryn Davidson; Jennifer A Perez; Kara Larson; Reza Rahbar Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-01-01 Impact factor: 6.223