Amar Miglani1, Scott Schraff2, Pamela Y Clarke3, Usmaan Basharat4, Peter Woodward5, Paul Kang6, Lindsay Stevens3, Jim Woodward5, Howard Williams7, Dana I Williams8,9. 1. Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA. 2. Arizona Otolaryngology Consultants, Phoenix, AZ, USA. 3. Department of Gastroenterology, Aerodigestive Program, Phoenix Children's Hospital, Phoenix, AZ, USA. 4. University of Arizona College of Medicine, Phoenix, AZ, USA. 5. Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA. 6. Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA. 7. Department of Anesthesiology, Valley Anesthesia and Phoenix Children's Hospital, Phoenix, AZ, USA. 8. Department of Gastroenterology, Aerodigestive Program, Phoenix Children's Hospital, Phoenix, AZ, USA. DUrsea@phoenixchildrens.com. 9. Division of Pediatric Gastroenterology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, 85016, USA. DUrsea@phoenixchildrens.com.
Abstract
PURPOSE OF REVIEW: Our objective is to summarize the presentation, diagnosis, and management of mild laryngeal clefts in children. We focus on deep interarytenoid notches (DIN), a subclassification of type 1 laryngeal clefts (LC1), and review the literature and our multidisciplinary experience utilizing injection laryngoplasty (IL). RECENT FINDINGS: DIN is a mild form of LC1 and is considered a normal anatomical variant. Recent cohort studies demonstrate IL to be a safe, low-risk, and efficacious treatment of LC1, but few studies focus on DIN. We present results from two aerodigestive clinic (ADC) pilot studies at our institution, in patients 1-3 years old, with DIN-related dysphagia and aspiration (DA). Feeding, respiratory-related symptom scores, and aspiration/penetration assessed on modified barium swallow (MBS) significantly improved following combined IL and feeding therapy using a thickener weaning protocol (TWP). Subgroup analysis reveals combined IL and TWP to be particularly effective in patients with severe baseline DA. Multidisciplinary aerodigestive evaluation and management with IL and feeding therapy focused on weaning levels of thickener is emerging as a novel and effective approach for treatment of DIN-related DA in young children. Further comparative, prospective trials investigating effects of IL and feeding therapy are required to validate results.
PURPOSE OF REVIEW: Our objective is to summarize the presentation, diagnosis, and management of mild laryngeal clefts in children. We focus on deep interarytenoid notches (DIN), a subclassification of type 1 laryngeal clefts (LC1), and review the literature and our multidisciplinary experience utilizing injection laryngoplasty (IL). RECENT FINDINGS: DIN is a mild form of LC1 and is considered a normal anatomical variant. Recent cohort studies demonstrate IL to be a safe, low-risk, and efficacious treatment of LC1, but few studies focus on DIN. We present results from two aerodigestive clinic (ADC) pilot studies at our institution, in patients 1-3 years old, with DIN-related dysphagia and aspiration (DA). Feeding, respiratory-related symptom scores, and aspiration/penetration assessed on modified barium swallow (MBS) significantly improved following combined IL and feeding therapy using a thickener weaning protocol (TWP). Subgroup analysis reveals combined IL and TWP to be particularly effective in patients with severe baseline DA. Multidisciplinary aerodigestive evaluation and management with IL and feeding therapy focused on weaning levels of thickener is emerging as a novel and effective approach for treatment of DIN-related DA in young children. Further comparative, prospective trials investigating effects of IL and feeding therapy are required to validate results.
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