Samuel W Fung1, Eveline Lapidus-Krol1, Monping Chiang1, Erica M Fallon1, Beth Haliburton1, Evan J Propst2, Priscilla Pl Chiu3. 1. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, ON, Canada. 2. Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, ON, Canada. 3. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, ON, Canada. Electronic address: priscilla.chiu@sickkids.ca.
Abstract
BACKGROUND: The purpose of this study was to determine risk factors and long-term outcomes in patients with esophageal atresia +/-tracheoesophageal fistula (EA/TEF) with vocal cord dysfunction (VCD) owing to recurrent laryngeal nerve (RLN) injury. METHOD: A retrospective chart review was performed for EA/TEF patients repaired at our institution from 1999 to 2014 (REB #1000032265). RESULTS: Of 197 patients, 22 (11.2%) were diagnosed with VCD by indirect laryngoscopy following EA/TEF repair. Aspiration was documented on video swallow study for 21 patients, and as a result, 13 required thickened feeds and 8 required gastrostomy tube feeds. Of the 16 H-type TEF patients, 8 (50%) had VCD. Following discharge, 20 (90.9%) patients with VCD eventually tolerated full feeds orally without aspiration but only 8 (36.4%) had documented recovery of vocal cord movement at long-term follow up (mean 452 days). Overall, patients with VCD were more likely to have feeding modifications, increased exposure to radiological studies, and increased frequency of Otolaryngology follow-up compared to EA/TEF patients without VCD. CONCLUSION: EA/TEF patients are at risk for VCD. Clinical improvement did not always correlate with recovery of VC motion. Strategies to minimize RLN damage will improve outcomes and quality of life for EA/TEF patients. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The purpose of this study was to determine risk factors and long-term outcomes in patients with esophageal atresia +/-tracheoesophageal fistula (EA/TEF) with vocal cord dysfunction (VCD) owing to recurrent laryngeal nerve (RLN) injury. METHOD: A retrospective chart review was performed for EA/TEFpatients repaired at our institution from 1999 to 2014 (REB #1000032265). RESULTS: Of 197 patients, 22 (11.2%) were diagnosed with VCD by indirect laryngoscopy following EA/TEF repair. Aspiration was documented on video swallow study for 21 patients, and as a result, 13 required thickened feeds and 8 required gastrostomy tube feeds. Of the 16 H-type TEFpatients, 8 (50%) had VCD. Following discharge, 20 (90.9%) patients with VCD eventually tolerated full feeds orally without aspiration but only 8 (36.4%) had documented recovery of vocal cord movement at long-term follow up (mean 452 days). Overall, patients with VCD were more likely to have feeding modifications, increased exposure to radiological studies, and increased frequency of Otolaryngology follow-up compared to EA/TEFpatients without VCD. CONCLUSION: EA/TEFpatients are at risk for VCD. Clinical improvement did not always correlate with recovery of VC motion. Strategies to minimize RLN damage will improve outcomes and quality of life for EA/TEFpatients. LEVEL OF EVIDENCE: Level III.
Authors: Claire M Lawlor; Benjamin Zendejas; Christopher Baird; Carlos Munoz-San Julian; Russell W Jennings; Sukgi S Choi Journal: Front Pediatr Date: 2020-11-27 Impact factor: 3.418