Jayanthy Pavithran1, Indu Vadakke Puthiyottil2, Madhumita Kumar3, Anju Viswambharan Nikitha4, Sivakumar Vidyadharan5, Renjitha Bhaskaran6, Arya Chandrababu Jaya7, Krishnakumar Thankappan8, Iyer Subramania9, K R Sundaram10. 1. Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: jayanthyp@aims.amrita.edu. 2. Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: indusadanandan366@gmail.com. 3. Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: docmadhumita@gmail.com. 4. Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: anjuvn1022@gmail.com. 5. Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: darandoc@gmail.com. 6. Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India. Electronic address: renjithabhaskaran@gmail.com. 7. Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: arya1cj@gmail.com. 8. Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: drkrishnakumart@gmail.com. 9. Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Electronic address: subu.amrita@gmail.com. 10. Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India. Electronic address: krs1943@yahoo.com.
Abstract
OBJECTIVES/HYPOTHESIS: In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. STUDY DESIGN: Prospective, observational. METHODOLOGY: Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used. RESULTS: FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). CONCLUSION: FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.
OBJECTIVES/HYPOTHESIS: In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. STUDY DESIGN: Prospective, observational. METHODOLOGY: Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used. RESULTS: FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). CONCLUSION: FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.
Authors: James A Curtis; James C Borders; Sarah E Perry; Avery E Dakin; Zeina N Seikaly; Michelle S Troche Journal: Dysphagia Date: 2021-04-10 Impact factor: 3.438