Aspiration in children with unilateral vocal fold paralysis

Irace, Alexandria L.; Dombrowski, Natasha D.; Kawai, Kosuke; Dodrill, Pamela; Perez, Jennifer; Hernandez, Kayla; Davidson, Kathryn; Hseu, Anne; Nuss, Roger C.; Rahbar, Reza

doi:10.1002/lary.27410

Cited by 25 publications

(22 citation statements)

References 32 publications

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“…This is consistent with findings from previous studies. 5,12,19,20 Although patients who did not have postoperative VFMI were more likely to have oral phase difficulties and less likely to have airway protection deficits, it is notable that the silent aspiration rate in this group was still 28%. Although the majority of our study's participants were identified with the use of FNL, more recently LUS has been the mainstay for early noninvasive identification of VFMI at our institution.…”

Section: Discussionmentioning

confidence: 84%

Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery

et al. 2021

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Objectives/Hypothesis: Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the dysphagia in this population and explore the associations between surgical complexity and vocal fold mobility with dysphagia and airway protection.Study Design: Retrospective chart review. Methods: This is a retrospective chart review of infants (age <12 months) who underwent congenital heart surgery between 7/2008 and 1/2018 and received a subsequent videofluoroscopic swallow study (VFSS). Demographic information, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category of each surgery, vocal fold mobility status, and VFSS findings were collected and analyzed.Results: Three hundred and seventy-four patients were included in the study. Fifty-four percent of patients were male, 24% were premature, and the average age at the time of VFSS was 59 days. Sixty percent of patients had oral dysphagia and 64% of patients had pharyngeal dysphagia. Fifty-one percent of patients had laryngeal penetration and 45% had tracheal aspiration. Seventy-three percent of these aspirations were silent. There was no association between surgical complexity, as defined by the STAT category, and dysphagia or airway protection findings. Patients with VFMI after surgery were more likely to have silent aspiration (odds ratio = 1.94, P < .01), even when adjusting for other risk factors.Conclusion: Infants who undergo congenital heart surgery are at high risk for VFMI and aspiration across all five STAT categories. This study demonstrates the high prevalence of silent aspiration in this population and the need for thorough postoperative swallow evaluation.

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Section: Discussionmentioning

confidence: 84%

Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery

et al. 2021

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“…Silent aspiration was described in several studies of preterm infants ( 130 – 132 , 134 ). Those with vocal cord paralysis are at high risk for silent aspiration.…”

Section: Resultsmentioning

confidence: 99%

Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

Cristea¹,

Ren²,

Amin³

et al. 2021

Am J Respir Crit Care Med

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Background Premature birth affects millions of neonates each year, placing them at risk for respiratory disease due to prematurity. Bronchopulmonary dysplasia is the most common chronic lung disease of infancy, but recent data suggest that even premature infants who do not meet the strict definition of bronchopulmonary dysplasia can develop adverse pulmonary outcomes later in life. This post-prematurity respiratory disease (PPRD) manifests as chronic respiratory symptoms, including cough, recurrent wheezing, exercise limitation, and reduced pulmonary function. This document provides an evidence-based clinical practice guideline on the outpatient management of infants, children, and adolescents with PPRD. Methods A multidisciplinary panel of experts posed questions regarding the outpatient management of PPRD. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. Results The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Recommendations were developed for or against three common medical therapies and four diagnostic evaluations in the context of the outpatient management of PPRD. Conclusions The panel developed recommendations for the outpatient management of patients with PPRD on the basis of limited evidence and expert opinion. Important areas for future research were identified.

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“…1 Clinicians should recognize the potential for silent aspiration and advocate for feeding evaluations to characterize swallowing mechanics. 22 Undiagnosed left VCP might lead to inappropriate treatment choices and early detection may improve outcomes. 23 Pediatric otolaryngologists caring for these children should strive for a timely and accurate diagnosis of VCP.…”

Section: Discussionmentioning

confidence: 99%

Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

Chorney

Zur

Buzi

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Assessing vocal cord mobility by flexible nasolaryngoscopy (FNL) can be difficult in neonates. To date, prospective studies evaluating the incidence and diagnostic accuracy of vocal cord paralysis (VCP) after surgical patent ductus arteriosus (PDA) ligation are limited. It is unknown whether video FNL improves diagnosis in this population. This study compared video recordings with bedside evaluation for diagnosis of VCP and determined inter-rater reliability of the diagnosis of VCP in preterm infants after PDA ligation. Methods: Prospective cohort of preterm neonates undergoing bedside FNL within two weeks of extubation following PDA ligation. In a subset, FNL was recorded. Two pediatric otolaryngologists, blinded to the initial diagnosis, reviewed the FNL video recordings. Results: Eighty infants were enrolled and 37 with a recorded FNL were included in the cohort. Average gestational age at birth was 25.2 weeks (SD: 1.2) and postmenstrual age at FNL was 37.0 weeks (SD: 4.5), which was 9.5 days (SD: 14.7) after extubation following PDA repair. There were 6 diagnosed with left VCP (16.2%; 95% CI: 4.3-28.1%) at bedside, and 9 diagnosed by video review (24.3%; 95% CI: 10.5-38.1%) ( P = .56). Videos confirmed all 6 VCP diagnosed initially, but also identified 3 additional cases. Though imperfect, reviewing FNL by video showed substantial reliability (kappa = .75), with 91.9% agreement. Conclusion: Video recorded FNL most often confirms a bedside diagnosis of VCP, but may also identify discrepancies. Physicians should consider the limitations of diagnosis especially when infants persist with symptoms such as weak voice or signs of postoperative aspiration. Level of Evidence 2b

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Aspiration in children with unilateral vocal fold paralysis

Cited by 25 publications

References 32 publications

Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery

Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery

Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

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