Pediatric dysphagia: Is interarytenoid mucosal height significant?

Abstract

Objectives: The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS).Methods: A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%).Results: There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%).Conclusion: There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology.

Beyond Laryngeal Clefts: Interarytenoid Injection Augmentation to Predict Success of Suture Augmentation in Children

“…Within our cohort we found 4.85% of patients to have a laryngeal cleft at the level of the TVF based on our current working definition, which is consistent with previous studies 29 . In addition, we affirmed previous studies which noted that patients with normal anatomy can present with pharyngeal dysphagia 25 and can significantly benefit in terms of advancing diet consistency by reducing aspiration risk with IAIA, 24 as our study was comprised mostly (53.4%) of patients with normal IAMH (above the level of the FVF).…”

“…24 Additional studies since have shown no correlation between interarytenoid mucosal height (IAMH) and dysphagia symptoms. 25 This poses an ambiguous clinical scenario in which our current consensus statements do not help guide clinicians caring for patients with normal interarytenoid anatomy and dysphagia given the results of these studies.…”

Injection augmentation and endoscopic repair of type 1 laryngeal clefts: development of a management algorithm

“…Additionally, some authors have argued that augmentation of the posterior larynx can improve clinical aspiration and SD even without definitive evidence of an anatomic cleft [16], as well as in the setting of a 'deep inter-arytenoid notch.' [17] One recent study attempted to measure the mucosal height of the posterior inter-arytenoid space and correlate this with the need for thickened feeds however no significant association was found [18]. In our experience, a blend of anatomic and functional cleft approaches serves the clinician best.…”

Predictive Utility of the Penetration‐Aspiration Scale in Inter‐Arytenoid Injection Augmentation

“…Patients with pharyngeal dysphagia and those with type I laryngeal cleft have been shown to benefit from IAIA 11,12 . Recent data suggest that the interarytenoid mucosal height may not necessarily correlate with presence or absence of dysphagia as even patients without a true type I laryngeal cleft who exhibit pharyngeal dysphagia can advance their diet after IAIA 13, 14 …”