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Int J Pediatr Otorhinolaryngol. 2018 Dec;115:10-18. doi: 10.1016/j.ijporl.2018.09.006. Epub 2018 Sep 13.

Outcomes and swallowing evaluations after injection laryngoplasty for type I laryngeal cleft: Does age matter?

Author information

1
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, USA.
2
Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, USA.
3
Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, USA; University of Pittsburgh School of Medicine, USA.
4
Paul C. Gaffney Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, USA; University of Pittsburgh School of Medicine, USA. Electronic address: tony.tarchichi@chp.edu.

Abstract

OBJECTIVES:

To improve the recognition of differences in presentation amongst patients with type 1 laryngeal clefts of various ages and better understand the age dependent outcomes of injection laryngoplasty. A second aim was to analyze the discrepancies between swallow assessment modalities in various age groups with type I laryngeal clefts undergoing injection laryngoplasty.

METHODS:

A retrospective review of electronic medical records of patients who underwent injection laryngoplasty from 2009 through 2015 at a tertiary care children's hospital. Data extracted included: Demographics, histories and physical exam findings, diagnostic studies, and medical and surgical treatments.

RESULTS:

Most (72/102, 70.6%) patients were male with a median gestational age at birth of 37 weeks (range 24-41 weeks). Formula thickening and GERD medications were used in 94/102 (92.2%) and 97/102 (95.1%) patients, respectively. Comorbid GERD, laryngomalacia, tracheomalacia, and subglottic stenosis were present in 98/102 (96.1%), 40/102 (39.2%), 9/102 (8.8%), and 14/102 (13.7%) patients, respectively. There was no significant difference in demographics, comorbidities or medical therapy between age groups. Symptoms at presentation differed between age groups with stridor (χ2(1) = 11.6, p = 0.002) and cyanosis (χ2(1) = 8.13, p = 0.012) being more common in the 0-3-month group compared to the 12-36 month group. Symptom resolution and the odds of undergoing additional surgery (second injection or suture repair) over time, however, did not differ. There was a significant reduction in aspiration with thins during FEES (McNemar χ2(1) = 10.7, p = 0.002) and aspiration with nectar during MBS (McNemar χ2(1) = 5.26, p = 0.035) post-injection. After injection, there was significant agreement in aspiration with thins between FEES and MBS (kappa = 0.308 ± SE 0.170, p = 0.035). However, finding aspiration with thins was more common during MBS than during FEES (McNemar χ2(1) = 7.00, p = 0.016). There were no differences in swallow evaluation findings between the age groups.

CONCLUSIONS:

Symptoms of type I laryngeal clefts may differ by age. However, there was no impact of age on the safety and efficacy of surgical intervention.

KEYWORDS:

Aspiration; Dysphagia; Injection laryngoplasty; Laryngeal cleft; Prolaryn gel

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