Outcomes and swallowing evaluations after injection laryngoplasty for type I laryngeal cleft: Does age matter?. (December 2018)

• Record Type: Journal Article
• Authors: Cole, Elisabeth; Dreyzin, Alexandra; Shaffer, Amber D.; Tobey, Allison B.J.; Chi, David H.; Tarchichi, Tony
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 115(2018:Dec.)
• Page Start: 10
• Page End: 18
• Publication Date: 2018-12
• Subjects: Laryngeal cleft -- Injection laryngoplasty -- Prolaryn gel -- Aspiration -- Dysphagia; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2018.09.006
• Languages: English
• ISSNs: 0165-5876

Abstract

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 (χ 2 (1) = 11.6, p = 0.002) and cyanosis (χ 2 (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 χ 2 (1) = 10.7, p = 0.002) and aspiration with nectar during MBS (McNemar χ 2 (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 χ 2 (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.