Long term outcome of laryngeal mobility disorder and quality of life after pediatric cardiac surgery. (July 2022)

• Record Type: Journal Article
• Authors: Biot, Thomas; Fieux, Maxime; Henaine, Roland; Truy, Eric; Coudert, Aurelie; Ayari-Khalfallah, Sonia
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 158(2022)
• Publication Date: 2022-07
• Subjects: Cardiac surgery -- Pediatric -- Fiberoptic -- Laryngoscopy -- Vocal cord dysfunction -- Vocal fold paralysis -- Vocal fold recovery -- Impaired oral feeding -- Dysphonia; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2022.111142
• Languages: English
• ISSNs: 0165-5876

Abstract

Abstract: Introduction: Laryngeal mobility disorder after a pediatric heart surgery is common (between 5 and 10% of cases), and has important consequences on swallowing, breathing and speaking. After reviewing the literature, the recovery rate is variable and the postoperative follow-up is often done on a short time frame. The primary objective of the study is to describe the recovery from laryngeal mobility disorder with a follow-up time of at least 5 years. The secondary objective is to describe of the quality of life of the child in terms of phonation and swallowing, and to identify potential risk factors for a lasting laryngeal mobility disorder. Methods: We collected data (morphological characteristics and details of the procedures and medical care) on children who had undergone a heart surgery with risks of complications, between 2010 and 2015, and with a laryngeal mobility disorder detected after the surgery through nasal flexible laryngoscopy. During a follow-up consultation, carried at least 5 years after the surgery, we performed a nasal flexible laryngoscopy to assess whether or not the patient had recovered a full mobility of the larynx. Two questionnaires were also given to the patients, the pVHI and the PEDI EAT-10, to assess respectively the quality of their speech and of their swallowing function. Results: The recovery rate for a laryngeal mobility disorder more than 5 years after surgery was found to be 65% (9 children out of the 14 included in the study). We identified a risk factor for the persistence of a laryngeal mobility disorder after surgery: the presence of an associated genetic syndrome, p = 0.025. Children with persistent laryngeal mobility disorder have an impaired quality of life score, using the pVHI scale, which correlates well with the flexible laryngoscopy findings, p = 0.033. Conclusion: Children with a lasting laryngeal mobility disorder have disabling respiratory and vocal symptoms in their daily lives. Nasal flexible laryngoscopy should therefore be systematically performed postoperatively after a surgery carrying risks. For improved patient management, early detection of these disorders by pharyngolaryngeal nasal flexible laryngoscopy in the aftermath of high-risk cardiac surgery is strongly advised, with prolonged follow-up. Highlights: Pediatric cardiac surgery carries risks for postoperative laryngeal mobility disorders. Recovery from laryngeal mobility disorders is estimated to be 65%. Permanent laryngeal mobility disorder can lead to a decrease in quality of life by affecting voice and swallowing.