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Safety and efficacy of Early injection laryngoplasty in pediatric patients.
Laryngoscope. 2019 07; 129(7):1699-1705.L

Abstract

OBJECTIVE

The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children.

METHODS

Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre- and postprocedure, incidence of aspiration-related sequelae, and adverse events.

RESULTS

Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation.

CONCLUSION

Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:1699-1705, 2019.

Authors+Show Affiliations

Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California, U.S.A.Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California, U.S.A.Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30353553

Citation

Bertelsen, Caitlin, et al. "Safety and Efficacy of Early Injection Laryngoplasty in Pediatric Patients." The Laryngoscope, vol. 129, no. 7, 2019, pp. 1699-1705.
Bertelsen C, Jacobson L, Osterbauer B, et al. Safety and efficacy of Early injection laryngoplasty in pediatric patients. Laryngoscope. 2019;129(7):1699-1705.
Bertelsen, C., Jacobson, L., Osterbauer, B., & Hochstim, C. (2019). Safety and efficacy of Early injection laryngoplasty in pediatric patients. The Laryngoscope, 129(7), 1699-1705. https://doi.org/10.1002/lary.27436
Bertelsen C, et al. Safety and Efficacy of Early Injection Laryngoplasty in Pediatric Patients. Laryngoscope. 2019;129(7):1699-1705. PubMed PMID: 30353553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and efficacy of Early injection laryngoplasty in pediatric patients. AU - Bertelsen,Caitlin, AU - Jacobson,Lia, AU - Osterbauer,Beth, AU - Hochstim,Christian, Y1 - 2018/10/23/ PY - 2018/03/02/received PY - 2018/05/08/revised PY - 2018/06/18/accepted PY - 2018/10/26/pubmed PY - 2019/8/2/medline PY - 2018/10/25/entrez KW - Vocal fold immobility KW - aspiration KW - injection laryngoplasty SP - 1699 EP - 1705 JF - The Laryngoscope JO - Laryngoscope VL - 129 IS - 7 N2 - OBJECTIVE: The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children. METHODS: Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre- and postprocedure, incidence of aspiration-related sequelae, and adverse events. RESULTS: Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation. CONCLUSION: Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1699-1705, 2019. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/30353553/Safety_and_efficacy_of_Early_injection_laryngoplasty_in_pediatric_patients_ L2 - https://doi.org/10.1002/lary.27436 DB - PRIME DP - Unbound Medicine ER -