Predictive Value of Laryngeal Penetration to Aspiration in a Cohort of Pediatric Patients.

Videofluoroscopic swallow studies (VFSS) provide dynamic assessment of the phases of swallowing under fluoroscopic visualization and allow for identification of abnormalities in the process, such as laryngeal penetration and aspiration. While penetration and aspiration both reflect degrees of swallowing dysfunction, the predictive potential of penetration for subsequent aspiration is not fully elucidated in the pediatric population. As a result, management strategies for penetration vary widely.

Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Pediatric Populations: Part 2.

Purpose: This is Part 2 of a two-part tutorial series establishing clinical guidelines pertaining to the administration of fiberoptic endoscopic evaluation of swallowing (FEES) developed by representatives of the American Board of Swallowing and Swallowing Disorders, all of whom are members of Special Interest Group 13. Whereas Part 1 focused on use of FEES with adults and included general information common to using FEES in any population, the purpose of this tutorial is to provide clinicians with updated best practice clinical guidelines for performing, interpreting, and documenting outcomes when using FEES with the pediatric population. This document has two main sections.

Fiberoptic Endoscopic Evaluation of Swallowing Across the Age Spectrum.

Purpose Fiberoptic endoscopic evaluation of swallowing (FEES) is a widely used instrumental procedure used to assess swallowing function in persons of all ages, from infants to older adults. In this article, the history of FEES in adults, the protocol, the scoring system, and the interpretation of abnormal findings are summarized. The use of FEES to guide treatment in adults is also covered briefly.

Fiberoptic Endoscopic Evaluation of Swallowing in Infants and Children: Protocol, Safety, and Clinical Efficacy: 25 Years of Experience.

Background: The application of fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric dysphagia protocol requires specialized knowledge of pediatric conditions that result in dysphagia, recognition of normal and abnormal laryngopharyngeal anatomy and function across ages, and the ability to identify maturational changes in anatomy and function of the aerodigestive tract that pertain to airway protection and swallowing function.

Methods: Over the past 25 years, we have performed over 7,000 collaborative Otolaryngology and Speech-Language Pathology FEES examinations in patients ranging from 2 days of age to young adults. During this time period, we have monitored the safety of the procedure, explored the feasibility and utility of FEES across conditions, compared and contrasted FEES to the videofluoroscopic evaluation of swallowing (VFSS), and developed specific pediatric FEES protocols with operational definitions for identification and interpretation of swallowing parameters.

Structure and Functions of Pediatric Aerodigestive Programs: A Consensus Statement.

Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or acquired conditions affecting breathing, swallowing, and growth. Although there has been a proliferation of programs, as well as national meetings, interest groups and early research activity, there is, as of yet, no consensus definition of an aerodigestive patient, standardized structure, and functions of an aerodigestive program or a blueprint for research prioritization. The Delphi method was used by a multidisciplinary and multi-institutional panel of aerodigestive providers to obtain consensus on 4 broad content areas related to aerodigestive care: (1) definition of an aerodigestive patient, (2) essential construct and functions of an aerodigestive program, (3) identification of aerodigestive research priorities, and (4) evaluation and recognition of aerodigestive programs and future directions.

Swallowing dynamics status post caustic ingestion in a pediatric patient: A multidisciplinary case report.

A case report of a 10 year old male illustrates the effect of damage to the tongue base, hypopharynx, cricopharyngeus, and esophagus on the sensory and motor components of the swallowing mechanism. The characteristics of the dysphagia were manifested clinically, radiographically, and endoscopically. A myectomy was required to restore functional swallowing as scar tissue formation in the cricopharyngeus severely interfered with the dynamic components of swallowing.

Compensatory laryngeal function and airway protection in children following airway reconstruction.

Objectives: Laryngotracheal reconstruction (LTR) procedures for repair of complex congenital or acquired airway stenosis of the larynx and/or trachea in pediatric patients have advanced over recent decades. The aim of the present project was to investigate the relationships among diagnoses, type of surgical intervention, and laryngeal findings in a post-LTR patient cohort to identify factors associated with adequate airway protection and swallowing outcomes.

Methods: A retrospective review of 30 airway patients undergoing simultaneous or close interval functional laryngeal and swallowing examinations was completed.

Updates on pediatric feeding and swallowing problems.

Purpose Of Review: There is increased recognition in the range of feeding and swallowing problems that occur in conjunction with congenital and acquired pediatric conditions. Differential diagnosis and management of these problems is often not straightforward and requires consideration and collaboration between multiple disciplines that are involved in the care of this special population. This article reviews recent investigations across disciplines regarding the cause and evaluation of pediatric feeding and swallowing issues, intervention efficacy, and available evidence to guide clinical practice.

Duration and extent of dysphagia following pediatric airway reconstruction.

Objective: Patients who undergo open airway reconstruction procedures are likely to experience some degree of post-operative dysphagia. This retrospective review describes the duration of post-operative dysphagia and the use of compensatory strategies in a group of 30 pediatric patients.

Methods: A retrospective chart review of pediatric patients referred for post-operative swallowing assessment following airway reconstruction during a six-month period was completed.

Current research in voice and swallowing outcomes following pediatric airway reconstruction.

Purpose Of Review: Pathologic airway conditions in pediatric patients include congenital or acquired subglottic stenosis, glottic stenosis, laryngotracheal stenosis, laryngeal webs or atresia, and tracheal lesions. Acute airway management via tracheotomy is often required with later surgical intervention for reconstruction and expansion of the airway. The effect of the surgical interventions used to expand the airway may impact upon the laryngeal functions of phonation and airway protection during swallowing.

The implications of upper-airway obstruction on successful infant feeding.

Oral feeding in infants requires highly integrated sucking, swallowing, and respiratory sequencing controlled by the neurologic system. Rapid neuromuscular coordination of oral, pharyngeal, and esophageal phases of swallowing must be coordinated with respiration in the swallowing process. When obstruction is present in the upper airway secondary to anatomic or physiologic anomalies, disruption to the oral feeding process may occur.

Eosinophilic esophagitis in infants and toddlers.

Feeding refusal is often described in conjunction with the diagnosis of eosinophilic esophagitis (EE) in pediatric patients; however, there are little data regarding the specific clinical manifestations and effective management of this condition in very young children. The aim of this study was to evaluate the presentation of EE in infants and toddlers referred to the Interdisciplinary Feeding Team Clinic of a tertiary referral center and to document responses to treatment. Database matching was performed (from January 2000 to June 2003) to identify infants and toddlers diagnosed with EE who had been referred to the Interdisciplinary Feeding Team Clinic.

Advances in the evaluation and management of pediatric dysphagia.

Purpose Of Review: Feeding and swallowing problems in the pediatric population, commonly referred to as pediatric dysphagia, are often complex. Multiple disciplines are frequently involved in both the evaluation and the management of symptoms exhibited by an increasing number of infants and children. The efficacy of commonly employed diagnostic and treatment strategies has been largely unexplored, although there has been a steadily increasing amount of research specific to pediatric dysphagia.