Adil Eelam, Al Shemari Hasan, Kacprowicz Amy, Perez Jennifer, Larson Kara, Hernandez Kayla, Kawai Kosuke, Cowenhoven Julia, Urion David, Rahbar Reza
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.
JAMA Otolaryngol Head Neck Surg. 2015 Nov;141(11):1006-11. doi: 10.1001/jamaoto.2015.2266.
Chronic airway aspiration is a challenging problem for physicians and caregivers and can cause significant pulmonary morbidity in pediatric patients. Our knowledge regarding the causes and optimal management of these patients is in its infancy.
To review our experience with the evaluation and management of pediatric patients with documented aspiration and normal upper airway anatomy.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective medical record review, we studied pediatric patients for airway disorders at a pediatric tertiary referral center who were diagnosed as having aspiration on modified barium swallow study during a 10-year period (June 1, 2002, through September 31, 2012).
Direct laryngoscopy and bronchoscopy performed with the patient under general anesthesia.
Demographics, comorbidities, management, and swallowing outcomes were analyzed.
Forty-six patients met the inclusion criteria. The mean age at presentation was 1.56 years, and there was a male to female ratio of approximately 2:1. Eight patients (17%) were syndromic, 16 (35%) had developmental delay, and 12 (26%) had congenital heart disease. Fifteen patients (33%) underwent brain magnetic resonance imaging, and none had a brainstem or posterior fossa lesion that accounted for their aspiration. Patients were subdivided according to the consistency of the fluids that they aspirated: 25 (54%) aspirated thin liquids, 15 (33%) aspirated thickened liquids, and 6 (13%) aspirated purees. Of these patients, 21 (84%), 12 (80%), and 3 (50%) had resolution of their swallowing dysfunction with feeding and swallowing therapy, respectively. A total of 3 patients (7%) required a tracheostomy for their refractory aspiration.
We recommend feeding and swallowing therapy for children with normal upper airway anatomy. Brain magnetic resonance imaging should be considered for patients with suspected brainstem or posterior fossa lesion based on neurologic examination findings. Most patients who aspirate thin and thickened liquids will have resolution of their swallowing dysfunction within 1 year of beginning therapy.
慢性气道误吸对医生和护理人员来说是一个具有挑战性的问题，并且会在儿科患者中导致严重的肺部发病情况。我们对这些患者的病因及最佳治疗方法的了解尚处于起步阶段。
回顾我们对经记录证实有误吸且上气道解剖结构正常的儿科患者进行评估和治疗的经验。
设计、地点和参与者：在这项回顾性病历审查中，我们研究了一家儿科三级转诊中心患有气道疾病的儿科患者，这些患者在10年期间（2002年6月1日至2012年9月31日）经改良钡剂吞咽研究被诊断为有误吸。
在全身麻醉下对患者进行直接喉镜检查和支气管镜检查。
分析人口统计学、合并症、治疗方法及吞咽结果。
46名患者符合纳入标准。就诊时的平均年龄为1.56岁，男女比例约为2:1。8名患者（17%）患有综合征，16名（35%）有发育迟缓，12名（26%）有先天性心脏病。15名患者（33%）接受了脑部磁共振成像检查，均未发现脑干或后颅窝病变可解释其误吸情况。患者根据误吸液体的黏稠度进行分类：25名（54%）误吸稀液体，15名（33%）误吸增稠液体，6名（13%）误吸泥状食物。在这些患者中，分别有21名（84%）、12名（80%）和3名（50%）通过喂食和吞咽治疗解决了吞咽功能障碍问题。共有3名患者（7%）因难治性误吸需要进行气管造口术。
我们建议对上气道解剖结构正常的儿童进行喂食和吞咽治疗。对于根据神经系统检查结果怀疑有脑干或后颅窝病变的患者，应考虑进行脑部磁共振成像检查。大多数误吸稀液体和增稠液体的患者在开始治疗后1年内吞咽功能障碍会得到解决。
