Hsu Jeffrey, Tibbetts Kathleen M, Wu Derek, Nassar Michel, Tan Melin
Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States.
Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States.
Int J Pediatr Otorhinolaryngol. 2017 Feb;93:37-41. doi: 10.1016/j.ijporl.2016.12.010. Epub 2016 Dec 16.
Infants with bilateral vocal fold immobility (BVFI) often have poor swallow function in addition to potential airway compromise. While there are several reports on BVFI and its effect on patients' airway status, little is known about long term swallow function.
We aim to characterize the swallowing function over time in pediatric patients with bilateral vocal fold immobility.
A retrospective review of medical records of infants diagnosed with BVFI at a tertiary care children's hospital between 2005 and 2014 was conducted. Patient demographics, nature and etiology of immobility, laryngoscopy findings, comorbidities, and swallow outcomes at diagnosis and follow-up were recorded. Swallowing outcomes as measured by presence or absence of a gastrostomy tube were compared by etiology, vocal fold status, and normal or developmentally delay using the Fisher's exact test.
110 patients with a diagnosis of vocal fold immobility were identified. Twenty-nine (26%) had BVFI and twenty-three had complete medical records. Etiologies of vocal fold immobility include cardiac related in 13% (3/23), idiopathic in 30% (7/23) prolonged intubation in 26% (6/23) central neurologic in 22% (5/23), trauma in 4% (1/23), and infection in 4% (1/23). Average follow-up time was 44 months (range 5-94 months). Ten patients (56.5%) required a gastrostomy tube at time of diagnosis. Of this cohort who received gastrostomy tubes, three (30%) ultimately transitioned to complete oral feeds. Return of vocal fold mobility did not correlate with swallow function. In those with non-neurologic etiologies, the need for gastrostomy tube at end of follow up was unlikely. There was a statistically significant difference in the percentage of gastrostomy tube-free children at most recent follow up in patients who were normally developed (86%) versus those who were developmentally delayed (33%) (p = 0.02).
We characterized the swallowing function of 23 pediatric patients with BVFI. Comorbidities are significant predictors of long term swallow function in patients with BVFI while return of vocal fold function is not.
双侧声带固定（BVFI）的婴儿除了可能存在气道问题外，吞咽功能通常也较差。虽然有几篇关于BVFI及其对患者气道状况影响的报道，但对于长期吞咽功能却知之甚少。
我们旨在描述双侧声带固定的儿科患者随时间变化的吞咽功能。
对2005年至2014年在一家三级儿童专科医院被诊断为BVFI的婴儿的病历进行回顾性研究。记录患者的人口统计学资料、固定的性质和病因、喉镜检查结果、合并症以及诊断和随访时的吞咽结果。使用Fisher精确检验，按病因、声带状态以及正常或发育迟缓情况，比较以是否存在胃造瘘管衡量的吞咽结果。
确定了110例诊断为声带固定的患者。其中29例（26%）患有BVFI，23例有完整的病历。声带固定的病因包括：与心脏相关的占13%（3/23），特发性的占30%（7/23），长时间插管的占26%（6/23），中枢神经系统疾病的占22%（5/23），创伤的占4%（1/23），感染的占4%（1/23）。平均随访时间为44个月（范围5 - 94个月）。10例患者（56.5%）在诊断时需要胃造瘘管。在接受胃造瘘管的这一组患者中，3例（30%）最终过渡到完全经口喂养。声带活动的恢复与吞咽功能无关。在非神经系统病因的患者中，随访结束时不太可能需要胃造瘘管。在发育正常的患者（86%）与发育迟缓的患者（33%）中，最近一次随访时无胃造瘘管儿童所占百分比存在统计学显著差异（p = 0.02）。
我们描述了23例BVFI儿科患者的吞咽功能。合并症是BVFI患者长期吞咽功能的重要预测因素，而声带功能的恢复则不是。
