Velayutham Priatharisiny, Irace Alexandria L, Kawai Kosuke, Dodrill Pamela, Perez Jennifer, Londahl Monica, Mundy Lauren, Dombrowski Natasha D, Rahbar Reza
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2018 Aug;128(8):1952-1957. doi: 10.1002/lary.27070. Epub 2017 Dec 27.
To determine the prevalence of silent aspiration in pediatric patients and identify which diagnoses may be associated with this finding.
An institutional review board-approved retrospective review was conducted for all patients under the age of 18 who underwent modified barium swallow (MBS) studies at a tertiary children's hospital in 2015. Speech-language pathologists reviewed MBS studies to identify aspiration/silent aspiration on each fluid consistency tested. Charts were reviewed to collect demographic information and the otolaryngologic, neurologic, genetic, and syndromic diagnoses of each patient.
Among 1,286 patients who underwent MBS, 440 (34%) demonstrated aspiration. Within the aspiration group, 393 (89%) specifically demonstrated silent aspiration. Thin fluids were silently aspirated in 81% of these patients. Of children aged <6 months, 41% were found to aspirate and, of those, 95% silently aspirated. Median age at which patients demonstrated silent aspiration was 1.1 years. Silent aspiration was documented in 41% of patients with laryngeal cleft, 41% of patients with laryngomalacia, and 54% of patients with unilateral vocal fold paralysis. Laryngeal cleft, laryngomalacia, unilateral vocal fold paralysis, developmental delay, epilepsy/seizures, syndrome, and congenital heart disease were all associated with silent aspiration.
Silent aspiration may be associated with a number of underlying conditions and is more common than previously described. Caregivers and clinicians should be aware that the absence of cough does not eliminate the possibility of aspiration. Modified barium swallow studies can reveal silent aspiration, which is difficult to detect on clinical feeding evaluation. Modified barium swallow findings can guide feeding therapy and the overall management of aspiration.
确定儿科患者中隐匿性误吸的患病率，并确定哪些诊断可能与这一发现相关。
对2015年在一家三级儿童医院接受改良钡剂吞咽（MBS）检查的所有18岁以下患者进行了一项经机构审查委员会批准的回顾性研究。言语病理学家对MBS检查进行审查，以确定在每种测试液体黏稠度下的误吸/隐匿性误吸情况。查阅病历以收集人口统计学信息以及每位患者的耳鼻喉科、神经科、遗传学和综合征诊断信息。
在1286例接受MBS检查的患者中，440例（34%）出现误吸。在误吸组中，393例（89%）明确表现为隐匿性误吸。这些患者中有81%在吞咽稀薄液体时出现隐匿性误吸。在年龄小于6个月的儿童中，41%被发现有误吸，其中95%为隐匿性误吸。出现隐匿性误吸的患者中位年龄为1.1岁。41%的喉裂患者、41%的喉软化症患者和54%的单侧声带麻痹患者有隐匿性误吸记录。喉裂、喉软化症、单侧声带麻痹、发育迟缓、癫痫/惊厥、综合征和先天性心脏病均与隐匿性误吸有关。
隐匿性误吸可能与多种潜在疾病相关，且比之前描述的更为常见。护理人员和临床医生应意识到，没有咳嗽并不排除误吸的可能性。改良钡剂吞咽检查可发现隐匿性误吸，这在临床喂养评估中很难检测到。改良钡剂吞咽检查结果可指导喂养治疗和误吸的整体管理。
4。《喉镜》，1952 - 1957，2018年。
