Cole Elisabeth, Dreyzin Alexandra, Shaffer Amber D, Tobey Allison B J, Chi David H, Tarchichi Tony
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, USA.
Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, USA.
Int J Pediatr Otorhinolaryngol. 2018 Dec;115:10-18. doi: 10.1016/j.ijporl.2018.09.006. Epub 2018 Sep 13.
To improve the recognition of differences in presentation amongst patients with type 1 laryngeal clefts of various ages and better understand the age dependent outcomes of injection laryngoplasty. A second aim was to analyze the discrepancies between swallow assessment modalities in various age groups with type I laryngeal clefts undergoing injection laryngoplasty.
A retrospective review of electronic medical records of patients who underwent injection laryngoplasty from 2009 through 2015 at a tertiary care children's hospital. Data extracted included: Demographics, histories and physical exam findings, diagnostic studies, and medical and surgical treatments.
Most (72/102, 70.6%) patients were male with a median gestational age at birth of 37 weeks (range 24-41 weeks). Formula thickening and GERD medications were used in 94/102 (92.2%) and 97/102 (95.1%) patients, respectively. Comorbid GERD, laryngomalacia, tracheomalacia, and subglottic stenosis were present in 98/102 (96.1%), 40/102 (39.2%), 9/102 (8.8%), and 14/102 (13.7%) patients, respectively. There was no significant difference in demographics, comorbidities or medical therapy between age groups. Symptoms at presentation differed between age groups with stridor (χ(1) = 11.6, p = 0.002) and cyanosis (χ(1) = 8.13, p = 0.012) being more common in the 0-3-month group compared to the 12-36 month group. Symptom resolution and the odds of undergoing additional surgery (second injection or suture repair) over time, however, did not differ. There was a significant reduction in aspiration with thins during FEES (McNemar χ(1) = 10.7, p = 0.002) and aspiration with nectar during MBS (McNemar χ(1) = 5.26, p = 0.035) post-injection. After injection, there was significant agreement in aspiration with thins between FEES and MBS (kappa = 0.308 ± SE 0.170, p = 0.035). However, finding aspiration with thins was more common during MBS than during FEES (McNemar χ(1) = 7.00, p = 0.016). There were no differences in swallow evaluation findings between the age groups.
Symptoms of type I laryngeal clefts may differ by age. However, there was no impact of age on the safety and efficacy of surgical intervention.
提高对不同年龄1型喉裂患者临床表现差异的认识，并更好地理解注射喉成形术的年龄依赖性结果。第二个目的是分析接受注射喉成形术的不同年龄组1型喉裂患者吞咽评估方式之间的差异。
对2009年至2015年在一家三级儿童专科医院接受注射喉成形术的患者的电子病历进行回顾性研究。提取的数据包括：人口统计学、病史和体格检查结果、诊断研究以及药物和手术治疗。
大多数（72/102，70.6%）患者为男性，出生时的中位胎龄为37周（范围24 - 41周）。分别有94/102（92.2%）和97/102（95.1%）的患者使用了配方奶增稠剂和GERD药物。分别有98/102（96.1%）、40/102（39.2%）、9/102（8.8%）和14/102（13.7%）的患者合并有GERD、喉软化、气管软化和声门下狭窄。各年龄组在人口统计学、合并症或药物治疗方面无显著差异。各年龄组的临床表现症状有所不同，与12 - 36个月组相比，喘鸣（χ(1) = 11.6，p = 0.002）和发绀（χ(1) = 8.13，p = 0.012）在0 - 3个月组更为常见。然而，随着时间推移，症状缓解情况以及接受额外手术（第二次注射或缝合修复）的几率并无差异。注射后，FEES期间稀薄液体误吸情况（McNemar χ(1) = 10.7，p = 0.002）和MBS期间花蜜样液体误吸情况（McNemar χ(1) = 5.26，p = 0.035）有显著减少。注射后，FEES和MBS在稀薄液体误吸情况方面有显著一致性（kappa = 0.308 ±标准误0.170，p = 0.035）。然而，MBS期间发现稀薄液体误吸比FEES期间更常见（McNemar χ(1) = 7.00，p = 0.016）。各年龄组吞咽评估结果无差异。
1型喉裂的症状可能因年龄而异。然而，年龄对手术干预的安全性和疗效没有影响。
