Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.
the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A.
Laryngoscope. 2019 Nov;129(11):2588-2593. doi: 10.1002/lary.27535. Epub 2019 Jan 23.
The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS).
A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%).
There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%).
There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology.
在儿科吞咽困难中，从正常解剖结构到喉裂，会厌间黏膜高度（IAMH）的临床意义尚不清楚。本研究旨在评估一组在微直接喉镜（MDL）下接受 IAMH 评估的患者，以评估 IAMH 与术前视频透视吞咽研究（VFSS）诊断为吞咽困难之间的相关性。
回顾性分析 2011 年至 2016 年间接受 MDL 治疗的 1351 例患者的病例系列，使用我们的会厌评估方案对术中 IAMH 进行评估。排除后，182 例患者分为三组：1）浓稠饮食：VFSS 推荐浓稠液体（n=182 例中的 82 例；45.1%），2）正常饮食：VFSS 允许稀薄液体（n=182 例中的 19 例；10.4%），3）对照组：未行 VFSS（n=182 例中的 81 例；44.5%）。
三组间 IAMH 无差异（P=0.35）。进行了功效分析，以实现检测≥0.5（1-5 黏膜高度量表）的效应大小的>80%功效。每组中大多数患者的 IAMH 均高于假声带（浓稠饮食组：57.3%，正常饮食组：57.9%，对照组：64.2%）。每组中 IAMH 与真声带平齐或低于真声带的患者百分比相似（浓稠饮食组：4.9%，正常饮食组：5.3%，对照组：6.1%）。
在本队列中，IAMH 与术前浓稠液体推荐之间无显著相关性。该数据不支持 IAMH 是小儿咽性吞咽困难的独立病因学因素的假设。比较 IAMH 与喂养治疗和手术后结果的进一步研究可能更好地阐明解剖结构与生理学之间的关系。
4.喉镜，129：2588-2593，2019。
