Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Audiology and Otosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Laryngoscope. 2023 Sep;133(9):2325-2332. doi: 10.1002/lary.30535. Epub 2022 Dec 29.
Pediatric bilateral vocal cord immobility (BVCI) represents a severe life-threatening condition that often causes severe dyspnea. Endoscopic arytenoid lateral abduction (EALA) is a relatively new, secure, minimal-invasive surgical technique. The present prospective observational study aims to evaluate the effects of EALA in terms of respiratory function, voice quality, and swallowing capabilities.
Twenty-one pediatric patients with BVCI underwent EALA. Eleven out of 21 patients had tracheostomy at the time of surgery. Pre and postoperative functional assessments included endoscopic evaluation, maximum phonation time, pediatric Voice Handicap Index (pVHI), GIRBAS Scale criteria, and Montreal Children's Hospital Feeding scale (MCH-Feeding scale). peak tidal inspiratory flow or peak inspiratory flow (PIF) and number of desaturations/hour (ODI/h) were evaluated in patients without tracheostomy.
Postoperative endoscopy showed glottic airway improvement in all patients. Average time for decannulation was 4.6 weeks. One patient has not yet been decannulated. No major complications occurred. In patients without tracheostomy, we observed a significant improvement of ODI/h and PIF after surgery (p < 0.05) as expected. PVHI, MCH-Feeding scale, and GIRBAS score significantly worsened 1 month after surgical intervention (p < 0.05). One year after surgery, however, all values, except for B and A parameters of the GIRBAS score, returned to levels comparable to those preoperative.
EALA represents a simple, safe and effective solution in pediatric patients with BVCI, avoiding tracheostomy, allowing early decannulation, preserving swallowing function, and maintaining good quality voice.
4 Laryngoscope, 133:2325-2332, 2023.
小儿双侧声带麻痹（BVCI）是一种严重的危及生命的疾病，常导致严重呼吸困难。内镜杓状软骨外侧外展术（EALA）是一种相对较新的、安全的、微创的手术技术。本前瞻性观察研究旨在评估 EALA 在呼吸功能、语音质量和吞咽能力方面的效果。
21 例小儿 BVCI 患者接受 EALA 治疗。21 例患者中有 11 例在手术时行气管切开术。术前和术后功能评估包括内镜评估、最长发声时间、小儿嗓音障碍指数（pVHI）、GIRBAS 量表标准和蒙特利尔儿童医院喂养量表（MCH-Feeding scale）。在无气管切开术的患者中，评估了峰潮吸气流速或吸气峰流速（PIF）和每小时脱氧饱和度（ODI/h）。
术后内镜检查显示所有患者的声门气道均得到改善。平均拔管时间为 4.6 周。1 例患者尚未拔管。未发生重大并发症。在无气管切开术的患者中，我们观察到术后 ODI/h 和 PIF 显著改善（p<0.05）。术后 1 个月，pVHI、MCH-Feeding 量表和 GIRBAS 评分显著恶化（p<0.05）。然而，术后 1 年，除 GIRBAS 评分的 B 和 A 参数外，所有值均恢复到与术前相当的水平。
EALA 是小儿 BVCI 患者的一种简单、安全、有效的治疗方法，可避免气管切开术，允许早期拔管，保留吞咽功能，维持良好的嗓音质量。
4 Laryngoscope, 133:2325-2332, 2023.
