Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Laryngoscope. 2024 Mar;134(3):1431-1436. doi: 10.1002/lary.30954. Epub 2023 Aug 23.
To assess the risk of aspiration associated with post-swallow residue subsites in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in bottle-fed infants <1 year of age.
This is a retrospective matched-pairs cohort study at an academic tertiary children's hospital. FEES and Videofluoroscopic Swallowing Study (VFSS) trials performed within the same infant <5 days apart were paired by matching bolus consistency and bottle flow rate. Positive aspiration was defined by the "or rule" in which aspiration is positive when either FEES or VFSS within a matched pair is positive.
Eighty-seven FEES-VFSS matched pairs from 29 patients (16 males; mean [SD] age, 2.9 [2.8] months) were included. The rate of positive aspiration, as defined by the "or rule", was 59% (51/87). In FEES, post-swallow pyriform sinus residue was present in 16% (14/87) and anterior commissure residue 27% (31/87). Risk of positive aspiration was increased by pyriform sinus residue (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.9-19.3, p < 0.01) and anterior commissure residue in FEES (OR 2.5, 95% CI 1.1-6.1, p = 0.03). In the neonate subgroup, <1 month of age, multivariate-adjusted analysis showed that anterior commissure residue had better diagnostic accuracy for aspiration than in older infants (overall 70% vs. 42%, p < 0.01; sensitivity 60% vs. 10%, p < 0.01), whereas pyriform sinus residue had worse accuracy (overall 41% vs. 70%, p = 0.02; sensitivity 13% vs. 43%, p = 0.02).
This study demonstrates that pyriform sinus and anterior commissure residue during infant FEES were associated with fivefold and twofold increased risk of aspiration, respectively.
3: Using a retrospective matched-pairs cohort, this study assesses the diagnostic accuracy of post-swallow residue in FEES for predicting aspiration. Laryngoscope, 134:1431-1436, 2024.
评估在<1 岁婴儿中，使用纤维内镜吞咽评估（FEES）测量吞咽后残留部位与误吸风险的相关性。
这是一项在学术性三级儿童医院进行的回顾性配对病例对照队列研究。FEES 和视频透视吞咽研究（VFSS）试验在同一婴儿<5 天内进行，通过匹配吞咽物稠度和奶瓶流速进行配对。FEES 或 VFSS 中的任一项检查阳性，即符合“或规则”，即可定义为阳性误吸。
共纳入 29 例（16 例男性；平均[标准差]年龄 2.9[2.8]个月）29 例患者的 87 对 FEES-VFSS 检查。根据“或规则”，阳性误吸率为 59%（51/87）。在 FEES 中，吞咽后梨状隐窝残留率为 16%（14/87），前联合残留率为 27%（31/87）。FEES 中梨状隐窝残留（比值比[OR] 5.4，95%置信区间[CI] 1.9-19.3，p<0.01）和前联合残留（OR 2.5，95%CI 1.1-6.1，p=0.03）增加了阳性误吸的风险。在<1 个月龄的新生儿亚组中，多变量调整分析显示，前联合残留对误吸的诊断准确性优于年长婴儿（总体为 70%比 42%，p<0.01；敏感性为 60%比 10%，p<0.01），而梨状隐窝残留的准确性较差（总体为 41%比 70%，p=0.02；敏感性为 13%比 43%，p=0.02）。
本研究表明，婴儿 FEES 中梨状隐窝和前联合残留分别与误吸风险增加 5 倍和 2 倍相关。
3：本研究使用回顾性配对病例对照队列评估了 FEES 中吞咽后残留物预测误吸的诊断准确性。
