Outcomes and Swallowing Evaluations after Injection Laryngoplasty for Type I Laryngeal Cleft: Does Age Matter?

Publication date: Available online 13 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elisabeth Cole, Alexandra Dreyzin, Amber D. Shaffer, Allison B.J. Tobey, David H. Chi, Tony Tarchichi

Abstract

Objectives

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.

Methods

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.

Results

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 (χ²(1) =11.6, p=0.002) and cyanosis (χ²(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 χ²(1) =10.7, p=0.002) and aspiration with nectar during MBS (McNemar χ²(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 χ²(1) =7.00, p=0.016). There were no differences in swallow evaluation findings between the age groups.

Conclusions

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.

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