The Aerodigestive Clinic: Multidisciplinary Management of Pediatric Dysphagia

2008 ◽  
Vol 17 (3) ◽  
pp. 101-109 ◽  
Author(s):  
Laura Haibeck ◽  
David L. Mandell
Keyword(s):  
Young Children ◽  
Airway Obstruction ◽  
Multidisciplinary Approach ◽  
Laryngopharyngeal Reflux ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pediatric Airway ◽  
Common Causes ◽  
The Individual ◽  
The Relationship

Abstract The purposes of this article are (a) to explore the relationship between pediatric upper airway obstruction and dysphagia and (b) to highlight the benefits of using a multidisciplinary approach when assessing infants and children with upper respiratory and swallowing disorders. The functions of breathing and swallowing are tightly coordinated in infants and young children, and pediatric upper airway disorders can often adversely affect the swallowing mechanism and may even predispose the individual to aspiration. Some of the more common causes of pediatric airway obstruction seen in this setting are laryngomalacia, vocal fold paralysis, laryngeal cleft, and Pierre Robin's sequence. In the setting of all of these disorders, associations may also exist with gastroesophageal reflux (GER) and laryngopharyngeal reflux, and this topic is also reviewed. In the multidisciplinary assessment of young children with aerodigestive disorders, fiberoptic flexible endoscopic evaluation of swallowing has gained traction as a useful test for simultaneous evaluation of pediatric upper airway obstruction and dysphagia and has provided complimentary information to the more traditional pediatric videofluoroscopic swallowing evaluation. A representative case study is provided that illustrates the relationship between pediatric upper airway obstruction and dysphagia and demonstrates the effectiveness of a multidisciplinary approach.

Sleep Fluoroscopy for Localization of Upper Airway Obstruction in Children

1996 ◽  
Vol 105 (9) ◽  
pp. 678-683 ◽  
Author(s):  
Sharon E. Gibson ◽  
Janet L. Strife ◽  
Charles M. Myer ◽  
David M. O'Connor
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Endoscopic Examination ◽  
Upper Airway Obstruction ◽  
Pediatric Airway ◽  
Valuable Adjunct ◽  
Neuromuscular Abnormalities ◽  
Multiple Levels ◽  
A Site ◽  
Airway Abnormalities

The management of children with upper airway obstruction (UAO) in whom previous airway surgeries or concomitant craniofacial or neuromuscular abnormalities exist is complicated by potential obstruction at multiple sites. Sleep fluoroscopy (SF) provides adynamic representation of relative degrees of obstruction at multiple levels of the pediatric airway. Fifty-five SF studies were performed on 50 infants and children to localize obstructive sites. Correlation was assessed with findings on direct laryngoscopy and bronchoscopy under spontaneous ventilation. In 24 (44%), endoscopic and SF findings correlated exactly. The SF studies identified a site of UAO in 11 patients with normal findings on endoscopic examination and multiple sites of UAO in 16 others. Two thirds of these occurred at the hypopharynx and tongue base. The SF studies failed to detect 5 airway abnormalities in 4 patients. The sensitivity of SF for endoscopically verified laryngotracheal lesions was lowest for glottic (67%) and subglottic (70%) locations and higher for tracheal (92%) and supraglottic (100%) sites. Sleep fluoroscopy altered the course of treatment in 26 (52%) children. It appears to be a valuable adjunct to endoscopy in the identification and management of pediatric UAO when hypopharyngeal collapse or multiple levels of obstruction are suspected.

Subglottic Cysts: A Complication of Neonatal Endotracheal Intubation?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (1) ◽  
pp. 103-105
Author(s):  
Jonathan M. Couriel ◽  
Peter D. Phelan
Keyword(s):  
Airway Obstruction ◽  
Endotracheal Intubation ◽  
Neonatal Period ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Relationship Of ◽  
The Relationship

Three patients with severe upper airway obstruction due to subglottic cysts and their subsequent progress and management are described. The relationship of the lesions to intubation in the neonatal period is discussed.

scholarly journals The relationship between partial upper-airway obstruction and inter-breath transition period during sleep

2017 ◽  
Vol 244 ◽  
pp. 32-40
Author(s):  
Dwayne L. Mann ◽  
Bradley A. Edwards ◽  
Simon A. Joosten ◽  
Garun S. Hamilton ◽  
Shane Landry ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Transition Period ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Partial Upper Airway Obstruction ◽  
The Relationship

The Westaby T-Y tracheobronchial stent in otolaryngology

1999 ◽  
Vol 113 (7) ◽  
pp. 652-656 ◽  
Author(s):  
P. D. Lacy ◽  
J. E. Fenton ◽  
D. A. Smyth ◽  
M. P. Colreavy ◽  
M. A. Walsh ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Tracheostomy Tube ◽  
Clinical Course ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Tracheobronchial Stent ◽  
Silicone Stent ◽  
The Individual

AbstractThe Westaby T-Y tracheobronchial silicone stent can be used for the relief of upper airway obstruction beyond the limit of a standard tracheostomy tube. We report on our experience in the use of the Westaby tube in 10 patients over a five-year period. The general features of the tube, indications for its use, and its method of insertion are described. The versatility and advantages over other stents are discussed. Two cases reports are described and the clinical course and outcomes of the individual patients are outlined.

THE COMPARISON OF CONFIGURATION, DEGREE AND SITES OF OBSTRUCTION IN PATIENTS WITH SLEEP DISORDERED BREATHING: EXAMINATION USING DRUG-INDUCED SLEEP ENDOSCOPY, MUELLER MANEUVER AND POLYSOMNOGRAPHY

2020 ◽  
pp. 54-57
Author(s):  
NIKEN AGENG RIZKI ◽  
SUSYANA TAMIN ◽  
FAUZIAH FARDIZZA ◽  
RETNO S. WARDANI ◽  
ARIEF MARSABAN ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Laryngopharyngeal Reflux ◽  
Nasal Congestion ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Mueller Maneuver

Objective: The purpose of this study is to evaluate the location, configuration, and degree of differences in upper airway obstruction between the Mueller Maneuver (MM) and Drug-induced sleep endoscopy (DISE), thus acquiring a better diagnostic value for SDB patients. Methods: A cross-sectional and analytical descriptive study using retrospective secondary data to evaluate the location, configuration and degree of upper airway obstruction in SDB subjects using the Mueller Maneuver and DISE. Polysomnography (PSG) type 2 was used to determine the SDB degree. Results: Subjects with SDB non-Obstructive sleep apnea (OSA) and OSA show a multilevel obstruction with a different location and configuration due to the various risk factors, such as nasal congestion, laryngopharyngeal reflux, obesity and menopause. Conclusion: Statistical differences in upper airway obstruction configuration between MM and DISE were found in the level of the velum (p=0,036), oropharynx (p<0,001) and epiglottis (p=0,036) and were also found in the obstruction degree of the velum, oropharynx, tongue base and epiglottis with p=0,002; p<0,001; p<0,001 and p<0,001. No statistical difference was found on the lowest oxygen saturation between PSG and DISE (p=0,055).

Revisiting Outpatient Tonsillectomy in Young Children

2003 ◽  
Vol 128 (3) ◽  
pp. 326-331 ◽  
Author(s):  
Adam T. Ross ◽  
Ken Kazahaya ◽  
Lawrence W. C. Tom
Keyword(s):  
Retrospective Study ◽  
Young Children ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Postoperative Treatment ◽  
Medical Comorbidity ◽  
Respiratory Compromise ◽  
Postsurgical Complications ◽  
Same Day Discharge

OBJECTIVE: Postoperative same-day discharge is safe for most children undergoing tonsillectomy. However, young children with upper airway obstruction have a higher risk of postoperative complications. We review our tonsillectomy experience in children under 36 months to evaluate the safety of outpatient tonsillectomy in this population. STUDY DESIGN AND SETTING: We conducted a retrospective study of all children under 36 months who underwent tonsillectomy during a recent 2-year period at The Children's Hospital of Philadelphia. RESULTS: The indication for tonsillectomy in 96% of 421 children was upper airway obstruction. Eighteen percent required postoperative treatment to prevent respiratory compromise; 56% of these patients had no associated medical comorbidity. Patients younger than 24 months and those with medical comorbidities were more likely to require intervention. CONCLUSION AND SIGNIFICANCE: It is not possible to preoperatively anticipate which children will have postsurgical complications. We recommend planning an overnight admission for children younger than 36 months undergoing tonsillectomy.

Acute Upper Airway Obstruction in Infants and Children

1980 ◽  
Vol 89 (5) ◽  
pp. 417-418 ◽  
Author(s):  
Pierre A. Vauthy ◽  
Ramalinga Reddy
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Upright Position ◽  
Upper Airway Obstruction ◽  
Infants And Children ◽  
Therapeutic Tool ◽  
Airway Anatomy ◽  
Oral Airway ◽  
Flexible Instrument ◽  
Common Causes

All infants and children seen by the pediatric pulmonary service who display symptoms of upper airway obstruction undergo transnasal fiberoptic evaluation with the 3.2 mm flexible instrument. The procedure enables the observer to immediately visualize the nasopharynx, supraglottic, glottic and subglottic structures. Instrumentation is done in the sitting upright position and takes the skilled observer about 20 seconds to perform. The differentiation of epiglottitis from subglottic croup, foreign body aspiration and other less common causes of airway obstruction is easily performed and well tolerated. The fiberoptic instrument is often utilized both as a diagnostic and therapeutic tool. It can be utilized to intubate cases of epiglottitis and to evaluate the epiglottis to determine the appropriate time for extubation. This procedure is superior to oral airway examination because it does not distort airway anatomy, can be performed in the upright position, and does not further exacerbate airway obstruction.

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