Outcomes of Vocal Fold Motion Impairment and Dysphagia after Pediatric Cardiothoracic Surgery: A Systematic Review

2019 ◽  
Vol 161 (5) ◽  
pp. 754-763 ◽  
Author(s):  
Susannah Orzell ◽  
Rahul Joseph ◽  
Julina Ongkasuwan ◽  
Joshua Bedwell ◽  
Jennifer Shin ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Ductus Arteriosus ◽  
Data Sources ◽  
Hospital Length Of Stay ◽  
Inclusion Criteria ◽  
Swallowing Function ◽  
Oral Diet ◽  
Vocal Fold Motion ◽  
Swallowing Outcomes

Objective The objective of this study was to systematically review the literature regarding vocal fold motion impairment (VFMI), respiratory outcomes, and swallowing outcomes in children following congenital heart surgery (CHS). Data Sources PubMed, Embase, Medline, and CINAHL databases. Review Methods Data sources were searched from inception to November 30, 2018. Studies that described recovery of VFMI and swallowing function following CHS were included, and a qualitative analysis was performed. Results A total of 1371 studies were identified, of which 8 met inclusion criteria for VFMI and 5 met inclusion criteria for swallowing outcomes. Studies including patients who underwent isolate patent ductus arteriosus ligation were excluded. VFMI was present in 8% to 59% of subjects, and rates of recovery ranged from 9% to 96% at 6 months to 6 years of follow-up. Inability to maintain an oral diet occurred in 14% to 100% of subjects with VFMI and 11% to 61% without VFMI following surgery. Tolerance of an oral diet without tube feeding was present in 66% to 75% of subjects with VFMI and 88% to 100% without VFMI at 24 days to 3.2 years of follow-up. Limited data suggest that time to extubation is longer in VFMI subjects, but overall hospital length of stay and mortality may not be affected by VFMI status. Conclusions Data evaluating dysphagia and VFMI after CHS are limited. Most studies suggest significant improvement in swallowing function, while rate of recovery of VFMI is variable. Future prospective studies with standardized screening and follow-up are needed to better elucidate outcomes to help develop algorithms for identification and management of VFMI after CHS.

Vocal Fold Immobility due to Birth Trauma: A Systematic Review and Pooled Analysis

2017 ◽  
Vol 157 (6) ◽  
pp. 948-954 ◽  
Author(s):  
Jad Jabbour ◽  
Lauren M. North ◽  
David Bougie ◽  
Thomas Robey
Keyword(s):  
Systematic Review ◽  
Vocal Fold ◽  
English Language ◽  
Experimental Studies ◽  
Pooled Analysis ◽  
Birth Trauma ◽  
Data Sources ◽  
Inclusion Criteria ◽  
Vocal Fold Immobility ◽  
Present Understanding

Objectives To describe the present understanding of birth trauma–related vocal fold immobility and quantitatively compare it with idiopathic congenital vocal fold immobility to explore whether it is a discrete entity. Data Sources PubMed, Ovid, and Cochrane databases. Review Methods English-language, observational, or experimental studies involving infants with idiopathic congenital or birth trauma–related vocal fold immobility were included. Data from these studies were pooled with our institution’s vocal fold immobility database, with the resultant idiopathic congenital and birth trauma cohorts compared regarding patterns and outcomes of immobility. Results The search returned 288 articles, with 24 meeting inclusion criteria. Of studies reviewing all-cause immobility, 8 of 9 (88.9%) identified birth trauma as an etiology, although birth trauma definitions and proposed mechanisms of immobility varied. The study subjects, combined with our institution’s database, yielded 188 idiopathic congenital and 113 birth trauma cases. Compared with idiopathic congenital cases, birth trauma cases had a higher proportion of unilateral immobility (72 of 113 [63.7%] vs 52 of 188 [27.7%], P < .001) and rate of resolution (41 of 51 [80.4%] vs 91 of 159 [57.2%], P = .003). Resolution occurred in 24 of 26 (91.3%) unilateral and 17 of 25 (68.0%) bilateral birth trauma cases and in 30 of 40 (75.0%) unilateral and 59 of 109 (54.1%) bilateral idiopathic congenital cases ( P = .11 and .20, respectively). Conclusion While the definition and mechanism of birth trauma–related vocal fold immobility warrant further investigation, these findings suggest that it is distinct from idiopathic congenital vocal fold immobility, with a unique presentation and potentially more favorable outcomes. This can inform counseling and management for infants with otherwise unexplained immobility but known birth trauma.

scholarly journals Visual biofeedback for paradoxical vocal fold motion (PVFM)

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Rachelle Alyce LeBlanc ◽  
Daniel Aalto ◽  
Caroline C. Jeffery
Keyword(s):  
Vocal Fold ◽  
Medication Use ◽  
Vocal Folds ◽  
Asthma Medication ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Visual Biofeedback ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Abstract Objectives Paradoxical vocal fold motion (PVFM) is a common condition where the vocal folds inappropriately adduct during inspiration. This results in dyspnea and occasionally significant distress. The condition is thought to be primarily functional, with behavioural therapy considered mainstay in the non-acute setting. However, practice variations and limited access to speech language pathology (SLP) services can pose management challenges. We aimed to examine the efficacy of surgeon performed visual biofeedback as first-line treatment for PVFM. Study design Prospective, non-randomized, non-comparative clinical study. Methods Adult patients referred for possible PVFM and congruent laryngoscopy findings over a two-year period were included. Patients were excluded if they presented in acute distress, had alternate diagnosis to explain symptomology and/or coexisting untreated lower respiratory pathology. Patients underwent immediate surgeon-performed visual biofeedback on the same visit day. The primary outcome of interest was change in Dyspnea Index (DI) scores pre- and post-intervention 3 months follow-up. The secondary outcome measured was change in asthma medication use from baseline to follow-up. Results Of 34 patients presenting, 25 met inclusion criteria. Of these, 72% were female with an average age of 36.9 ± 14.1. Approximately 48% of patients had a diagnosis of well-controlled asthma at presentation and co-morbid psychiatric diagnoses were common (52%). Pre- and post-intervention analysis showed significant improvement in DI scores (p < 0.001) and reduction in bronchodilator use (p = 0.003). Conclusion This is a prospective study that evaluates the role of visual biofeedback in PVFM patients. Our data suggests that visual biofeedback effectively reduces short-term subjective symptoms and asthma medication use. Level of evidence 3 Graphical abstract

scholarly journals Swallowing Outcomes in Elderly Patients following Microvascular Reconstruction of the Head and Neck

2018 ◽  
Vol 159 (2) ◽  
pp. 320-327 ◽  
Author(s):  
Mitchell L. Worley ◽  
Evan M. Graboyes ◽  
Julie Blair ◽  
Suhael Momin ◽  
Kent E. Armeson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Academic Medical Center ◽  
Multivariable Analysis ◽  
Aerodigestive Tract ◽  
Microvascular Reconstruction ◽  
Upper Aerodigestive Tract ◽  
Swallowing Function ◽  
Swallowing Outcomes

Objective To describe swallowing outcomes in elderly patients undergoing microvascular reconstruction of the upper aerodigestive tract and identify risk factors for poor postoperative swallowing function. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Sixty-six patients aged ≥70 years underwent microvascular reconstruction of the upper aerodigestive tract. The primary outcome measure was the Functional Oral Intake Scale (FOIS); preoperative and postoperative scores were dichotomized to define “good swallowing” and “poor swallowing.” Logistic regression was performed to identify risk factors for poor postoperative swallowing function. Results In total, 91% of reconstructions were performed for oncologic defects. The most common defect site was the oral cavity (67%), and the anterolateral thigh (29%) was the most frequently used donor site. At 3-year follow up, 75% of patients had good swallowing function with 95% of patients who achieved good swallowing function doing so within 6 months of surgery. On multivariable analysis, patients with pT4 tumors (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.0-25.6) and those undergoing at least partial glossectomy (OR, 4.7; 95% CI, 1.1-20.7) were more likely to experience poor swallowing function at 6-month follow-up. Conclusion Approximately half of elderly patients achieve good swallowing function within 6 months following microvascular reconstruction of the upper aerodigestive tract. Elderly patients with pT4 tumors and those requiring glossectomy are at highest risk for poor swallowing outcomes. These data can be used to inform preoperative patient counseling and design interventions aimed at improving swallowing function in those at high risk for poor outcomes.

scholarly journals How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5379
Author(s):  
Tzu-Yen Huang ◽  
Wing-Hei Viola Yu ◽  
Feng-Yu Chiang ◽  
Che-Wei Wu ◽  
Shih-Chen Fu ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Vocal Fold ◽  
Thermal Injury ◽  
Mechanical Injury ◽  
Injury Mechanisms ◽  
Group A ◽  
Nerve Dysfunction ◽  
Vocal Fold Motion ◽  
Swallowing Outcomes

Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, p = 0.017), received neck dissection (A/B/C = 17%/31%/55%, p < 0.001), had thermal injury (p = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, p < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.

Dysphagia Severity and Outcomes Following Iatrogenic High Vagal Nerve Injury

2021 ◽  
pp. 000348942110269
Author(s):  
Ethan R. Miles ◽  
Priya D. Krishna ◽  
Jared C. Inman ◽  
Steve C. Lee ◽  
Paul C. Walker ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Vocal Fold ◽  
Oral Intake ◽  
Retrospective Chart Review ◽  
Vagal Nerve ◽  
Swallowing Function ◽  
Tertiary Referral Center ◽  
Swallowing Therapy ◽  
Vocal Fold Injection

Objective: To examine severity of dysphagia and outcomes following iatrogenic high vagal nerve injury. Methods: Retrospective chart review of all patients with iatrogenic high vagal nerve injury that were seen at a tertiary referral center from 2012 to 2020. Results: Of 1304 patients who met criteria for initial screening, 18 met all inclusion criteria. All 18 required intervention to address postoperative dysphagia. Eleven required enteral feeding tubes with 7 eventually able to advance to exclusively per oral diets. Fourteen underwent vocal fold injection and 6 underwent laryngeal framework surgery. Sixteen pursued swallowing therapy with speech language pathology. Patients lost a mean of 8.6 kg of weight in the 6 months following the injury. Swallowing function on the Functional Outcome Swallowing Scale (FOSS) and Functional Oral Intake Scale (FOIS) was 4.4 and 2.4 respectively immediately following the injury and improved to 1.9 and 5.3 at the last follow-up. No patients had complete return of normal swallowing function at last follow up. Conclusion: Iatrogenic high vagal injury causes significant lasting dysphagia which improves with intervention but does not completely resolve. Interventions such as vocal fold injection, medialization laryngoplasty, cricopharyngeal myotomy, or swallowing therapy may be required to reestablish safe swallowing in these patients.

Patent ductus arteriosus in preterm infants born before 30 weeks’ gestation: high rate of spontaneous closure after hospital discharge

2018 ◽  
Vol 28 (8) ◽  
pp. 995-1000 ◽  
Author(s):  
Vittorio Romagnoli ◽  
Annalisa Pedini ◽  
Monica Santoni ◽  
Grazia Scutti ◽  
Massimo Colaneri ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Hospital Discharge ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Spontaneous Closure ◽  
High Rate ◽  
Inclusion Criteria ◽  
Surgical Ligation ◽  
Patent Ductus

AbstractAimThe aim of this study was to determine the spontaneous closure rate of patent ductus arteriosus at a 2-year follow-up, following failed medical therapy and beyond initial hospital discharge, and to evaluate in-hospital spontaneous or pharmacological closure rates.Materials and methodsA retrospective evaluation was conducted in a cohort of preterm infants admitted to the Neonatal ICU of Ancona between January, 2004 and June, 2013. Inclusion criteria were gestational age between 24+0 and 29+6 weeks or birth weight <1250 g; admission within 48 hours from birth; and discharge alive from hospital. All infants received routine heart ultrasound between 48 and 72 hours of life. Haemodynamically significant patent ductus arteriosus was defined as a duct diameter >1.5 mm, a left atrium-to-aorta ratio >1.4, and/or reversal of end-diastolic flow in the aorta >30% of the anterograde. First-line treatment was intravenous ibuprofen. Intravenous indomethacin was used if ibuprofen failed. Surgical ligation was considered in haemodynamically significant patent ductus arteriosus after medical treatment.ResultsA total of 593 infants met the inclusion criteria, and patent ductus arteriosus was diagnosed in 317 (53.4%). Among them, 283 (89.3%) infants had haemodynamically significant patent ductus arteriosus, with pharmacological closure achieved in 228 (80.6%) infants and surgical ligation performed in 20 (7.1%). Follow-up at 24 months was available for 39 (81.3%) of 48 infants with patent ductus arteriosus at the hospital discharge: 36 (92.3%) underwent spontaneous closure, two (5.1%) underwent surgical ligation, and one (2.6%) had a patent ductus arteriosus.DiscussionA significant number of patent ductus arteriosus that fail pharmacological closure undergo spontaneous closure by the age of 2 years. This information should be taken into account when considering surgery or additional attempts of pharmacological closure.

Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations

2021 ◽  
Vol 12 (4) ◽  
pp. 535-541
Author(s):  
Jennifer M. Barr ◽  
Kandice Bowman ◽  
Monica Deshpande ◽  
Elizabeth N. Dewey ◽  
Henry A. Milczuk ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Arch ◽  
Vocal Fold ◽  
Arterial Switch Operation ◽  
Ductus Arteriosus ◽  
Median Sternotomy ◽  
Norwood Procedure ◽  
Laryngeal Function ◽  
Vocal Fold Immobility

Background: Loss of laryngeal function after congenital cardiac surgery causes morbidity and prolongs hospitalization. Early diagnosis of vocal fold immobility (VFI) and referral to pediatric otolaryngology (pOTO) aids in laryngeal rehabilitation. Understanding the incidence and recovery rates of VFI enables counseling for families of infants undergoing high-risk surgery. Methods: A retrospective chart review from November 2014 to July 2019 of infants postcardiac surgery where the aortic arch or surrounding structures were manipulated and were screened via flexible fiberoptic laryngoscopy (FFL) at a single institution was performed. Patients were divided into five surgical categories: Norwood procedure, aortic arch augmentation via median sternotomy, arterial switch operation, coarctation repair via lateral thoracotomy, and cardiac surgeries including ligation of a patent ductus arteriosus (PDA). Patients undergoing isolated PDA ligation were excluded. Results: One hundred ninety-nine qualifying operations occurred during this period; 28 patients did not undergo FFL before discharge and were excluded from the analysis. Immediately following cardiac surgery, 34% (58 of 171 patients) had VFI. Follow-up was completed by 38 of 58 patients with VFI. Complete recovery was demonstrated in 63% (24 of 38) of patients by 6 months and in 86% (33 of 38) within 18 months. The highest risk occurred with the Norwood procedure and arch augmentation via median sternotomy. Conclusions: Infants undergoing surgery involving the aortic arch and surrounding structures have high rates of VFI. Follow-up by pOTO is recommended to optimize laryngeal rehabilitation. Most patients have spontaneous recovery within 18 months of cardiac surgery.

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