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Lawlor CM, Choi SS. Lipid‐Laden Macrophage Index as a Diagnostic Tool for Pediatric Aspiration: A Systematic Review. OTO Open 2023; 7:e33. [PMID: 36998564 PMCID: PMC10046735 DOI: 10.1002/oto2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 03/30/2023] Open
Abstract
Objective Lipid-laden macrophage index (LLMI) has been proposed as a marker for aspiration on bronchoalveolar lavage. It has also been studied as a marker for gastroesophageal reflux and other pulmonary diseases. This review aims to determine the clinical correlation between LLMI and pediatric aspiration. Data Sources PubMed (MeSH search), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) portals through December 17th, 2020. Review Methods Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. Search criteria included all occurrences in the title or abstract of the terms "pulmonary aspiration" and "alveolar macrophages." Results Five studies describing 720 patients met inclusion, 3 retrospective case-control studies, and 2 prospective observational studies. Four studies suggested a link between elevated LLMI and aspiration, and 1 found no association. Control groups varied and included healthy nonaspirators to nonaspirators with other pulmonary diseases. Diagnosis of aspiration was not standardized across the studies. Three papers proposed cutoff values for LLMI, all different. Conclusion The existing literature indicates that LLMI is not a sensitive or specific marker for aspiration. Further study is needed to define the utility of LLMI in pediatric aspiration.
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Affiliation(s)
- Claire M. Lawlor
- Department of OtolaryngologyChildren's National Health SystemWashingtonDistrict of ColumbiaUSA
| | - Sukgi S. Choi
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
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Lawlor CM, Choi S. Diagnosis and Management of Pediatric Dysphagia. JAMA Otolaryngol Head Neck Surg 2020; 146:183-191. [DOI: 10.1001/jamaoto.2019.3622] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Claire M. Lawlor
- Department of Otolaryngology, Children’s National Health System, Washington, DC
| | - Sukgi Choi
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
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Padia R, Coppess S, Horn DL, Parikh SR, Hoang J, Faherty A, DeMarre K, Johnson K. Pediatric dysphagia: Is interarytenoid mucosal height significant? Laryngoscope 2019; 129:2588-2593. [PMID: 30671968 DOI: 10.1002/lary.27535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS). METHODS A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%). RESULTS There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%). CONCLUSION There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology. LEVEL OF EVIDENCE 4. Laryngoscope, 129:2588-2593, 2019.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Steven Coppess
- Seattle Children's Hospital, the University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - David L Horn
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Jennifer Hoang
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Amy Faherty
- the Speech and Language Services, Department of Rehabilitation Services, Seattle, Washington, U.S.A
| | - Kimberley DeMarre
- the Speech and Language Services, Department of Rehabilitation Services, Seattle, Washington, U.S.A
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle, Washington, U.S.A.,the Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
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Isaac A, El-Hakim H. Type 1 Laryngeal Cleft and feeding and swallowing difficulties in infants and toddlers: A Review. Clin Otolaryngol 2018; 44:107-113. [DOI: 10.1111/coa.13223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Andre Isaac
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery; Departments of Surgery and Pediatrics; The Stollery Children's Hospital; University of Alberta Hospital; Edmonton AB Canada
| | - Hamdy El-Hakim
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery; Departments of Surgery and Pediatrics; The Stollery Children's Hospital; University of Alberta Hospital; Edmonton AB Canada
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Sobol SE. Diagnosis and Management of Laryngotracheoesophageal Cleft. Curr Probl Pediatr Adolesc Health Care 2018; 48:82-84. [PMID: 29571545 DOI: 10.1016/j.cppeds.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Laryngotracheoesophageal cleft (LTEC) is a rare anatomic cause of aspiration in the newborn and infant. The clinical presentation of infants with LTEC is variable and will usually vary with the degree of anatomic communication between the airway and esophagus. The diagnosis of LTEC is often challenging, particularly in cases where the presentation and pathology are more subtle. Management of LTEC depends upon the clinical presentation, degree of aspiration, and anatomic depth of the cleft. The goal of this review is to present the clinician with a practical approach to diagnosis and management of this rare but challenging congenital airway anomaly.
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Affiliation(s)
- Steven E Sobol
- Division of Otolaryngology, Center for Pediatric Airway Disorders, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
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Abstract
Laryngotracheoesophageal clefts are rare congenital anomalies of the aerodigestive tract. Patients may present with airway and/or swallowing impairments. An approach to evaluation and management is presented. Important pearls for conservative and surgical management are discussed. Open versus endoscopic surgical techniques are reviewed.
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Affiliation(s)
- Julie E Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Western University, 800 Commissioners Rd. E., London, Ontario, Canada
| | - Reza Rahbar
- Department of Otolaryngology, Communication Enhancement, Harvard University, Boston Children's Hospital, 300 Longwood Ave, LO-367, Boston, MA 02115.
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Strychowsky JE, Dodrill P, Moritz E, Perez J, Rahbar R. Swallowing dysfunction among patients with laryngeal cleft: More than just aspiration? Int J Pediatr Otorhinolaryngol 2016; 82:38-42. [PMID: 26857313 DOI: 10.1016/j.ijporl.2015.12.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/30/2015] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Modified Barium Swallow (MBS) is the most widely utilized instrumental assessment of swallowing disorders in children; however, the exact role in the evaluation of laryngeal clefts remains controversial. METHODS This study was an IRB-approved retrospective review on patients diagnosed with laryngeal cleft from 2002 to 2014. The objective was to describe the range of swallowing dysfunction that may be present in patients with laryngeal clefts both pre- and post-intervention (conservative management versus surgery). A speech-language pathologist reviewed MBS studies and medical records to determine Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) scores. RESULTS One hundred seventy-five patients who underwent laryngeal cleft repair during the study period (type 1, n=111; type 2, n=54; type 3, n=9; type 4, n=1) were included. Fifty patients who were managed conservatively (type 1) were also included. Swallowing impairment was demonstrated in all phases of swallowing for all cleft types. Oral phase impairment ranged from 27-67% pre-intervention to 19-75% post-intervention, triggering impairment from 24-42% pre-intervention to 24-75% post-intervention, and pharyngeal phase impairment (laryngeal penetration and aspiration) from 57-100% pre-intervention to 40-100% post-intervention. Laryngeal penetration and aspiration on thin and thick liquids, silent aspiration, PAS, and FOIS scores are reported. Significant improvements in swallowing function (p<0.05) were documented in all of the conservatively and surgically managed sub-groups. CONCLUSIONS The MBS study is a useful tool for evaluating swallowing function in patients with laryngeal cleft and provides information beyond the lack or presence of aspiration. Understanding impairments in all phases of swallowing may be beneficial for perioperative management.
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Affiliation(s)
- Julie E Strychowsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, 800 Commissioners Rd E, VH B3-444, London, ON, N6A 5W9, Canada.
| | - Pamela Dodrill
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA.
| | - Ethan Moritz
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA.
| | - Jennifer Perez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA.
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
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Yawn RJ, Fazili M, Provo-Bell G, Wootten CT. The utility of bronchoalveolar lavage findings in the diagnosis of eosinophilic esophagitis in children. Int J Pediatr Otorhinolaryngol 2015; 79:1834-7. [PMID: 26362482 DOI: 10.1016/j.ijporl.2015.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bronchoalveolar lavage (BAL)-nucleated cell counts and the lipid-laden alveolar macrophage index (LLMI) have been investigated in predicting chronic aspiration as well as reflux esophagitis with variable results. To date, BAL neutrophil percentages and the LLMI have not been described in patients with eosinophilic esophagitis (EoE). OBJECTIVES To evaluate BAL neutrophil percentages and LLMI levels in patients with EoE and compare these levels in patients with aerodigestive concerns without biopsy-proven EoE. METHODS Retrospective review of patients referred to an aerodigestive evaluation team for overlapping aerodigestive complaints (dysphagia, stridor, subglottic stenosis, feeding intolerance, and chronic aspiration). Patients underwent microlaryngoscopy, esophagogastroduodenoscopy with biopsy, and bronchoscopy and BAL were indicated by symptoms. BAL neutrophil percentages, LLMI levels, esophageal biopsy results, and esophageal dual-probe pH/impedance were recorded and compared. RESULTS Fifty-one patients were included in the study that underwent comprehensive workup for aerodigestive complaints. Patients were subdivided into two groups: (1) negative esophageal biopsy (for EoE) and (2) positive esophageal biopsy. There were no significant differences between the groups in percentage neutrophils (p=0.55, unpaired t-test) or LLMI levels (p=0.14, unpaired t-test). DISCUSSION BAL neutrophil percentages and the LLMI are unreliable in identifying patients with silent aspiration and gastroesophageal reflux. To date, there is no report of the utility of BAL neutrophil percentages and the LLMI in diagnosing patients with EoE. Our series indicates no correlation in neutrophil percentages or LLMI in patients with EoE versus patients without EoE that are referred to tertiary centers with aerodigestive concerns. CONCLUSION BAL neutrophil percentages and LLMI levels are not a reliable predictor of eosinophilic esophagitis in children with complex aerodigestive concerns. Esophageal biopsy remains the gold standard for diagnosis of EoE and the challenge remains to find other markers that raise suspicion for EoE for the non-gastroenterologist or that stage the extent of disease beyond the esophagus.
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Affiliation(s)
- Robert J Yawn
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN 37232 USA
| | - Mohammad Fazili
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Vanderbilt Children's Hospital, Nashville, TN 37232 USA
| | - Gwen Provo-Bell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN 37232 USA
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN 37232 USA.
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Lahiri T. The utility of the lipid-laden macrophage index for the evaluation of aspiration in children. Cancer Cytopathol 2013; 122:161-2. [DOI: 10.1002/cncy.21365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Thomas Lahiri
- Department of Pediatrics; Vermont Children's Hospital at Fletcher Allen Health Care
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Thiel G, Clement WA, Kubba H. The management of laryngeal clefts. Int J Pediatr Otorhinolaryngol 2011; 75:1525-8. [PMID: 21937125 DOI: 10.1016/j.ijporl.2011.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To review the clinical presentation and management of all infants and children presenting with laryngeal clefts to a tertiary pediatric ENT centre and to identify changes in practice over time. PATIENTS AND METHODS A retrospective case note review of the management of all infants and children with a diagnosis of a laryngeal cleft identified in our Department between 01/11/2003 and 31/12/2010. RESULTS Twelve children with laryngeal clefts were identified. Six clefts were grade 1, five grade 2 and one grade 3b. All grade 1 clefts were managed conservatively. Of the grade 2 clefts, four required surgery with one being managed conservatively. Two were repaired using an open technique and two using an endoscopic technique. The grade 3b cleft was repaired endoscopically. Two cleft repairs broke down post-operatively requiring further surgery. CONCLUSIONS Conservative management remains the management of choice for lower grade clefts. Where a laryngeal cleft requires repair there has been a trend towards the endoscopic over open technique, even of more extensive clefts.
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Affiliation(s)
- Gundula Thiel
- Department of Paediatric Otolaryngology - Head and Neck Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom.
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Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Curr Opin Otolaryngol Head Neck Surg 2010; 18:554-63. [DOI: 10.1097/moo.0b013e32834029de] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:577-81. [DOI: 10.1097/moo.0b013e328340ea77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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