Deep interarytenoid notch in young children managed with systematic thickener wean and injection laryngoplasty

• Published in: International journal of pediatric otorhinolaryngology 2019-03, Vol.118, p.115-119
• Main Authors: Basharat, Usmaan, Schraff, Scott, Stevens, Lindsay M., Clarke, Pamela Y., Kang, Paul, Woodward, Jim, Schroeder, Shauna R., Rao, Aparna, Page, Nathan, Williams, Dana I.
• Format: Article
• Language: English
• Subjects: Aspiration; Deep interarytenoid notch; Dysphagia; Injection laryngoplasty; Laryngeal cleft; Thickener
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2018.12.032

Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1–3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.