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Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit

Background and Objectives Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic eval...

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Published in:Pediatric pulmonology 2021-06, Vol.56 (6), p.1651-1658
Main Authors: Aguirregomezcorta, Fernando R., Osona, Borja, Peña‐Zarza, Jose A., Gil, Jose A., Vetter‐Laracy, Susanne, Frontera, Guiem, Figuerola, Joan, Bover‐Bauza, Catalina
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cited_by cdi_FETCH-LOGICAL-c3938-dd196d7b3f53143508227a49e8d0caa459c5d23b762550a39299c1db3e3713823
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container_title Pediatric pulmonology
container_volume 56
creator Aguirregomezcorta, Fernando R.
Osona, Borja
Peña‐Zarza, Jose A.
Gil, Jose A.
Vetter‐Laracy, Susanne
Frontera, Guiem
Figuerola, Joan
Bover‐Bauza, Catalina
description Background and Objectives Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. Methods Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. Results Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post‐swallowing food residues (OR, 8.08). Conclusions The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.
doi_str_mv 10.1002/ppul.25328
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Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. Methods Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. Results Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post‐swallowing food residues (OR, 8.08). Conclusions The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.</description><identifier>ISSN: 8755-6863</identifier><identifier>EISSN: 1099-0496</identifier><identifier>DOI: 10.1002/ppul.25328</identifier><identifier>PMID: 33620151</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>children ; chronic aspiration ; Dysphagia ; Endoscopy ; fiberoptic endoscopic evaluation of swallowing ; Pediatrics ; Pulmonary aspiration ; Pulmonology ; Swallowing ; swallowing disorders</subject><ispartof>Pediatric pulmonology, 2021-06, Vol.56 (6), p.1651-1658</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3938-dd196d7b3f53143508227a49e8d0caa459c5d23b762550a39299c1db3e3713823</citedby><cites>FETCH-LOGICAL-c3938-dd196d7b3f53143508227a49e8d0caa459c5d23b762550a39299c1db3e3713823</cites><orcidid>0000-0002-7481-2541 ; 0000-0003-1977-9109 ; 0000-0001-9042-8868 ; 0000-0001-6337-0269 ; 0000-0003-3522-7187</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33620151$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aguirregomezcorta, Fernando R.</creatorcontrib><creatorcontrib>Osona, Borja</creatorcontrib><creatorcontrib>Peña‐Zarza, Jose A.</creatorcontrib><creatorcontrib>Gil, Jose A.</creatorcontrib><creatorcontrib>Vetter‐Laracy, Susanne</creatorcontrib><creatorcontrib>Frontera, Guiem</creatorcontrib><creatorcontrib>Figuerola, Joan</creatorcontrib><creatorcontrib>Bover‐Bauza, Catalina</creatorcontrib><title>Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit</title><title>Pediatric pulmonology</title><addtitle>Pediatr Pulmonol</addtitle><description>Background and Objectives Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. Methods Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. Results Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post‐swallowing food residues (OR, 8.08). Conclusions The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.</description><subject>children</subject><subject>chronic aspiration</subject><subject>Dysphagia</subject><subject>Endoscopy</subject><subject>fiberoptic endoscopic evaluation of swallowing</subject><subject>Pediatrics</subject><subject>Pulmonary aspiration</subject><subject>Pulmonology</subject><subject>Swallowing</subject><subject>swallowing disorders</subject><issn>8755-6863</issn><issn>1099-0496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp90ctq3DAUBmBRGppp2k0foAi6KQWnuliytCzpLTCQWXTW4tiSBwVZciU7w9CXr6dOu-giKx3Qd34O_Ai9oeSaEsI-juMcrpngTD1DG0q0rkit5XO0UY0QlVSSX6KXpdwTsvxp-gJdci4ZoYJu0K_PHg4xFV8wRIsHiHBwg4sTTj2GMvoMk08Rz8XHA-5963IaJ99hF20qXRrP4wOEeWXLUjlCCOl45j5iwDtnPUx5cbs5DCmmkA4nvI9-eoUuegjFvX58r9D-65cfN9-r7d2325tP26rjmqvKWqqlbVreC05rLohirIFaO2VJB1AL3QnLeNtIJgQBrpnWHbUtd7yhXDF-hd6vuWNOP2dXJjP40rkQILo0F8NqzaRQvNYLffcfvU9zjst1hgmmasmkahb1YVVdTqVk15sx-wHyyVBizpWYcyXmTyULfvsYObeDs__o3w4WQFdw9MGdnogyu91-u4b-BhXel5Q</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Aguirregomezcorta, Fernando R.</creator><creator>Osona, Borja</creator><creator>Peña‐Zarza, Jose A.</creator><creator>Gil, Jose A.</creator><creator>Vetter‐Laracy, Susanne</creator><creator>Frontera, Guiem</creator><creator>Figuerola, Joan</creator><creator>Bover‐Bauza, Catalina</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7481-2541</orcidid><orcidid>https://orcid.org/0000-0003-1977-9109</orcidid><orcidid>https://orcid.org/0000-0001-9042-8868</orcidid><orcidid>https://orcid.org/0000-0001-6337-0269</orcidid><orcidid>https://orcid.org/0000-0003-3522-7187</orcidid></search><sort><creationdate>202106</creationdate><title>Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit</title><author>Aguirregomezcorta, Fernando R. ; Osona, Borja ; Peña‐Zarza, Jose A. ; Gil, Jose A. ; Vetter‐Laracy, Susanne ; Frontera, Guiem ; Figuerola, Joan ; Bover‐Bauza, Catalina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3938-dd196d7b3f53143508227a49e8d0caa459c5d23b762550a39299c1db3e3713823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>children</topic><topic>chronic aspiration</topic><topic>Dysphagia</topic><topic>Endoscopy</topic><topic>fiberoptic endoscopic evaluation of swallowing</topic><topic>Pediatrics</topic><topic>Pulmonary aspiration</topic><topic>Pulmonology</topic><topic>Swallowing</topic><topic>swallowing disorders</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aguirregomezcorta, Fernando R.</creatorcontrib><creatorcontrib>Osona, Borja</creatorcontrib><creatorcontrib>Peña‐Zarza, Jose A.</creatorcontrib><creatorcontrib>Gil, Jose A.</creatorcontrib><creatorcontrib>Vetter‐Laracy, Susanne</creatorcontrib><creatorcontrib>Frontera, Guiem</creatorcontrib><creatorcontrib>Figuerola, Joan</creatorcontrib><creatorcontrib>Bover‐Bauza, Catalina</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric pulmonology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aguirregomezcorta, Fernando R.</au><au>Osona, Borja</au><au>Peña‐Zarza, Jose A.</au><au>Gil, Jose A.</au><au>Vetter‐Laracy, Susanne</au><au>Frontera, Guiem</au><au>Figuerola, Joan</au><au>Bover‐Bauza, Catalina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit</atitle><jtitle>Pediatric pulmonology</jtitle><addtitle>Pediatr Pulmonol</addtitle><date>2021-06</date><risdate>2021</risdate><volume>56</volume><issue>6</issue><spage>1651</spage><epage>1658</epage><pages>1651-1658</pages><issn>8755-6863</issn><eissn>1099-0496</eissn><abstract>Background and Objectives Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. Methods Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. Results Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post‐swallowing food residues (OR, 8.08). Conclusions The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. 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subjects children
chronic aspiration
Dysphagia
Endoscopy
fiberoptic endoscopic evaluation of swallowing
Pediatrics
Pulmonary aspiration
Pulmonology
Swallowing
swallowing disorders
title Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit
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