September 2019 HSC Section 1 Congenital and Pediatric Problems

TABLE II. Clinical Characteristics of 1,286 Patients Who Underwent Modified Barium Swallow Study.

n

No Aspiration

Overt Aspiration

Silent Aspiration

All patients

1286

846 (65.8%)

47 (3.7%)

393 (30.6%)

Age

< 6 months

311

185 (59.5%)

6 (1.9%)

120 (38.6%)

6–12 months

197

120 (60.9%)

11 (5.6%)

66 (33.5%)

1–2 years

254

161 (63.4%)

9 (3.5%)

84 (33.1%)

2 years

524

380 (72.5%)

21 (4.0%)

123 (23.5%)

Gender Male

754

494 (65.5%)

29 (3.8%)

231 (30.6%)

Female

531

351 (66.1%)

18 (3.4%)

162 (30.5%)

Diagnosis Airway disorder

284

154 (54.2%)

10 (3.5%)

120 (42.3%)

Laryngeal cleft

124

66 (53.2%)

7 (5.6%)

51 (41.1%)

Laryngomalacia

138

79 (57.2%)

3 (2.2%)

56 (40.6%)

Vocal fold paralysis

32

16 (50.0%)

0 (0%)

16 (50.0%)

Unilateral VFP

28

13 (46.4%)

0 (0%)

15 (53.6%)

Bilateral VFP

4

3 (75.0%)

0 (0%)

1 (25.0%)

Neurologic disease

440

259 (58.9%)

16 (3.6%)

165 (37.5%)

Developmental delay

351

209 (59.5%)

12 (3.4%)

130 (37.0%)

Hypotonia

161

93 (57.8%)

6 (3.7%)

62 (38.5%)

Epilepsy/seizures

133

72 (54.1%)

5 (3.8%)

56 (42.1%)

Microcephaly/macrocephaly

65

41 (63.1%)

2 (3.1%)

22 (33.8%)

Cerebral palsy

50

27 (54.0%)

4 (8.0%)

19 (38.0%)

Hereditary disorder

14

5 (35.7%)

0 (0%)

9 (64.3%)

Neuromuscular disorder

11

6 (54.5%)

0 (0%)

5 (45.5%)

Meningitis encephalitis

3

1 (33.3%)

0 (0%)

2 (66.7%)

Brain trauma

2

0 (0%)

0 (0%)

2 (100%)

Syndrome

153

88 (57.5%)

6 (3.9%)

59 (38.6%)

Down syndrome

62

32 (51.6%)

3 (4.8%)

27 (43.5%)

Congenital heart disease

84

40 (47.6%)

3 (3.6%)

41 (48.8%)

Prematurity

238

145 (60.9%)

12 (5.0%)

81 (34.0%)

GERD

401

276 (68.8%)

9 (2.2%)

116 (28.9%)

GERD 5

gastroesophageal reflux disease.

(Table IV). Laryngeal cleft (adjusted RR [aRR] 5 1.67; 95% CI 5 1.35, 2.05), laryngomalacia (aRR 5 1.26; 95% CI 5 1.02, 1.55), and unilateral VFP (aRR 5 1.42; 95% CI 5 1.01, 2.00) were all significantly associated with silent aspiration after adjusting for age and other diag- noses in the multivariable model. Additionally, develop- mental delay (aRR 5 1.32; 95% CI 5 1.11, 1.57), epilepsy/ seizures (aRR 5 1.52; 95% CI 5 1.21, 1.90), syndrome (aRR 5 1.37; 95% CI 5 1.11, 1.69), and congenital heart disease (aRR 5 1.69; 95% CI 5 1.33, 2.14) were signifi- cantly associated with risk of silent aspiration in the multivariable regression model. Prematurity ( P 5 0.13) and GERD ( P 5 0.28) were not significantly associated with silent aspiration.

of those, 81 (87%) silently aspirated. Of 401 children with a history of GERD, 125 (31%) were found to aspirate and, of those, 116 (93%) silently aspirated.

Characteristics of Patients With Silent Aspiration

Among patients with silent aspiration, 192 (49%) aspi- rated on thin fluids only, 43 (11%) on thickened fluids only, and 125 (32%) aspirated on both thin and thickened fluids (Table III). Thirty-three patients (8%) silently aspirated on pureed or solid food. Median age at which patients demon- strated silent aspiration was 1.1 years (IQR 5 0.4–2.5 years). Patients who silently aspirated were younger than those who did not aspirate (median 5 1.7, IQR 5 0.6–4.0, P < 0.001).

Silent Aspiration Versus Overt Aspiration Patients with silent aspiration and those with overt aspiration were also compared. Patients with silent aspi- ration were younger than patients with overt aspiration

Silent Aspiration Versus No Aspiration We compared the clinical characteristics of patients with silent aspiration and those who did not aspirate

Laryngoscope 00: Month 2017 128: August 2018

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