Pediatric Dysphagia, Drooling, and Aspiration: What the Comprehensive Otolaryngologist Should Know (AMW)
2021 AAO-HNSF Annual Meeting & OTO Experience
In 25% of infants and children experience some degree of dysphagia and the incidence is rising. The prevalence of pediatric dysphagia is higher in patients with neurodevelopmental disorders, cardiothoracic conditions, and a history of prematurity. Sialorrhea, frequently present, is often both a manifestation and an exacerbating factor of thin liquid dysphagia. Aspiration associated with pediatric dysphagia and drooling may result in pneumonia, hospital admission, and, eventually, bronchiectasis. While many afflicted children will outgrow dysphagia by the age of 4 – 5 years old, the negative impact on the patient and the family in terms of patient growth, risk of aerodigestive infection, financial burden of thickeners and repeated medical evaluations and interventions is significant. Given the prevalence and rising incidence of pediatric dysphagia, the comprehensive practice Otolaryngologist will encounter pediatric patients with swallowing, drooling, and aspiration complaints in their practice. The goals of this panel are to review the medical work up of pediatric dysphagia, understand the treatment options for drooling, and review the surgical options for management of aspiration. We will review the key presenting symptoms of pediatric dysphagia and aspiration. We will review the diagnostic modalities available, including use of video fluoroscopic swallow (VFS), fiberoptic endoscopic evaluation of swallow (FEES), and sialograms. Medical interventions, diet modifications, thickening agents, reflux medications and drying agents will be discussed. The complications associated with uncontrolled dysphagia, sialorrhea, and aspiration will be reviewed. Surgical options including supraglottoplasty, treatment of surgical clefts, salivary gland botulinum toxin injection, and salivary gland resection will be presented. Upon completion of the session, the comprehensive otolaryngologist should be able to apply a treatment algorithm for pediatric dysphagia, drooling, and aspiration to their practice.
Credits
CME:1.0, MOC:1.0