Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors
Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors
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DOI：
10.1002/ppul.20488
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发表时间：
2006-11-01
影响因子：
3.1
通讯作者：
Loughlin, Gerald M.
中科院分区：
文献类型：
--
作者：
Lefton-Greif, Maureen A.;Carroll, John L.;Loughlin, Gerald M.
背景在没有明显危险因素的儿童中，吞咽功能障碍的存在仍然没有得到充分的重视。早期识别和及时开始适当的治疗是减少与吞咽困难相关的发病率的关键。描述以不明原因呼吸问题为表现的口咽吞咽困难儿童的临床表现、影像学特征和长期结局。我们完成了一项回顾性图表审查，所有儿童没有已知的吞咽困难的危险因素，在介绍给言语-语言病理学（1991年12月至1995年4月），喂养/吞咽评价，因为难治性呼吸问题和吞咽困难的问题，并随后被诊断为吞咽困难的视频透视吞咽研究（VFSS）。2002年8月，对14名儿童的照顾者进行了后续电话访谈。我们确定了19名儿童（平均年龄1.14岁;范围0.9-5.75）吞咽困难表现为不明原因的呼吸问题。在VFSS上，咽部吞咽延迟发作是最常见的异常放射学发现，并且总是先于穿透或气管抽吸。11例（57.9%）患儿出现误吸。抽吸仅发生在液体中，100%的抽吸事件是无声的（即，无咳嗽）。11名平均年龄为3.2岁（范围0.7-10岁）的儿童吞咽困难不是问题，3名9岁或9岁以上的儿童持续存在吞咽困难。当幼儿出现不明原因的呼吸问题时，在鉴别诊断中应考虑口咽吞咽困难，而这些幼儿没有与吞咽功能障碍相关的已知危险因素。虽然吞咽困难问题的解决预后非常好，但可能需要数年时间。
Background. The presence of swallowing dysfunction in children without obvious risk factors remains under appreciated. Early identification and prompt initiation of appropriate treatments are critical for reduction of morbidities associated with dysphagia.Objective. To describe the clinical presentations, radiologic characteristics, and long-term outcomes in children with oropharyngeal dysphagia presenting as unexplained respiratory problems. We completed a retrospective chart review of all children without known dysphagic risk factors upon presentation to Speech-Language Pathology (December 1991-April 1995) for feeding/swallowing evaluations because of refractory respiratory problems and dysphagic concerns, and who subsequently were diagnosed with dysphagia on Videofluoroscopic Swallow Study (VFSS). In August 2002, follow-up telephone interviews were conducted with caregivers of 14 children.Results. We identified 19 children (mean age 1.14 years; range 0.9-5.75) with dysphagia presenting as unexplained respiratory problems. On VFSS, delayed pharyngeal swallow onset was the most common abnormal radiologic finding and always preceded penetration or tracheal aspiration. Eleven (57.9%) children aspirated. Aspiration occurred only with liquids and 100% of aspiration events were silent (i.e., no cough). Dysphagia was not a concern in 11 children at a mean age 3.2 years (range 0.7-10) and persisted in three children who were 9 years or older.Conclusions. Oropharyngeal dysphagia should be considered in the differential diagnosis of young children without known risk factors associated with swallowing dysfunction when they present with unexplained respiratory problems. Although the prognosis for resolution of dysphagic concerns is very good, it may take several years.