Aspiration Of Liquid Research Articles

Cross-sectional study comparing different therapeutic modalities for cystic lymphangiomas in children

OBJECTIVE:Here, we describe our experience with different therapeutic modalities used to treat cystic lymphangiomas in children in our hospital, including single therapy with OK-432, bleomycin and surgery, and a combination of the three modalities.METHODS:We performed a retrospective, cross-sectional study including patients treated from 1998 to 2011. The effects on macrocystic lymphangiomas and adverse reactions were evaluated. Twenty-nine children with cystic lymphangiomas without any previous treatment were included. Under general anesthesia, patients given sclerosing agents underwent puncture of the lesion (guided by ultrasound when necessary) and complete aspiration of the intralesional liquid. The patients were evaluated with ultrasound and clinical examinations for a maximum follow-up time of 4 years.RESULTS:The proportions of patients considered cured after the first therapeutic approach were 44% in the surgery group, 29% in the bleomycin group and 31% in the OK-432 group. These proportions were not significantly different. Sequential treatment increased the rates of curative results to 71%, 74% and 44%, respectively, after the final treatment, which in our case was approximately 1.5 applications per patient.CONCLUSION:The results of this study indicate that most patients with cystic lymphangiomas do not show complete resolution after the initial therapy, regardless of whether the therapy is surgical or involves the use of sclerosing agents. To achieve complete resolution of the lesions, either multiple operations or a combination of surgery and sclerotherapy must be used and should be tailored to the characteristics of each patient.

Hollow AFM cantilever pipette

Hollow atomic force microscope (AFM) cantilevers were used earlier to dispense liquids of sub 100nm diameter and inject reagents into one single cell. However, aspiration of liquid was never shown. In this work, we demonstrate pipetting (dispensing and aspiration) of liquid using hollow AFM cantilevers. The microfabricated 155μm long cantilever had a volume capacity of 2.64pL, with pipetting flow rate control of 5fL/s. This functionality enables to move liquid matter at nanoscale, do force-spectroscopy and imaging with the same AFM.

Sequential Swallowing of Liquid in Elderly Adults: Cup or Straw?

This article describes the study of the characteristics of sequential swallowing of 100ml of liquid (dyed water) in two swallowing trials, directly from a cup and through a straw, in healthy elderly individuals. The aim of the study was to determine whether differences in the swallowing pattern are influenced by the type of utensil used. The subjects were subjected to clinical assessment and fiberoptic endoscopic evaluation of swallowing. The research found that intake from the cup showed a significantly lower median as regards time to drink the total volume. The final intake volume was significantly larger from the cup. A statistically significant difference was found in the oral spillage of liquid, which was notably higher in the cup trial. Despite the presence of residue in the valleculae and pyriform sinuses, in neither trial was there penetration or aspiration of liquid. The straw has a favorable influence on the quality of the sequential swallowing of liquid in regard to bolus containment within the oral cavity, which was better with that utensil. The cup provides a higher final volume in a shorter time for intake but there is more fluid spillage.

A rare case of fatal acute respiratory distress syndrome following diesel oil siphonage

Sir, Diesel oil aspiration is an uncommon mode of hydrocarbon aspiration and can lead to severe chemical pneumonitis either due to direct inhalation of aerosol or aspiration of liquid or indirectly following aspiration of vomitus secondary to diesel oil ingestion during the manual siphoning from fuel tanks. Siphonage of fuel from the motor vehicles fuel tanks is a typical practice seen in third world countries. Data are sparse on outcomes and complications of direct diesel oil aspiration following manual siphoning.[12] We report a case of 21-year-old male industrial worker who was admitted to the emergency room with a history of diesel oil ingestion and aspiration following accidental siphoning of oil. He was febrile, dyspneic with altered sensorium and having feeble pulse (pulse rate-124/min) and falling blood pressure (82/40 mmHg). On auscultation of chest, coarse, basal, inspiratory crepitations were heard. Arterial blood gas (ABG) analysis showed severe hypoxemia with metabolic acidosis. In view of deteriorating clinical condition, his trachea was intubated with endotracheal tube and was supported with intravenous fluids and inotropes. He was then shifted to intensive care unit (ICU) for mechanical ventilatory support and further management. In ICU, chest X-ray Anteroposterior view (AP) showed bilateral, non-segmental, homogeneous opacities in the lower zones. There was a significant increase in leukocyte counts (total leukocyte count-16,200/Ul, neutrophills 92%). Empirical broad spectrum antibiotics (piperacillin/tazobactam 4.5 g IV q8h) were immediately started after sending blood and tracheal aspirate for culture and sensitivity. On day 2 in ICU, the patient's clinical condition deteriorated dramatically. Chest X-ray showed bilateral progression of infiltrates involving nearly all lobes of the lungs. ABG analysis showed severely diminished PF ratio (PaO2/ FIO2 < 100). These findings were suggestive of a severe form of acute respiratory distress syndrome (ARDS).[3] Aggressive supportive therapy and low tidal volume ventilation strategy was immediately initiated.[4] We also started a continuous infusion of low dose methylprednisolone (@ 1 mg/kg/day after giving bolus of 1 mg/kg IV). On day 5, he had an episode of pulseless ventricular tachyarrhythmia, unresponsive to all possible resuscitative measures and eventually expired that day. Direct aspiration of hydrocarbons may cause severe chemical (lipoidal) pneumonitis with perilous outcome.[25] The severity of lung tissue damage depends on physical characteristics of hydrocarbon, which includes viscosity, volatility and side chains of hydrocarbons. The probability of severe lung affliction is extensive with hydrocarbons having high volatility and low viscosity (<60 saybolts seconds universal (SSU)).[6] Diesel fuel (grade 1D and 2D) have a low viscosity (32-45 SSU) and is highly volatile and a potential hydrocarbon to cause severe progressive lung damage and fatal ARDS.[6] In early period of hydrocarbon induced pneumonia, patients may have non-specific symptoms such as cough, breathlessness and rarely chest pain or haemoptysis.[7] Later, these patients may develop cardiomyopathies or fatal cardiac arrhythmias.[7] Although right middle lobes are commonly affected by direct aspiration of diesel, chest radiographic findings may include consolidation, atelectasis, pleural effusion and lower lobe involvement as seen in this patient.[128] The management strategies in these patients are usually symptomatic and supportive. There is limited and controversial role of corticosteroids and antibiotics with sparse data on outcomes.[18] This patient showed accelerated deterioration of lung functions and eventually expired due to fatal cardiac arrhythmias within a period of 4 days despite initiating corticosteroids, broad-spectrum antibiotics and strict adherence to ventilator protocols followed in ARDS patients.[4] This case highlights that chemical pneumonitis triggered by direct diesel oil aspiration following manual siphoning is a pernicious clinical condition in which lung damage is progressive and extensive resulting in ARDS, which seldom respond to standard management strategies. Moreover, death can ensue due to fatal cardiac arrhythmias even in early course of the disease. Critical carers should circumspect this rare and fatal clinical condition early in its course and should intervene with aggressive management strategies to avoid cataclysmic outcomes.

Correlation between brain injury and dysphagia in adult patients with stroke.

Summary Introduction: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20–90%. Some studies correlate the location of a stroke with dysphagia, while others do not. Objective: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke. Method: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES®), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic. Results: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES®, decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey. Conclusion: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type.

The Diagnostic Test Accuracy of Clinical Swallow Assessment for Oropharyngeal Aspiration: A Systematic Review.

Review question/objective The objective of this systematic review is to synthesise the best available evidence on the diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment (CSA) compared with Video Fluoroscopic Swallow Study (VFSS) in diagnosing oropharyngeal aspiration in children and adults with dysphagia. In this review, VFSS will be the 'Gold Standard' or, reference test and CSA will be the index test. VFSS is the radiographic assessment of swallow function usually performed by a Speech Pathologist and Radiologist. CSA is defined as a non-invasive, non-instrumental assessment of swallow function. It is usually performed by a Speech Pathologist and includes a thorough case history and assessment of oro-motor function. For example, tongue, jaw movement, cough reflex and review of swallow function with a range of food and fluids. A rating is usually provided to describe the level of function and likely presence or absence of aspiration. Based on the CSA findings the Speech Pathologist recommends specific diet and fluid modifications, feeding techniques and positioning techniques to enable safe oral feeding. Inclusion criteria Types of participants Studies will be considered in this review if they include: infants, children or adults with dysphagia. The following definitions will be used within this review: - infant will be defined as < 36 months; - children will be defined as 36 months – 18 years; - adults will be defined as 18 years and over; - dysphagia will be defined as 'a swallowing disorder' 6. The definition uses 36 months as the cut off between infants and children as this is the stage when the infant transitions from sucking patterns used for bottle feeding and early solids and begins to chew solids, self feed and drink from a range of cups consistent with an older child 4. There will be no exclusion of studies based on age or gender. Studies will be excluded that include the population of head and neck cancer (HNC) patients, patients with a tracheostomy in situ and patients with craniofacial anomalies. The primary treatment for HNC patients includes surgery and radiotherapy . Radiotherapy can have a specific impact on swallowing , not necessarily seen in other populations and surgical resections can result in predictable swallowing difficulties . Patients with a tracheostomy in situ and patients with craniofacial anomalies also have known anatomical changes that have a specific impact on swallow function. The clinician undertaking the clinical swallow assessment has access to any anatomical changes following surgery. This is different to other populations whereby information regarding specific neurological and anatomical information is not necessarily available. Focus of the review The focus of this review will be on diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment (CSA) compared with Video Fluoroscopic Swallow Study (VFSS) in diagnosing oropharyngeal aspiration in children and adults with dysphagia. In this review, VFSS will be the 'Gold Standard' or, reference test and CSA will be the index test. The terms VFSS and Modified Barium Swallow (MBS) refer to the same study. Although this review will use the term VFSS defined as the radiographic assessment of the oral and pharyngeal swallow, MBS studies will also be included. The terms Clinical Swallow Assessment and Bedside Swallow Evaluation also refer to the same diagnostic tool . Clinical Swallow Assessment (CSA) will be used within this review, defined as the non-instrumental, non-radiologic assessment of swallow function by a Speech Pathologist, however studies of Bedside Swallow Evaluation will also be included. Studies that do not use CSA as the index test or do not use VFSS as the reference test will be excluded. In addition, studies of effectiveness, experience or comparison of treatment interventions will be excluded. The diagnostic test accuracy of CSA and VFSS will be compared using: sensitivity and specificity. Where possible, positive and negative predictive values will also be analysed and reported. Sensitivity of a diagnostic test is defined as 'the ability of the test to identify correctly those who have the disease'34. Specificity of a diagnostic test is defined as 'the ability of the test to identify correctly those who do not have the disease' Positive predictive value is defined as the proportion of patients who test positive and actually have the disease in question . Negative predictive value is defined as the proportion of patients who test negative and actually do not have the disease in question .

PP020-SUN BODY MASS INDEX AND MORTALITY IN INSTITUTIONALISED ELDERLY

of postures, sensory and compensatory interventions. The examination leads to recommendations regarding the optimum delivery and maintenance of nutrition and hydration (e.g. per oral, non-oral or combination of the two, special preparation of food). Methods: A retrospective study was undertaken to investigate differences between FEES and clinical examination in determining adequate nutrition and diet modifications. Patients with dysphagia were examined clinically by speech-language therapists to assess swallowing function. Additionally all patients with pharyngeal disorders of swallowing were tested with FEES. The oral intake was evaluated using the Functional Oral Intake Scale (FOIS) (Crary et al., 2004). These data were collected in the clinical examination and FEES. Laryngeal penetration and aspiration of saliva, food and liquid were identified with FEES. The Penetration-Aspiration-Scale (PAS) (Rosenbek et al., 1988) was used to determine the risk of aspiration. Results: Preliminary analysis (N = 19) shows no significant differences in feeding status but the mean-score of FOIS tends to be higher after FEES. Furthermore there is a high significant negative correlation between FOIS and PAS (r = 0.75; p < 0.001). Conclusion: These preliminary findings suggest that FEES is a useful aid to evaluate the swallowing safety and to specify nutritional recommendations for patients with dysphagia.

A Dilemma in Dysphagia Management: Is Aspiration Pneumonia the Chicken or the Egg?

A Dilemma in Dysphagia Management: Is Aspiration Pneumonia the Chicken or the Egg?

Deglutição em crianças com alterações neurológicas: avaliação clínica e videofluoroscópica

swallowing in children with neurologic disorders. to relate the data obtained in the clinical and in the videofluoroscopic evaluations of swallowing in children with neurologic disorders. a retrospective analysis of 24 protocols of speech-language evaluation and of medical records of children, of both genders, referred to clinical and videofluoroscopic evaluations of swallowing at the School of Medicine of Ribeirão Preto - University of São Paulo, from January 2001 to June 2005. The following aspects were analyzed in the clinical evaluation: diet consistency, functional aspects of the swallowing mechanism and results of the cervical auscultation. Videofluoroscopic evaluation was performed to determine the dynamic aspects of the oral and pharyngeal phases. during the clinical evaluation of the oral phase, for both liquid and pasty consistencies, a greater occurrence of inadequate bolus control was observed (n = 15 e n = 14, respectively). In the pharyngeal phase, also for both consistencies, an adequate cervical auscultate was more frequently observed before swallowing (n = 16 e n = 13) followed by the inadequate cervical auscultation during swallowing (n = 15 e n = 12). In the videofluoroscopic evaluation, during the oral phase, for both consistencies, the presence of inadequate food propulsion was the most frequent finding (n = 13 e n = 13) and, in the pharyngeal phase, the most frequent finding was the absence of laryngotracheal aspiration (n = 12 e n = 17). There was a statistically significant correlation between the cervical auscultate and the excursion of the hyoid and the larynx, and between the cervical auscultate and laryngotracheal aspiration of liquid and pasty consistencies. both procedures are important and complementary in the diagnosis of dysphagia.

Outpatient Management of Pediatric Burns

The leading etiologies of pediatric burns are scald, thermal, and electrical injuries. The initial management of burns involves assessment of burn depth and total body surface area (TBSA) affected, a history, and physical examination. Calculation of percent of TBSA affected is an important determinant of the necessity for hospitalization versus outpatient management. Only second- and third-degree burns are included in the calculation. The criteria for outpatient management vary based on the center experience and resources. One such set of criteria in an experienced burn center includes burn affecting less than 15% TBSA, therefore not requiring fluid resuscitation; the ability to take in oral fluids, excluding serious perioral burns; no airway involvement or aspiration of hot liquid; no abuse; and dependable family able to transport the patient for clinic appointments. Once the child is ready to reenter school, the physician must discuss with the family and school staff any needs and expectations for the child, including wound care. Social reintegration can be difficult. Educating the teachers and staff of the child's appearance may help prepare the students.

A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease

This study was designed to identify which of 3 treatments for aspiration on thin liquids-chin-down posture, nectar-thickened liquids, or honey-thickened liquids-results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's disease. This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study. Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category, followed by nectar-thickened liquids and chin-down posture. Patients with most severe dementia exhibited least effectiveness on all interventions. Patient preference was best for chin-down posture followed closely by nectar-thickened liquids. To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and/or Parkinson's disease, a videofluorographic swallow assessment is needed. Evidence-based practice requires taking patient preference into account when designing a dysphagic patient's management plan. The longer-term impact of short-term prevention of aspiration requires further study.

Ｓｅｃｒｅｔｉｏｎ Ｓｃａｌｅを用いたビデオ内視鏡下嚥下機能評価

This study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and miss-swallowing frequency in the prediction of food and liquid aspiration. Videoendoscopy was performed in Fourty-three patients. A four-level rating scale was employed to determine the severity of accumulated oropharyngeal secretions. On this secretion scale patients graded 0 and 1 could eat, but those graded 3 could not. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of the aspiration of food or liquid. The Results are discussed in terms of integrating this information with clinical bedside examinations.

What Is the Incidence and Significance of “Dry-Lungs” in Bodies Found in Water?

Drowning without aspiration of liquid, generally attributed to death from asphyxia while submerged and in laryngospasm, has been reported to occur in approximately 10% to 15% of drowning victims. The occurrence of "dry-drowning" recently has been questioned and the hypothesis developed that "dry-lungs" in bodies found dead in the water could conceal more natural deaths than previously recognized. Based on 578 selected adult victims who presumably drowned, we analyzed the correlation between the cases with a low combined lung/pleura liquid weight (< 1000 g and < 750 g) and a wide set of individual, circumstantial, and postmortem (PM) variables, using multivariate logistic regression analysis. Victims with lung weight < 1000 g were screened for long-QT syndrome (LQTS) founder mutations in KCNQ1 and KCNH2 genes. Of the 578 victims, 120 (20.7%) had a lung weight of < 1000 g, and 22 of these (3.8%) of < 750 g. Multivariate analysis showed a significant correlation for women (P < 0.001), for women aged 65 years or older (P < 0.001), and for men with prolonged PM submersion time (P < 0.001). "Normal" lungs were found in only 8 (1.4%) victims. Low-weight (< 1000 g), overdistended lungs with no sign of liquid penetration were seen in 11 (1.9%). No LQTS founder mutations were detected. The actual incidence of death of persons found in water who have normal lungs or do not have penetration of liquid into their airways, based on our study, is much lower (below 2%) than currently assumed.

The challenges of managing dysphagia in brain-injured patients.

Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected. Dysphagia is treated using a variety of strategies, depending on the presenting symptoms. Individuals with dysphagia following traumatic brain injury present with particular difficulties, relating to impairments of cognition, communication and behavioural control. A description of the normal swallow is presented below with a review of dysphagic disorders, assessment methods and management. This is followed by a case account of a young man with dysphagia subsequent to traumatic brain injury to highlight some of the difficulties which can be encountered in the management of dysphagia.

Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow.

The purpose of this prospective study was to investigate the predictive value of oropharyngeal secretions by use of 5-point and modified 3-point secretion scales for aspiration of food or liquid and diet recommendation outcomes. One hundred consecutive patients and 4 control subjects participated. The 5-point secretion severity scale correlated highly to aspiration (Spearman's rho = .516, p < .0001) and to diet recommendation outcomes (Spearman's rho = .72, p < .0001). Patients who received tube feedings were more likely to demonstrate a higher secretion level than patients who received oral feedings (Pearson chi squared analysis value = 25.461, p < .0001). Patients with a tracheotomy tube tended to demonstrate higher secretion levels than patients without a tracheotomy tube (Spearman's rho = .446, p < .0001). The relationship of the 3-point secretion severity scale level with aspiration was .488, p < .0001 (Spearman's rho), and that with diet recommendation outcomes was .746, p < .0001 (Spearman's rho).

Management of swallowing in supraglottic and extended supraglottic laryngectomy patients.

Aspiration of food and liquid following supraglottic and supracricoid laryngectomy has been documented and found to be the most frequent major postoperative complication that extends hospitalization. The advantages as well as disadvantages of discharging a patient with percutaneous endoscopic gastrostomy (PEG) placement and home therapy versus an aggressive in-hospital dysphagia management program remain controversial. The present investigation examines an aggressive in-patient postoperative dysphagia management program following decannulation. Twenty-one patients participated in a four-part dysphagia management program following decannulation: patient education, indirect therapy, swallowing evaluation, and nutrition education. Eleven patients achieved functional swallowing goals prior to discharge with no reports of pneumonia or rehospitalization over a 3-month follow-up period. Six patients were discharged with a tracheostomy and duo tube; five of these patients were started on an oral diet the same day of decannulation. Four patients decannulated prior to discharge did not achieve functional swallowing. Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in-home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non-compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery.

Modified barium swallow does not affect how often PEGs are placed after stroke.

Dysphagia frequently follows stroke, but often resolves quickly. Percutaneous endoscopic gastrostomy (PEG) or other feeding tubes are placed to improve nutrition and hydration, and reduce the risk of aspiration pneumonitis. We evaluated the impact of modified barium swallow in determining PEG placements and the influence of specific swallowing abnormalities on PEG placement. The abnormalities assessed were presence of pharyngeal stasis and/or visualization of posterior pharyngeal transfer problems and aspiration of liquid or solids. A total of 302 patients with stroke were admitted to our hospital between 1989 and 1993, but only those with hemorrhagic or nonhemorrhagic stroke by computed tomographic (CT) scans or magnetic resonance imaging (MRI) or autopsy were included in our study. Patients with transient ischemic attacks (TIAs), central nervous system tumors, and traumas were excluded. Barium swallow studies were performed on 69 (23%) of patients; 49 (71%) were abnormal, based on aspiration of barium, pharyngeal stasis, or postpharyngeal transfer dysphagia. PEGs were placed in only 18% of those with abnormal studies. Of the patients with normal barium swallow studies, 25% had a PEG placed. Two hundred thirty-three patients underwent no barium swallow studies, but 11 (4.72%) of these had PEG placed. The rate of PEG placement was not related to any one of the abnormalities noted on the modified barium swallow. Rather, patients who received PEG had significant neurological deficits and increased prevalence of aspiration pneumonitis. The decision to insert PEG was made on clinical grounds and not on abnormal barium studies alone.

Recognition and Management of Hot Liquid Aspiration in Children

Although infrequently reported, aspiration of hot liquid can occur in conjunction with upper-body scald burns, leading to acute compromise of the small pediatric airway with clinical features similar to those of acute infectious epiglottitis. This can be a very difficult problem if subtle signs of impending airway compromise are not appreciated. Reported here are four such cases managed over a 3-year period at a regional pediatric burn center, emphasizing points of history and physical examination that facilitate early recognition of this life-threatening problem. Aspiration of hot liquid should be suspected in children with burns in or around the mouth, particularly if there are any subtle signs of upper airway edema. If this complication is suspected, immediate endotracheal intubation should be performed in those with acute respiratory embarrassment, and prompt investigation by direct laryngoscopy in the operating room is appropriate in those who have not yet developed overt respiratory distress. [Sheridan RL: Recognition and management of hot liquid aspiration in children. Ann Emerg Med January 1996;27:89-91.]

Aspiration and Relative Risk of Medical Complications Following Stroke

To determine the relative risk of pneumonia, dehydration, and death associated with videofluoroscopic evidence of aspiration, silent aspiration, aspiration of 10% or greater on one or more barium test swallows, and aspiration of thick liquid or more solid consistencies in the subacute phase after stroke. Prospective, longitudinal cohort study. Inpatient stroke rehabilitation unit. There were 114 consecutive patients who met the following criteria: (1) stroke as defined by clinical history and neurological examination with compatible computed tomographic or magnetic resonance imaging scan; (2) age 20 to 90 years, inclusive; (3) no known history of significant oropharyngeal anomaly; and (4) videofluoroscopic evidence of dysphagia. Of 122 eligible patients, eight refused participation. Development of pneumonia, dehydration, and death. The relative risk for developing pneumonia was 6.95 times greater (P = .027) for those patients who aspirated compared with those who did not, 5.57 times greater (P = .012) for those who aspirated silently compared with those who coughed when aspirating or who did not aspirate, and 8.36 times greater (P = .002) for those who aspirated 10% or greater on one or more barium test swallows compared with those who aspirated less than 10% or did not aspirate. Aspiration, silent aspiration, and aspiration of 10% or greater on one or more barium test swallows during videofluoroscopic evaluation are associated with an increased risk of pneumonia, but not dehydration or death, during the subacute phase after stroke.

EARLY TREATMENT OF THE UNIVERSAL OTITIS MEDIA OF INFANTS WITH CLEFT PALATE

In 138 infants with cleft palate, secretory or suppurative otitis media was a universal complication. Middle ear aeration was instituted by means of myringotomy, aspiration of middle ear liquid, and insertion of tympanostomy tubes, and this procedure was repeated whenever recurrence of middle ear effusion followed blockage or extrusion of the tubes. In infants with either complete or incomplete clefts of the palate, satisfactory middle ear status could usually be maintained. Otorrhea through tympanostomy tubes occurred frequently, but usually responded promptly to treatment. Palate repair resulted in sharp improvement in middle ear status. Early relief of middle ear effusion anti establishment and maintenance of middle ear aeration in infants with cleft palate may help maintain normal hearing acuity throughout infancy, with favorable implications for language and intellectual development, and may reduce the risk of permanent middle ear damage and hearing impairment. Further study is necessary to determine the long-term efficacy of this regimen.