Symptoms Of Aspiration Research Articles

Efficacy of enhanced dysphagia assessment and dietary intervention in post-stroke dysphagia patients: a randomized controlled study.

This study evaluated the effectiveness of an enhanced dysphagia assessment method combined with dietary interventions for patients experiencing dysphagia post-stroke. A prospective randomized controlled trial was conducted with 98 hospitalized post-stroke patients suffering from dysphagia. Participants were randomly assigned into two groups: the study group (receiving enhanced dysphagia assessment and dietary interventions) and the control group (receiving standard nursing care), using a computer-generated randomization list. Swallowing function was assessed using the Mann Assessment of Swallowing Ability (mMASA), Dysphagia Severity Scale (DSS), and Wada's water swallowing test. Additionally, quality of life and nutritional status were evaluated for both groups, before and after the intervention. Post-intervention, the study group exhibited significantly better scores on mMASA and Wada's water swallowing test, and lower DSS scores compared to the control group (all P < 0.05). Initially, no significant differences were observed between the groups concerning aspiration symptoms, nutritional and respiratory dysfunction, psychological disorders, and total scores (all P > 0.05). However, post-intervention, the study group showed significant improvements in these parameters and lower scores compared to the control group (all P < 0.05). Additionally, the study group demonstrated higher BMI, albumin (ALB), and hemoglobin (Hb) levels post-intervention (all P < 0.05), and a markedly lower incidence of aspiration and aspiration pneumonia (all P < 0.05). Enhanced dysphagia assessment combined with dietary interventions significantly improves swallowing function, quality of life, and nutritional status in post-stroke dysphagia patients. This approach also reduces the incidence of related complications, suggesting substantial clinical benefits.

Impact of inspiratory muscle training on aspiration symptoms in patients with dysphagia following ischemic stroke.

To investigate the impact of inspiratory muscle training on lung function and swallowing function in patients with dysphagia-induced aspiration following ischemic stroke and to evaluate the effectiveness of inspiratory muscle training on aspiration symptoms. Fifty-eight inpatients with dysphagia-induced aspiration following ischemic stroke were selected and randomly divided into a control group (n=29, conventional swallowing therapy) and a treatment group (n=29, conventional swallowing therapy plus inspiratory muscle training). Both groups received conventional swallowing function training, including oral sensory training, oral motor training, airway safety protection training, and neuromuscular electrical stimulation therapy for 10-20min per session, twice daily for 2weeks. The treatment group additionally received inspiratory muscle resistance training using the POWERbreathe device for 20min per session, twice daily for 2weeks. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Functional Oral Intake Scale (FOIS) based on the videofluoroscopic swallowing study (VFSS) before and after treatment. Lung function, including maximal peak expiratory flow rate (PEF) and forced vital capacity (FVC), was evaluated using the Miraclink X-SCRIBE cardiac stress testing system. Before treatment, there were no significant differences in FOIS, FDS, and PAS scores between the two groups (P>0.05), while post-treatment, both groups showed significant improvements in these indicators (P<0.05), with the treatment group showing more significant improvements than the control group (P<0.05). Further, before treatment, there were no significant differences in FVC and PEF scores between the two groups (P>0.05), whereas post-treatment, the treatment group showed significant improvements in these indicators (P<0.05) and the control group showed no significant changes (P>0.05). The treatment group also showed more significant improvements than the control group (P<0.05). Finally, a correlation analysis revealed a significant linear relationship between FVC and PEF in the post-treatment PAS in the treatment group (P<0.05). Inspiratory muscle training can improve lung function in patients with dysphagia following ischemic stroke, as it develops swallowing function more effectively than conventional swallowing function training alone. Moreover, inspiratory muscle training is effective in treating aspiration caused by dysphagia, with enhancements in aspiration related to improved lung function.

A Pilot Study of a Modified Swallowing Screening Tool for Critically Ill Patients in the Intensive Care Unit.

The lack of early assessment tools for swallowing function in patients in the intensive care unit (ICU) may lead to delays in oral intake. This study assessed the effectiveness of a new bedside swallowing screening tool in detecting dysphagia in patients in the ICU or isolation settings, where isolation settings refer to conditions such as COVID-19, where patient mobility is limited. We assessed swallowing function in 13 patients with severe acute respiratory distress syndrome. To ensure patient safety, a bedside preliminary investigation was performed to assess the patient's alertness level, and ultrasound findings of the vocal cords were obtained. Patients were nasogastric(NG) tube feeding or fasted if they did not meet a certain readiness level. Additionally, patients who passed the preliminary investigation underwent methylene blue dye or citric acid swallowing tests if they had or had not undergone tracheostomy, respectively. The Gugging Swallowing Screen (GUSS) test was used to determine whether an oral diet was appropriate. Of the 13 patients, 1 failed to meet the criteria during the preliminary examination, and 12 underwent the examination and initiated oral intake. Significant differences were found in the GUSS scores between the tracheostomy and non-tracheostomy groups but not in the examination validity. NG tube was implemented if the examination criteria were not met at each stage. Patients who passed the newly developed dysphagia screening tool exhibited no aspiration symptoms post-oral feeding initiation, enabling their discharge. In conclusion, the proposed screening test can be performed safely and easily, allowing for early dysphagia detection, reduced aspiration risk, and safe oral feeding in patients in the ICU or isolation settings.

Foreign body lodged in the subglottic area: a case report in a child

Subglottic foreign bodies are rare and represent an extreme emergency that can threaten life. Our aim is to share our experience in the management and multidisciplinary approach to a subglottic foreign body in a child. We report the case of a 4-year-old child from a rural area, who was admitted as an emergency. He was referred by the pediatric team after presenting with symptoms of foreign body aspiration. The general examination revealed laryngeal dyspnea (stage IV) with unstable hemodynamic parameters. ENT examination showed pharyngeal granulations; near-obstructive hypertrophy of the inferior turbinates, muco-purulent rhinorrhea with pale nasal mucosa; cerumen plugs, and intact tympanic membranes. Pulmonary auscultation noted crackles in both lung fields. We diagnosed a laryngo-tracheal foreign body complicated by stage IV laryngeal dyspnea. The child underwent an emergency tracheostomy followed by endoscopy and removal of the foreign body. The postoperative course was uncomplicated. Although rare, subglottic foreign bodies present a challenge for early management. Therefore, we emphasize to our colleagues the severity of subglottic foreign bodies. Prevention is the best therapeutic alternative.

Indication and efficacy of injection laryngoplasty for laryngeal clefts - A retrospective cohort study

PurposeLaryngeal cleft (LC) is an anatomical defect of the larynx, where there is a gap (or cleft) between the arytenoids. Milder types can be treated with injection laryngoplasty (IL), involving injection with a filler, resulting in a decreased depth of the cleft and thereby reducing tracheal penetration or aspiration. The effect, however, is temporary. The aim of this study was to investigate the possible indications and the efficacy of IL for LC. MethodsPatients who underwent IL for LC between March 2018 and June 2023 were retrospectively evaluated. The following parameters were studied: incidence of LC symptoms and objective swallowing evaluations before and after IL, the duration of possible symptom improvement, complications, and the number of subsequent suture repairs. ResultsEighty-five patients were included. Before IL, 81 (96 %) patients had symptoms of aspiration during feeding, compared to 41 (54 %) patients after IL (p ≤ 0.001). In 42 (49 %) patients, temporary symptom relief occurred, in 22 (26 %) patients symptoms persisted, in 16 (19 %) patients symptoms decreased permanently. Mild complications such as cough and desaturations in the direct postoperative period occurred. ConclusionThis study shows a statistically significant decrease in the number of parents/caretakers reporting swallowing symptoms after injection laryngoplasty, and a decrease in the average percentage of parents/caretakers reporting various other symptoms. Based on our results, injection laryngoplasty can be recommended as a diagnostic tool in the treatment of laryngeal cleft. Furthermore, it can be used as bridge therapy (i.e. until patients outgrow their symptoms, or until suture repair).

Validation and cultural adaptation of a Greek Version of Pediatric Eating Assessment Tool 10 (PEDI – EAT – 10) in Greek-Cypriot Parents

Purpose The Pediatric Eating Assessment Tool (PEDI-EAT-10) is a parents/caregivers screening tool that assesses pediatric patients at risk of penetration and/or aspiration symptoms. The aim of this study was the validation of PEDI-EAT-10 in the Greek language. Materials and Methods This cross-sectional study included 222 parents/caregivers of children with (n = 122) and without (n = 100) feeding and/or swallowing disorders, with age range 3 – 12 years. The children were selected from Cypriot schools and health settings. All parents filled out the PEDI-EAΤ-10 questionnaire and after its initial completion, it was re-administered after 2 weeks. Results A statistically significant difference was observed in the PEDI-EAT-10 total mean scores between the study’s two groups [t (220) = 9.886, p < 0.001]. Internal consistency was high (Cronbach’s alpha= 0.801) with very good split-half reliability equal to 0.789. A significant and strong test-retest reliability was computed (r = 0.998, p < 0.001). The PEDI-EAT-10 cutoff point was 11.00 (AUC: 0.869, p < 0.001) for children with feeding and/or swallowing disorders in accordance with the PAS scale. Conclusions In conclusion, the Greek version of PEDI-EAT-10 is shown to be a valid and reliable screening tool for the assessment of the pediatric population with a risk of dysphagia.

Congenital Absence of the Epiglottis in a 35 Years Old Patient.

Absent epiglottis is a rare reported anomaly in adults with unknown incidence. Most patients with absent epiglottis have presented with life-threatening symptoms of respiratory distress or severe aspiration in infancy or early childhood. We report a case of a 35 year old male patient with complete absence of epiglottis, presented with complaint of hoarseness of voice since birth.

S2283 Aspiration Pneumonia: An Atypical Case Presentation of Esophageal Malignancy

Introduction: Esophageal malignancy is the most common cause of tracheoesophageal fistula (TEF) in adults. TEFs develops in 5-15% of patients with esophageal malignancy, often being found late in the disease course. TEFs are often a result of cellular damage from radiation therapy. Patients often present with symptoms including coughing, pneumonia, hemoptysis, hypoxic respiratory distress, and aspiration. The symptoms of cough, aspiration, and pneumonia remain consistent with expected symptoms of esophageal radiation, and thus, can lead to delay in diagnosis of tracheoesophageal fistula. Case Description/Methods: The patient was a 75-year-old male with a history of non-Hodgkin’s lymphoma status post radiation, and chronic dysphagia was admitted to the medical intensive care unit for acute hypoxic respiratory failure requiring non-invasive mechanical ventilation. Labs were remarkable for white blood cell count of 17.9, hemoglobin 10.5, platelets 400, and all electrolytes were within normal limits. Total bilirubin, transaminases, alkaline phosphatase, and lipase were unremarkable. Computed tomography (CT) chest w/o contrast noted multifocal aspiration pneumonia, most severe at the left lung base. CT abdomen w/o contrast showed irregular thickening of the mid to distal esophagus suspicious for a neoplastic etiology, for which GI was consulted for an esophagogastroduodenoscopy (EGD). Subsequently he developed pulseless electrical activity-arrest requiring intubation. At this point, it was conducive for the patient to undergo EGD, which found invasive squamous cell carcinoma of the esophagus with tracheal fistulation. Due to poor prognosis, the palliative care team was consulted at which point the patient elected for hospice with comfort measures only (Figure). Discussion: Despite improvement in detection techniques, the incidence of esophageal malignancy in the United States continues to rise. Esophageal cancer is the 6th leading cause of cancer related death in men with a 5-year survival rate of 15-25%. It is important that these patients are diagnosed early in the disease course. Unfortunately, due to the rapidly progressive nature of the disease and the frequent lack of clinical symptoms during early stages, esophageal carcinoma is especially difficult to detect. Although TEFs are typically found late in the disease course, it is critical to recognize that complications associated with esophageal fistulas can be the presenting findings of esophageal malignancy.Figure 1.: Upper left: Proximal esophagus with evidence of necrosis Upper right: TEF of mid esophagus Lower left: partially obstructive squamous cell carcinoma of the mid esophagus Lower right: CT scan revealing advanced multifocal aspiration pneumonia of the left lung.

Impact of Pulmonary Function on Voice Outcomes After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

Pulmonary function is closely associated with voice quality especially in patients with voice disorder including unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is the standard treatment for patients with UVFP. We investigated the subjective and objective voice outcomes according to pulmonary function test (PFT) before IL in patients with UVFP. We retrospectively analyzed the patients who underwent IL for UVFP between 2004 and 2021 (N = 1201), and finally investigated 261 patients with PFT results before IL. The patients were classified into three groups according to results of PFT: normal (n = 189, 72%), mild (n = 40, 15%), and moderate (n = 32, 13%) obstructive pattern. Aspiration symptoms and subjective and objective voice parameters of voice handicap index (VHI), GRBAS score, maximal phonation time (MPT), Jitter, Shimmer, and noise to harmonic ratio (NHR) were compared between normal and abnormal (mild or moderate obstructive pattern) PFT groups. Age (68.0 ± 9.1 and 61.2 ± 12.6, respectively) was significantly higher and males were more common (84.7% and 57.7%, respectively) in abnormal PFT than in normal PFT. Aspiration showed significant improvement in all groups. The subjective and objective voice parameters significantly improved after IL in normal and mild obstruction groups, but MPT, Shimmer, and VHI did not significantly improve in the moderate obstruction group. The improvement in VHI-30 after IL was significantly higher in the normal group (20.0 ± 29.5) than in the mild (10.3 ± 32.8) or moderate (9.9 ± 33.2) obstruction group (P = 0.035). Improved amounts of MPT, Jitter, Shimmer, and NHR were not significantly different among the groups, but improvement of VHI was smallest in the moderate obstructive pattern group. Voice parameters showed significant improvement after IL in both normal and mild obstructive pattern groups, but MPT and VHI did not significantly improve in the moderate obstructive pattern group. In addition, patients with normal pulmonary function had marked improvement of subjective symptoms after IL in comparison with patients with abnormal pulmonary function.

Bio-signal Feature Analysis to Detect Aspiration Caused by Dysphagia.

Dysphagia causes aspiration symptoms and can trigger aspiration pneumonia, poor nutritional status, etc. To address these risks, it is important to properly evaluate dysphagia and link it with treatment and training. However, current dysphagia evaluation methods cannot assess a swallowing function equivalent to that in daily life, owing to the examination method and environment. In this study, we analyzed bio-signal features to realize a system that can detect aspiration symptoms in daily life. Focusing on the neck electrical impedance, swallowing sounds, and a surface electromyogram of the suprahyoid muscles, we created a swallowing-measurement device and analyzed the bio-signals of the throat movement during swallowing. By measuring the swallowing of dysphagic patients, we investigated the characteristic differences, depending on the presence or absence of aspiration symptoms. The analysis results suggest that there were differences in each bio-signal depending on the presence or absence of aspiration symptoms, and these bio-signals could detect aspiration symptoms. This method can detect aspiration symptoms in daily life and evaluate dysphagia more appropriately and simply than current evaluation methods.

High incidence of dyspnoea and pulmonary aspiration in giant hiatus hernia: a previously unrecognised cause of dyspnoea.

Dyspnoea is common in patients with giant paraoesophageal hernia (PEH). Pulmonary aspiration has not previously been recognised as a significant contributory factor. Aspiration pneumonia in association with both gastro-oesophageal reflux disease (GORD) and PEH has a high mortality rate. There is debate about routine anti-reflux measures with surgical repair. Reflux aspiration has been examined in a consecutive cohort using scintigraphic scanning and symptoms. Reflux aspiration scintigraphy (RASP) results and symptoms were evaluated in consecutive patients with PEH managed in our service between January 2012 and March 2017. PEH was diagnosed in 96 patients. Preoperative reflux pulmonary scanning was performed in 70 patients: 54 were female (77.1%) and the mean age was 68years (range 49-85). Dyspnoea was the most common symptom (77.1%), and a symptomatic history of aspiration was seen in 18 patients (25.7%). Clinical aspiration was confirmed by RASP in 13 of these cases. Silent RASP aspiration occurred in a further 27 patients without clinical symptoms. RASP was negative in five patients with clinical symptoms of aspiration. No aspiration by either criterion was present in 27 patients. Dysphagia was negatively related to aspiration on RASP (p<0.01), whereas dyspnoea was not (p=0.857). GORD, dyspnoea and silent pulmonary aspiration are frequent occurrences in the presence of giant PEH. Subjective aspiration was the most specific and positive predictor of pulmonary aspiration. Dyspnoea in PEH patients may be caused by pulmonary aspiration, cardiac compression and gas trapping. The high rate of pulmonary aspiration in PEH patients may support anti-reflux repair.

Exposure to bile and gastric juice can impact the aerodigestive microbiome in people with cystic fibrosis

Studies of microbiota reveal inter-relationships between the microbiomes of the gut and lungs. This relationship may influence the progression of lung disease, particularly in patients with cystic fibrosis (CF), who often experience extraoesophageal reflux (EOR). Despite identifying this relationship, it is not well characterised. Our hypothesis is that the gastric and lung microbiomes in CF are related, with the potential for aerodigestive pathophysiology. We evaluated gastric and sputum bacterial communities by culture and 16S rRNA gene sequencing in 13 CF patients. Impacts of varying levels of bile acids, pepsin and pH on patient isolates of Pseudomonas aeruginosa (Pa) were evaluated. Clonally related strains of Pa and NTM were identified in gastric and sputum samples from patients with symptoms of EOR. Bacterial diversity was more pronounced in sputa compared to gastric juice. Gastric and lung bile and pepsin levels were associated with Pa biofilm formation. Analysis of the aerodigestive microbiomes of CF patients with negative sputa indicates that the gut can be a reservoir of Pa and NTM. This combined with the CF patient’s symptoms of reflux and potential aspiration, highlights the possibility of communication between microorganisms of the gut and the lungs. This phenomenon merits further research.

LARINGOMALACIA

Laryngomalacia is existing in the manifestation of stridor, a high-pitched, musical, vibrating, multiphase inspiratory noise occurring within the first 10 days of life. Recognizing symptoms that determine disease severity helps anticipate end results. Infants with stridor who do not have remarkable feeding-related symptoms can be managed confidently, without intervention. Infants, who have stridor and feeding-related symptoms, are managed from acid suppression therapy. Those with added symptoms of aspiration, failure to thrive, and consequences of airway obstruction and hypoxia require surgical intervention. Most with laryngomalacia will have mild-to-moderate symptoms and not require surgery.

Therapists in the Uniformed Services: Improving Care in Emergency Response Medical Missions.

People diagnosed with COVID-19 who require hospitalization are primarily admitted secondary to shortness of breath because of hypoxia but also display difficulties with overall muscle weakness, which could impair gait, activities of daily living, speech, cognitive-linguistics, or swallowing. This article provides a clinical perspective of how a physical therapist, occupational therapist, and speech language pathologist in the US Public Health Service Commissioned Corps were deployed with an augmentation team and how they improved care at a hospital that was overwhelmed with patients diagnosed with COVID-19. The rehabilitation team completed 246 evaluation and treatment encounters in a 12-day period and began seeing patients within 24 hours on-site. After the rehabilitation team arrived, patients were noted to be more mobile, independent in activities of daily living, and able to tolerate the least restrictive diets without signs and symptoms of aspiration. As a result of rehabilitation services, safe discharges were expedited, length of stay was reduced, and the hospitals' inpatient admission capacity was maximized. The augmentation team learned the importance of including rehabilitation specialties for treating patients with COVID-19. Mobilizing rehabilitation specialties along with medical and nursing staff helps maximize the overall recovery, health, and outcomes for patients. Leadership that is responsible for the development and deployment of future medical teams in military, emergency response, and public health efforts should consider all therapy disciplines as an essential component for each team.

Supraglottic Schwannoma: Dilemma and Challenges in Management.

Laryngeal schwannomas are rare lesions that represent less than 1.5% of all benign laryngeal tumors. Its slow and submucosal growth may cause a delay in consultation and management. Herein, a case of right supraglottic schwannoma is diagnosed in a 34-year-old lady who was unconcerned about hoarseness for 10years. She was referred to otorhinolaryngology clinic for assessment when hoarseness was detected during consultation for a gynecology surgery. Apart from hoarseness, there were no noisy breathing, shortness of breath or aspiration symptoms. Flexible nasopharyngolaryngoscopy showed a submucosal bulge at the right vestibular fold obscuring the vocal fold causing an airway concern. Computer tomography scan of the neck revealed a heterogenous enhancing mass centered at the right supraglottis measuring 2.6 × 2.7 × 2.7cm. There were no erosions of the adjacent thyroid and arytenoid cartilages. Subsequently, complete excision of the lesion was done endoscopically. Definitive diagnosis of schwannoma was obtained via histopathology examination. This paper presents our approach and operative steps in the excision of this lesion using microlaryngoscopy with cold instruments.

Congenital oesophageal stenosis in oesophageal atresia: underrecognised and often missed?

Congenital oesophageal stenosis (COS) is characterised by an intrinsic oesophageal narrowing that is present, but not necessarily symptomatic at birth. Small studies report an association of COS with oesophageal atresia (OA) in up to 14% of OA cases. Although OA is usually appreciated shortly after birth, the diagnosis of a concomitant COS is frequently delayed. This risk may be increased with the current movement away from routine postoperative upper gastrointestinal (GI) contrast study following OA repair. We performed a systematic review of the literature to assess the timing of diagnosis of COS in patients with COS and OA and how this impacted on patient outcomes. A systematic review in accordance with PRISMA guidelines was undertaken. Only patients with OA associated with COS were included. Delayed diagnosis was defined as presentation > 1month of age. 14 full-text studies with a total of 131 patients were included. Diagnosis of COS was delayed in 62/131 (47%) patients. These children presented with symptoms of dysphagia and aspiration at a median age of 13.5months (IQR 7-30months). In total, 18/131 patients were identified at the initial operation, due to difficulty passing a tube distally into the stomach. The data on timing of contrast studies were provided in 60/131 (46%) patients. A routine postoperative contrast study was performed in 39/60 (65%) of these, of which COS was identified immediately in 28/39 (72%). A diagnosis of COS could also be made on retrospective review of the early contrast study in a further 6/39 patients, giving an overall sensitivity of 87%. The association of COS and OA may be underrecognised and diagnosis delayed if routine contrast study is not performed. Contrast studies, performed in the neonatal period are effective at detecting a concomitant COS (sensitivity > 87%). This review supports routine early contrast study after OA repair with specific consideration of the presence of COS.

ENDOBRONCHIAL FOREIGN BODY ASPIRATION MIMICKING AN ENDOBRONCHIAL TUMOR

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Aspiration of foreign body (FB) into the airways may have an indolent presentation in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by radiography and bronchoscopy, some patients are misdiagnosed as having endobronchial tumors. We describe an interesting case of bronchus intermedius FB that mimicked an endobronchial tumor. CASE PRESENTATION: A 61-year-old, male long-time heavy smoker with history of excessive alcohol use and stroke with residual left-sided hemiparesis presented with a 3-month history of worsening dry cough, hemoptysis and dyspnea. Chest computed tomography revealed occlusion of the bronchus intermedius with an enhancing lesion highly suspicious for an obstructing bronchial mass, along with moderate pleural effusion and enlarged subcarinal lymphadenopathy. Thoracentesis of the pleural effusion showed exudative fluid with predominantly neutrophilic cells that was negative for malignancy on cytology twice. Flexible bronchoscopy a firm, endobronchial lesion causing near total occlusion of the bronchus intermedius. Forceps endobronchial biopsy of the lesion and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of a subcarinal lymph node revealed no malignant cells. The patient then underwent flexible bronchoscopy with removal of the occluding lesion using cryoablation. The obstructing mass appeared to be freely movable when the cryoprobe was attached to it. A basket was used to retrieve the entire resected mass, which appeared to be an aspirated pill surrounded by granulation tissue on gross examination. Histopathology of the specimen showed no evidence of malignancy but was consistent with FB aspiration. DISCUSSION: Symptoms of FB aspiration in adults may be absent and often delayed, in some reports for up to 26 months. Dysphagia and impaired cough reflex are the main mechanisms for FB aspiration. This was likely the case in our patient with a history of stroke and excessive alcohol use. In case of such an indolent presentation and invisibility of the FB on chest imaging due to formation of granulation tissue, FB aspiration may be overlooked in adults. In our patient, this was further cofounded by the presence of pleural effusion and mediastinal lymphadenopathy, which were concerning lymphadenopathy, but were likely due to post-obstructive pneumonia. Bronchoscopic cryotherapy, which resulted in the correct diagnosis in this patient, has been described in the diagnosis of benign and malignant lesions of the airways and for recanalization. CONCLUSIONS: This case highlights the importance of suspecting FB aspiration when evaluating airway lesions. Choice of a noninvasive method, such as bronchoscopic cryotherapy, for removing an endobronchial lesion, may preclude the need for thoracotomy. REFERENCE #1: 1- Alharthi BJ, et al. Occult foreign body in the lung mimicking bronchogenic carcinoma. BMJ Case Rep. 2014;2014:bcr2014207438. Published 2014 Dec 17. doi:10.1136/bcr-2014-207438 REFERENCE #2: 2- Hewlett JC, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-3409. doi: 10.21037/jtd.2017.06.137. PMID: 29221325; PMCID: PMC5708401. REFERENCE #3: 3- Sehgal IS, et al. Use of cryoprobe for removal of a large tracheobronchial foreign body during flexible bronchoscopy. Lung India. 2016 Sep-Oct;33(5):543-5. doi: 10.4103/0970-2113.188978. PMID: 27625452; PMCID: PMC5006338. DISCLOSURES: No relevant relationships by Omar Abdulfattah, source=Web Response No relevant relationships by Muath Alsharif, source=Web Response No relevant relationships by Traves Crabtree, source=Web Response no disclosure on file for Keivan Shalileh

Suspicion of tooth aspiration during general anaesthesia in a paediatric patient – a case report

Foreign body aspiration or suspicion of it is a serious medical condition, which can cause life-threatening complications, especially in paediatric population. More than 80% of foreign body aspirations occur in children under three years of age. Children are a particularly vulnerable group due to specifi c anatomy of the airway. Symptoms of aspiration vary from suff ocation, coughing to complete absence of symptoms, which is why a diff erential diagnosis between aspiration and ingestion is sometimes very diffi cult. A six-year-old boy was admitted for elective surgery to correct vertical strabismus. At the pre-anaesthesia evaluation, the child was classifi ed as an ASA II patient, due to frequent laryngitis and bronchitis. The Mallampati score was 1 with no wobbly teeth recorded. After anaesthesia induction, the airway was secured with a laryngeal masksize 3.0 without complications. Upon awakening of the patient and removal of the laryngeal mask, blood was observed in the lodge of the lower left incisor and a lack thereof. The patient was without signs of respiratory distress. An emergency chest X-ray ruled out a foreign body in the airway, and subsequent X-rays of the abdomen revealed the presence of teeth in the projection of the stomach. The child was discharged to home care without complications. The clinical picture of foreign body aspiration under anaesthesia may be atypical and asymptomatic. Therefore, even the slightest suspicion of aspiration, especially in anaesthesia procedures, should be ruled out or confi rmed. Complications are most often the result of late-recognized aspiration.

Correlation of Voice Hoarseness and Vocal Cord Palsy: A Prospective Assessment of Recurrent Laryngeal Nerve Injury Following Anterior Cervical Discectomy and Fusion.

Injury to the recurrent laryngeal nerve (RLN) has been implicated as a common complication following anterior cervical discectomy and fusion (ACDF) surgery. The purpose of this study is to determine the true incidence of voice hoarseness and RLN palsy following ACDF surgery, to determine the reliability of symptoms in the diagnosis of RLN injury, and to evaluate factors related to the development of these symptoms. All patients undergoing elective (primary or secondary) ACDF surgery at a single institution consented to and enrolled in the present study. All approaches were through the left side. Enrolled patients received both preoperative and postoperative (within 1 month following surgery) laryngoscopy by a fellowship-trained ENT physician for evaluation of RLN function. Patients also responded as to whether they were experiencing postoperative symptoms of dysphagia, aspiration, and voice changes. In total, 108 patients were included in this study. Mean age of the population was 59.2 ± 10.7 years and mean body mass index was 31.2 ± 7.1 kg/m2. Three patients had previously undergone a thyroidectomy, whereas 20 patients had undergone a previous ACDF. Average intubation time for ACDF surgery was 121.6 ± 38.5 minutes. After surgery and excluding patients who were experiencing preoperative symptoms, 19 patients (20.4%) complained of dysphagia, 2 patients (1.9%) complained of aspiration symptoms, and 5 patients (4.6%) complained of voice hoarseness. There was no incidence of vocal cord palsy from postoperative laryngoscopy. From multivariate analysis, endotracheal cuff pressure after retractor placement was correlated to postoperative voice hoarseness, dysphagia, and aspiration symptoms. From the results of this prospective study, the RLN remained functional even a month after surgery despite several cases of postoperative dysphagia, aspiration, and voice changes. Endotracheal cuff pressure, number of vertebral levels, body mass index, and intubation time were important variables related to postoperative symptoms. Voice hoarseness does not necessarily indicate recurrent laryngeal nerve injury after ACDF but may be caused by compressive forces on laryngeal tissue during retraction or intubation. Laryngoscopy should be performed in cases with high clinical suspicion. 2.

Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires.

Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS). We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results. One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043-1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04). I-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.