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Pediatric Dysphagia
Pediatric dysphagia is a common condition encountered in clinical practice. We review the physiology and development of swallow, presentation, epidemiology, and etiology of dysphagia. Additionally, comorbidities, associated conditions, and medical management of dysphagia are discussed. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 23, 2024 Category: ENT & OMF Authors: Wade McClain, Jordan Luttrell, Elton Lambert Source Type: research

Pediatric Esophageal Foreign Bodies and Caustic Ingestions
Foreign body ingestions commonly occur in children aged under 6  years. While serious complications of ingestions are rare, sharp objects, caustics, multiple magnets, and button batteries can be associated with poorer outcomes including gastrointestinal (GI) obstruction, perforation, necrosis, and fistula formation. Initial workup should include history, physic al examination, and plain film radiographs that will identify radiopaque objects. Removal of the foreign body is typically warranted if the object is high risk, it is located higher up in the GI tract, the patient is symptomatic, or the object is retained for a pro...
Source: Otolaryngologic clinics of North America - March 21, 2024 Category: ENT & OMF Authors: Kristina Powers, Cristina Baldassari, Jordyn Lucas Source Type: research

Advanced Diagnostic Techniques in Obstructive Sleep Apnea
Optimal surgical and medical management of obstructive sleep apnea (OSA) requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities has been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, the authors provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in ...
Source: Otolaryngologic clinics of North America - March 21, 2024 Category: ENT & OMF Authors: Seckin O. Ulualp, Eric J. Kezirian Source Type: research

Neurostimulation for Pediatric Obstructive Sleep Apnea
Up to 80% of children with Down syndrome (DS) are affected by obstructive sleep apnea (OSA), and only 16% to 30% will have resolution of their OSA with adenotonsillectomy. Hypoglossal nerve stimulation is a well-established therapy for adults with OSA and was recently approved by the Food and Drug Administration for use in children with DS and residual OSA. There is robust experience with this therapy in adults that has led to well-established care pathways. However, given the challenges inherent to caring for a complex pediatric population, these pathways are not directly transferrable to children with DS. (Source: Otolar...
Source: Otolaryngologic clinics of North America - March 21, 2024 Category: ENT & OMF Authors: Doug Chieffe, Christopher Hartnick Source Type: research

Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Adenotonsillectomy
While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter ph...
Source: Otolaryngologic clinics of North America - March 21, 2024 Category: ENT & OMF Authors: Nicholas R. Lenze, Suhas R. Bharadwaj, Christina M. Baldassari, Erin M. Kirkham Source Type: research

Tracheostomy-Related Swallowing Issues in Children
Children with tracheostomies have multiple challenges with respect to achieving normal deglutition. These children may have underlying neurologic or genetic conditions that can predispose to dysphagia, but even in children without underlying comorbidities, the presence of a tracheostomy tube impacts the mechanics of swallowing, leading to difficulty with different consistencies as well as management of normal oral secretions. Intubation prior to tracheostomy also impacts sensation in the upper aerodigestive tract increasing the risk of aspiration. Occlusion of the tracheostomy with a speaking valve or cap improves outcomes...
Source: Otolaryngologic clinics of North America - March 21, 2024 Category: ENT & OMF Authors: Eileen M. Raynor, Daniel Wohl Source Type: research

Oral Structural Dysphagia in Children
Oral causes of dysphagia in infancy may involve the lips, the tongue, or the palate. Whereas ankyloglossia is commonly diagnosed in infants with dysphagia, assessment of the need for surgical intervention may be less straightforward. Tongue size (macroglossia) may be associated with dysphagia as it may cause limitation of movement of the food or milk bolus by the lips or cheeks. Congenital conditions such as cleft lip and palate, micrognathia, or craniofacial microsomia may also be associated with dysphagia. Diagnosis and treatment of these conditions can be improved with the engagement of lactation and feeding experts as ...
Source: Otolaryngologic clinics of North America - March 18, 2024 Category: ENT & OMF Authors: Rose P. Eapen, Amelia F. Drake, Allison Keane Source Type: research

Laryngeal Structural Dysphagia in Children
The upper aerodigestive system is closely intertwined from an embryologic and functional perspective. Laryngotracheal anatomic abnormalities, such as laryngomalacia, stenosis, vocal cord paralysis, and laryngeal clefts, affect not only the respiratory function but also the swallow function. Laryngotracheal pathology can interfere with the suck –swallow–breathe mechanism in infants. It can also exacerbate gastroesophageal reflux. Chronic aspiration secondary to laryngotracheal anomalies can result in respiratory and pulmonary complications. Surgical treatment of laryngotracheal anomalies can also cause transient or long...
Source: Otolaryngologic clinics of North America - March 18, 2024 Category: ENT & OMF Authors: Allison Keane, Lauren K. Leeper, Amelia F. Drake Source Type: research

Nearly 200 Years of Sleep Apnea: We ’ve Come a Long Way
In 1836, the first installment of The Posthumous Papers of the Pickwick Club (also known as The Pickwick Papers), the first novel by English author Charles Dickens, was published. In it he introduces the reader to Joe, the Fat Boy, who is obese, consumes great amounts of food, constantly falls asleep in any situation at any time, is difficult to arouse, and snores. This description so intrigued the medical field that many hypotheses about the symptoms were examined, but it was not until well over a century after the novel was published that physicians started to interrelate these features. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 18, 2024 Category: ENT & OMF Authors: Sujana S. Chandrasekhar Tags: Foreword Source Type: research

Sex Differences in Obstructive Sleep Apnea Including Pregnancy and Response to Treatment
This article highlights the sex differences in obstructive sleep apnea (OSA) and sheds light on the varying presentations, diagnostic challenges, as well as treatment responses observed in men and women. The disparities in prevalence, manifestations, and therapeutic outcomes underscore the need for a nuanced approach to OSA diagnosis and management that considers sex-specific factors. Furthermore, this article highlights the importance of recognizing and treating OSA during pregnancy, as it poses unique challenges and potential risks to both maternal and fetal health. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 13, 2024 Category: ENT & OMF Authors: Taylor S. Erickson, Megan L. Durr Source Type: research

Advanced Diagnostic Techniques in Obstructive Sleep Apnea
Optimal surgical and medical management of obstructive sleep apnea requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities have been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, we provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in children and a...
Source: Otolaryngologic clinics of North America - March 13, 2024 Category: ENT & OMF Authors: Seckin O. Ulualp, Eric J. Kezirian Source Type: research

Health Inequalities in the Diagnosis and Treatment of Obstructive Sleep Apnea in Children and Adults
Our understanding of the prevalence of obstructive sleep apnea (OSA) in the United States is confounded by significant inequalities in diagnosis and treatment based on gender, race and socioeconomic status. Health literacy and cultural norms contribute to these inequities. Large gaps in data exist, as certain populations like Native Americans, Pacific Islanders, and sexual minorities have been sparsely studied, or not at all. Future research should aim to develop more inclusive diagnostic strategies to address OSA in diverse populations. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 13, 2024 Category: ENT & OMF Authors: Javier J.M. Howard, Robson Capasso, Stacey L. Ishman Source Type: research

Assessing Dysphagia in the Child
This study focuses on the types of assessment tools available and how and when they are utilized for children of different ages and abilities. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 13, 2024 Category: ENT & OMF Authors: Eileen Raynor, Jennifer Kern Source Type: research

Dysphagia in Head and Neck Cancer
Dysphagia is a common symptom in patients with head and neck cancer that can significantly impact health outcomes and quality of life. The origin of dysphagia in these patients is often multifactorial, making diagnosis and management especially complex. The evaluating otolaryngologist should be well versed with the patient ’s neoplasm, comorbidities, and treatment history alongside dysphagia-specific imaging modalities. Management is often dynamic, requiring frequent monitoring, interprofessional collaboration, and a variety of supportive and invasive measures to achieve optimal outcomes. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 13, 2024 Category: ENT & OMF Authors: Deepak Lakshmipathy, Melissa Allibone, Karthik Rajasekaran Source Type: research

Sleep Renewed: Innovations in Sleep Apnea Care for Adults and Children
Welcome to our latest issue of Otolaryngologic Clinics of North America dedicated to advances in sleep disorders as they relate to surgical treatment in pediatric and adult populations. We offer this issue as a timely and relevant update regarding the treatment of sleep patients as our Otolaryngology community witnesses an increasing prevalence in sleep-disordered breathing. This affects millions worldwide, and it is evident that sleep disorders impact both individual health and societal well-being. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 8, 2024 Category: ENT & OMF Authors: Reena Dhanda Patil, Stacey Ishman, Carol Li Tags: Preface Source Type: research