We present our work to children with persistent pharyngeal dysphagia and use the interarytenoid injection augmentation (IAIA) procedure as a diagnostic and therapeutic tool to help determine which patients will be the most likely to respond to interarytenoid suture augmentation (IASA) or laryngeal cleft repair. This work represents the largest series in the literature on IAIA procedures, including one of the oldest patient populations, which serves to isolate the impact of this intervention and improve the ability of this data to best predict which patient will respond to IASA. This data has been incredibly useful to better inform peri-operative conversations with the families of patients undergoing these procedures.
Objective
To assess the efficacy of interarytenoid injection augmentation (IAIA) and the ability of IAIA to predict response to interarytenoid suture augmentation (IASA) based on diet advancement on video fluoroscopic swallow studies (VFSS).
Methods
Retrospective cohort analysis of patients with persistent pharyngeal dysphagia at a tertiary children's hospital with VFSS pre- and post-IAIA were included between March 2011 and June 2019.
Results
Median age of the 229 patients was 2.2 years (5.8 months–19 years). Interarytenoid mucosal height (IAMH) was found to be above the false vocal folds in 112 patients (53.4%) and at true vocal folds in 10 (4.9%) patients. On VFSS post-IAIA, 95 (41.5%) patients were successfully advanced in recommended diet consistency, 115 (50.2%) were stable, and 19 (8.3%) needed thicker consistency. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% confidence interval (CI; 0.50–0.85). Poisson regression found no covariates with significant association with improvement on IAIA. For IASA patients, 35/60 (58.3%) improved on post-op VFSS. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% CI (0.63–1.33). Positive predictive value for IAIA predicting response to IASA was 77% with positive likelihood ratio of 2.3. The response to IAIA versus no response to IAIA likelihood ratios were found to have a statistically significant difference (p < 0.05).
Conclusions
Our study suggests IAIA yields objective improvement in swallow function on VFSS in nearly half of our patients and may be a reliable diagnostic tool to predict response to IASA in patients with persistent pharyngeal dysphagia with or without a laryngeal cleft.
Level of Evidence
Level 3 Laryngoscope, 2022
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