September 2019 HSC Section 1 Congenital and Pediatric Problems

International Journal of Pediatric Otorhinolaryngology 115 (2018) 10–18

E. Cole et al.

Fig. 1. Demographics and comorbidities in each age group. (A) There were no signi fi cant di ff erences in the percentage of patients with each comorbidity or treatment between the age groups. (B) However, age at fi rst symptoms was signi fi cantly older in the 12 – 36-month group compared with both the 0 – 3 and 4 – 11-month groups. Age at diagnosis, time from symptoms to diagnosis, and time from symptoms to fi rst injection were signi fi cantly greater in the 4 – 11- month group vs the 0 – 3-month group, in the 12 – 36 month group vs the 0 – 3 month group, and in the 12 – 36 month group vs the 4 – 11 month group. *p < 0.05 using Wilcoxon rank-sum or t-tests. Abbreviations: WGA=Weeks Gestational Age (at birth); NICU=Neonatal Intensive Care Unit; GERD = Gastroesophageal Re fl ux Disease; G- tube = Gastrostomy tube.

27/102 (26.5%) patients went on to require formal repair. The total number of patients requiring additional operative management (addi- tional injection or surgical repair) was 35/102 (34.3%). One patient underwent revision surgery after repair. Times between injections or from injection to repair were not signi fi cantly di ff erent between age groups ( Fig. 1 B). Also, second injection, repair, or any additional op- erative management (second injection or repair) was not signi fi cantly more common over time in any age groups ( Fig. 2 ). Presenting symptoms and the percentage of patients with symptom resolution after fi rst injection are summarized in Fig. 3 . Overall, 29/102 (28.4%) patients presented with stridor, 54/102 (52.9%) choking, 64/ 102 (62.8%) coughing, 9/102 (8.8%) failure to thrive, 10/102 (9.8%) apnea, 15/102 (14.7%) aspiration, 6/102 (5.9%) retractions, and 13/ 102 (12.8%) cyanosis. Of the 29 patients who presented with stridor, 24 (82.8%) experienced resolution of this symptom after the fi rst injection. Similarly, choking resolved in 29/54 (53.7%), coughing resolved in 33/ 64 (51.6%), failure to thrive resolved in 8/9 (88.9%), apnea resolved in 10/10 (100.0%), aspiration resolved in 12/15 (80.0%), retractions re- solved in 6/6 (100.0%), and cyanosis resolved in 11/13 (84.6%). Stridor was a less common presenting symptom in the 12 – 36-month 3.3. Symptom presentation and resolution after fi rst injection

group (3/41 patients, 7.3%) compared with the 0 – 3 month (7/15 pa- tients, 46.7%; χ 2 (1) = 11.6, p =0.002) and 4 – 11-month (19/46, pa- tients, 41.3%; χ 2 (1) = 13.3, p < 0.001) groups. Likewise, cyanosis was less common in the 12 – 36-month group (2/41 patients, 4.9%) compared with the 0 – 3-month group (5/15, 33.3%; χ 2 (1) =8.13, p =0.012) ( Fig. 3 A). The proportion of patients experiencing resolu- tion was not signi fi cantly di ff erent between the age groups for any symptom ( Fig. 3 B). Next, the results of swallowing examinations were evaluated in patients with the same exam both before and after fi rst injection. Fig. 4 A displays the percentage of patients with fi ndings during CSE before and after fi rst injection. Twelve patients underwent CSE with thin liquids before and after injection; 5/12 (41.7%) had abnormal fi ndings on CSE before the fi rst injection and 7/12 (81.3%) had ab- normal fi ndings after the fi rst injection. Seven patients underwent CSE with nectar-thickened liquids; 2/7 (28.6%) had abnormal fi ndings pre- injection and 1/7 (14.3%) had abnormal fi ndings post-injection. Four patients underwent CSE with honey-thickened liquids; 0/4 (0.0%) had abnormal fi ndings pre-injection and 1/4 (25.0%) had abnormal fi nd- ings post-injection. The percentage of patients with abnormal fi ndings 3.4. Clinical swallowing exam fi ndings

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