title: Experience of using electromyography of the genioglossus in the investigation of paediatric dysphagia.
abstract: OBJECTIVE
  The aim of the study was to assess, retrospectively, the utility of genioglossus electromyography (gEMG) in evaluating children with suspected neurogenic feeding and swallowing difficulties.
  
  
  METHODS
  Children who were evaluated using gEMG at a tertiary paediatric neurology dysphagia service were reviewed. Data were analysed by the presence/absence of neurogenic changes on gEMG and the method of feeding at their most recent follow-up.
  
  
  RESULTS
  The study group comprised 59 individuals (36 males, 23 females; median age 20 mo; range 1 mo-15 y). The study cohort included individuals with heterogeneous neurological phenotypes (n=40), craniofacial syndrome (n=10), and congenital bulbar palsy (n=9). gEMG identified 35 out of 59 (60%) with neurogenic changes. At follow-up, 24 individuals were on oral feeds and 35 were on alternative methods of feeding (nasogastric /gastrostomy). Eight out of 24 children on oral feeds showed neurogenic changes compared with 27 out of 35 on alternative feeds. χ(2) analysis of feeding method at follow-up and the presence or absence of neurogenic change on EMG was highly significant (p≤0.002). When confounding factors for alternative feeds were accounted for on univariate analysis, the neurogenic changes, severe gastro-oesophageal reflux disease, and respiratory comorbidities were statistically significant in predicting the alternative feeding, whereas growth failure and behavioural difficulties were not significant confounders. Moreover, multiple logistic regression analysis revealed that the neurogenic changes were independently predictive of an alternative method of feeding after adjusting for other confounders with an odds ratio of 29.6 (95% confidence interval 3.97-220; p<0.007).
  
  
  CONCLUSIONS
  gEMG is a valuable complementary tool in the evaluation of children with neurogenic dysphagia as the degree of severity is independently correlated with long-term feeding outcomes.
authors.affiliation: Department of Neurosciences, Great Ormond Street Hospital, London, UK. kayalvizhi.vijayakumar@gosh.nhs.uk
authors.forename: Kayal
authors.initials: K
authors.lastname: Vijayakumar
authors.forename: Juliet
authors.initials: J
authors.lastname: Rockett
authors.forename: Martina
authors.initials: M
authors.lastname: Ryan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Harris
authors.forename: Matthew
authors.initials: M
authors.lastname: Pitt
authors.forename: Catherine
authors.initials: C
authors.lastname: Devile
mesh_terms: D000293:Adolescent; D001933:Brain Stem / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000503:physiopathology*; D004576:Electromyography; D005248:Feeding Methods; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology*; D012189:Retrospective Studies; D014059:Tongue / Q000503:physiopathology*