Airway obstruction in children with cerebral palsy: need for tracheostomy?
OBJECTIVE
To examine the progress of the airway obstruction over time in children with cerebral palsy (CP) and the timing of any interventions.


METHODS
The medical notes of patients with CP younger than 16 years admitted with airway obstruction to a tertiary referral Pediatric Otolaryngology Center from 2006 to 2012 were retrospectively reviewed. The gender, age of referral, co-morbidities, type of surgical intervention and age this was performed and the time interval between sequential surgeries were documented.


RESULTS
Fifteen children with CP and airway obstruction were admitted, eight boys and seven girls with an average age of referral 8 years (range 3-13.3 years). Adenotonsillectomy was performed in 11/15 patients at a mean age of 9.1 years (range 4.5-14 years). Tracheostomy was performed in 8/15 children at an average age of 11.6 years (range 7.5-15 years). Seven out of 11 patients having undergone adenotonsillectomy, required tracheostomy after an average time interval of 1.9 years (range 0.5-3.5 years). Tracheostomy was performed in 80% of referred patients with CP older than 10 years, while surgical intervention was uncommon in children younger than 5 years. There was a statistically significant correlation between the age of the children and the performance of a tracheostomy (Pearson's correlation coefficient 0.68, p = 0.005).


CONCLUSIONS
The severity of the airway obstruction in children with CP tends to increase with age. We postulate that this increase results from worsening hypotonia of pharyngeal musculature. Children with CP and severe upper airway obstruction are likely to require tracheostomy as they grow older.
Department of Otolaryngology, Sheffield Children's Hospital, Sheffield, United Kingdom. Electronic address: gkontorinis@gmail.com.
Georgios
G
Kontorinis
Mahilravi S
MS
Thevasagayam
Neil D
ND
Bateman
D000233:Adenoidectomy / Q000379:methods; D000293:Adolescent; D000367:Age Factors; D000402:Airway Obstruction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods; D014139:Tracheostomy / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome
Adenotonsillectomy; Cerebral palsy; Neuromuscular hypotonia; Obstructive sleep apnea; Tracheostomy; Upper airway obstruction