title: Swallowing dysfunction among patients with laryngeal cleft: More than just aspiration?
abstract: BACKGROUND
  The Modified Barium Swallow (MBS) is the most widely utilized instrumental assessment of swallowing disorders in children; however, the exact role in the evaluation of laryngeal clefts remains controversial.
  
  
  METHODS
  This study was an IRB-approved retrospective review on patients diagnosed with laryngeal cleft from 2002 to 2014. The objective was to describe the range of swallowing dysfunction that may be present in patients with laryngeal clefts both pre- and post-intervention (conservative management versus surgery). A speech-language pathologist reviewed MBS studies and medical records to determine Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) scores.
  
  
  RESULTS
  One hundred seventy-five patients who underwent laryngeal cleft repair during the study period (type 1, n=111; type 2, n=54; type 3, n=9; type 4, n=1) were included. Fifty patients who were managed conservatively (type 1) were also included. Swallowing impairment was demonstrated in all phases of swallowing for all cleft types. Oral phase impairment ranged from 27-67% pre-intervention to 19-75% post-intervention, triggering impairment from 24-42% pre-intervention to 24-75% post-intervention, and pharyngeal phase impairment (laryngeal penetration and aspiration) from 57-100% pre-intervention to 40-100% post-intervention. Laryngeal penetration and aspiration on thin and thick liquids, silent aspiration, PAS, and FOIS scores are reported. Significant improvements in swallowing function (p<0.05) were documented in all of the conservatively and surgically managed sub-groups.
  
  
  CONCLUSIONS
  The MBS study is a useful tool for evaluating swallowing function in patients with laryngeal cleft and provides information beyond the lack or presence of aspiration. Understanding impairments in all phases of swallowing may be beneficial for perioperative management.
authors: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, 800 Commissioners Rd E, VH B3-444, London, ON, N6A 5W9, Canada. Electronic address: julie.strychowsky@lhsc.on.ca.
authors: Julie E
authors: JE
authors: Strychowsky
authors: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA. Electronic address: pamela.dodrill@childrens.harvard.edu.
authors: Pamela
authors: P
authors: Dodrill
authors: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA. Electronic address: emoritz@wesleyan.edu.
authors: Ethan
authors: E
authors: Moritz
authors: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA. Electronic address: jennifer.perez@childrens.harvard.edu.
authors: Jennifer
authors: J
authors: Perez
authors: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA. Electronic address: reza.rahbar@childrens.harvard.edu.
authors: Reza
authors: R
authors: Rahbar
mesh_terms: D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000503:physiopathology*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D007830:Larynx / Q000002:abnormalities* / Q000503:physiopathology; D008297:Male; D010614:Pharynx / Q000503:physiopathology*; D012189:Retrospective Studies
chemical_list: D001466:Barium Sulfate
keywords: Dysphagia; Laryngeal cleft; MBS; Modified barium swallow; Swallow study