30. Aspiration and Swallowing

Question 1

What is cyclical cyanosis relieved by crying and coughing and choking when trying to eat indicative of?

Answer 1

Bilateral nasal obstruction

Question 2

What are the haberman feeder and the mead-johnson nurser often used for?

Answer 2

Patients that cannot generate sufficient negative intraoral pressure(cleft lip/palate)

Question 3

Components of CHARGE

Answer 3

Coloboma 
Heart disease
Atresia (choanal)
Retardation 
Genital hypoplasia 
Ear abnormalities

Question 4

What are the two main syndromes which are associated with macroglossia?

Answer 4

Down

Beckwith-Wiedemann

Question 5

Typical presentation of vallecular cyst

Answer 5

Stridor
Dysphagia
FTT

Question 6

What % of stridor in peds is 2/2 laryngomalacia?

What % of LM can be treated non-operatively?

Answer 6

70%

90%

Question 7

What is the pathophysiology of congenital laryngeal webs?

Answer 7

Incomplete reabsorption of laryngeal lumen epithelium during development

Question 8

What is the MCC of acquired laryngeal webs?

Answer 8

Laryngeal trauma from instrumentation/intubation

Question 9

How are thin vs thick laryngeal webs managed?

Answer 9

Thin: endoscopic lysis
Thick: open laryngofissure w keel placement

Question 10

What is posterior laryngeal cleft associated with in 1/3 of cases?

Answer 10

TEF

Question 11

What are the 4 types of laryngeal clefts?

Answer 11

1: interarytenoid, above the level of TVF
2: extend below TVF and partially through cricoid
3: extend through cricoid into extrathoracic trachea
4: extend into thoracic trachea

Question 12

Management of the 4 types of laryngeal clefts

Answer 12

1: medical management vs endoscopic
2: endoscopic
3: open
4: open

Question 13

What % of peds patients have GERD sx?

Answer 13

50-67%, majority resolve by 1-2 yr

Question 14

What is required for dx of EE?

Answer 14

15 eosin or more per HPF
Bx performed after 6-8 wk PPI
Multipl bx required b/c EE is patchy

Question 15

Tx EE

Answer 15

Dietary changes 
Systemic steroids (~4 wk)

Question 16

Most than 1/3 of cases of congenital tracheal stenosis are associated with:

Answer 16

Pulmonary slings or other CV anomalies

Question 17

What is the etiology of dysphagia seen with congenital tracheal stenosis?

Answer 17

Increased WOB or vascular compression of the esophagus

Question 18

What % of patients w congential tracheal stenosis can be managed medically?

Answer 18

10%

Question 19

What type of stridor do pts w tracheomalacia present with?

Answer 19

Expiratory

Question 20

What is a temporizing measure for tracheomalacia if there is no extrinsic compression to address?

Answer 20

Positive pressure