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Separate Fact from Fiction About Pediatric Aspiration

Mythbusters: Pediatric Aspiration
10:00 am – 12:00 pm
Room N228

Because of the lack of research on managing pediatric aspiration, concerned parents of children who have swallowing dysfunction search high and low for solutions to their problems. A Wednesday Miniseminar aims to help otolaryngologists answer the questions of those parents.

Julina Ongkasuwan, MD

“This is a challenging topic because there is not a lot of great data about how to diagnose and manage these children,” said session moderator Julina Ongkasuwan, MD.

The panel will feature speakers with a great deal of experience in treating patients with pediatric aspiration. They will share that experience to help attendees improve their management options for pediatric patients, she said.

A multidisciplinary panel, including a speech language pathologist, will discuss six topics, including the use of VitalStim, the relationship between laryngomalacia and aspiration, lipid-laden macrophages, bronchoalveolar lavage, silent aspiration, breast milk/sterile water aspiration, and the effect of speaking valves.

“These topics are for those in the trenches dealing with these problems in children,” said Dr. Ongkasuwan, director of the Voice Center at Baylor College of Medicine at Texas Children’s Hospital. “There have been only a handful of studies of some of these topics in children, and a lot of things are being extrapolated from the adult world. It is a huge issue because children are not small adults.”

The use of VitalStim, which uses electrical stimulation on cervical swallowing muscles, remains debatable. It was first used in adults.

“It is controversial, and we want to lay out the data we have and talk about our feelings on the use of VitalStim for patients with severe dysphagia.” Dr. Ongkasuwan said.

The relationship between laryngomalacia and aspiration will focus on whether children should be screened for the presence of dysphasia before supraglottoplasty.

“There are reports that up to 25 percent of these children may have dysphasia afterward, so it is an important topic,” Dr. Ongkasuwan said.

Lipid-laden macrophages can be used as a diagnostic tool for aspiration, but the test scores need to be clarified, and otolaryngologists need to be aware that microphages can be present in a number of pulmonary diseases rather than just aspiration, she said. The use of bronchoalveolar lavage as a diagnostic tool also will be explored.

Silent aspiration has long been a challenge because it can be overlooked in spite of its danger. The presentation will delve into the dangers and how it is best managed.

Aspiration of breast milk and sterile water also has been controversial because clinicians have varying opinions about its benefits. However, this is an area that has some data, which will be reviewed, Dr. Ongkasuwan said.

The final presentation is about the effect of speaking valves and tracheostomies on aspiration.

Before the presentations, the panel will poll the audience on the topic, after which the speakers will deliver their presentations and discuss with a panel of experts.

“We are hoping with this session that we can address relatively common questions in dealing with kids who have problems with aspiration, as well as the related diagnostic dilemmas and management,” Dr. Ongkasuwan said. 

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