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Outcomes studies of epiglottic and base of tongue prolapse in children

Robert F Yellon1, Lawrence M Borland

  • 1Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. yellra@chp.edu

The Laryngoscope
|December 20, 2007
PubMed

Insights

A grading system for epiglottic and base of tongue (EBT) prolapse in children was reapplied, showing varied outcomes. Many children with EBT prolapse still require tracheotomy, particularly those with developmental delay.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Airway Disorders
  • Gastroenterology

Background:

  • Epiglottic and base of tongue (EBT) prolapse is a condition affecting children's airways.
  • Flexible fiberoptic laryngoscopy (FFL) is used to assess EBT prolapse.
  • A grading system exists for EBT prolapse, but its longitudinal application requires further study.

Purpose of the Study:

  • To compare initial and follow-up flexible fiberoptic laryngoscopy (FFL) findings in children with epiglottic and base of tongue (EBT) prolapse using a previously established grading system.
  • To evaluate surgical outcomes and tracheotomy decannulation rates in this patient population.

Main Methods:

  • Retrospective review of medical records for 14 children diagnosed with EBT prolapse.
  • Transnasal FFL performed in the supine position on at least two occasions for each child.
  • Application of a previously published EBT prolapse grading system to initial and most recent FFL findings.

Main Results:

  • At follow-up FFL, 43% of children had the same grade of EBT prolapse, 36% had a milder grade, and 21% had a more severe grade.
  • 36% of children were decannulated, while 64% remained tracheotomy dependent.
  • Children with developmental delay were significantly more likely to remain tracheotomy dependent (P < .03).
  • Gastroesophageal reflux disease (86%) and abnormal swallowing function (43%) were common comorbidities.

Conclusions:

  • The EBT prolapse grading system is applicable for longitudinal assessment in children.
  • Gastroesophageal reflux disease and swallowing dysfunction are prevalent in children with EBT prolapse.
  • Surgery may benefit selected patients, but many children, especially those with developmental delay, continue to require tracheotomy.
Abstract

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