Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia
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Published on: June 23, 2023
Ryne C Simpson1, Guillermo Beltran Ale1, William T Harris1
1Division of Pediatric Pulmonology and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are valuable for evaluating pediatric aerodigestive patients with dysphagia. These procedures provide key findings that significantly impact clinical decisions and management strategies.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Otolaryngology
Background:
- Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are common in pediatric aspiration cases.
- The added value of FB with direct laryngoscopy and rigid bronchoscopy (DLB) for dysphagia is not well-quantified.
Purpose of the Study:
- To detail endoscopic and cytologic findings of FB and BAL.
- To assess the management impact of FB and BAL in pediatric aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia.
Main Methods:
- Retrospective chart review of children under 3 years old at an Aerodigestive center.
- Analysis of patient characteristics, endoscopic findings, BAL results, and management metrics.
- Secondary analysis of the association between endoscopic findings and medication changes.
Main Results:
- 91 procedures were reviewed; common findings included bronchitis (73.6%) and adenoidal hypertrophy (31.9%).
- BAL frequently showed neutrophilic inflammation; common pathogens included S. viridans and H. influenzae.
- FB and BAL results influenced clinical decisions in 71.4% of patients; bronchitis and tracheomalacia were linked to medication adjustments.
Conclusions:
- Flexible bronchoscopy and bronchoalveolar lavage are high-yield procedures.
- These procedures are clinically impactful for pediatric aerodigestive patients with oropharyngeal dysphagia.
- Combined airway evaluation with FB and BAL aids in guiding patient management.
Introduction:
Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are frequently performed in children with known or suspected aspiration, however, the additive value of FB in conjunction with direct laryngoscopy and rigid bronchoscopy (DLB) has not been previously quantified. This study details the common endoscopic/cytological findings and associated management impact of FB and BAL in pediatric Aerodigestive patients undergoing combined airway evaluation (FB and DLB) for oropharyngeal dysphagia.
Materials And Methods:
A retrospective chart review was performed in children <3 years of age followed through a large Aerodigestive center undergoing outpatient, combined airway endoscopy for dysphagia. Patient and procedural characteristics, endoscopic and BAL findings, and management metrics were collected and analyzed. A secondary analysis evaluated the association between endoscopic findings and medication changes.
Results:
Ninety-one procedures (median patient age, 15 months) were identified. All procedures included both FB and DLB, and just over half (52.7%) included esophagogastroduodenoscopy. Common endoscopic findings included bronchitis (73.6%), adenoidal hypertrophy (31.9%), and tracheomalacia (10.8%). BAL cytology frequently identified neutrophilic inflammation (mean 39.6% neutrophils [interquartile range 6.5%-71%)]. Cultured pathogens commonly included Streptococcus viridans (46.6%), Hemophilus influenzae (36.3%), Moraxella catarrhalis (30.1%), and Streptococcus pneumoniae (25.0%). FB and BAL results contributed to clinical decisions in 65 of 91 (71.4%) patients. Endoscopically-diagnosed bronchitis (odds ratio [OR] 7.27, 95% confidence interval [CI] 2.4-21.99) and tracheomalacia (OR 5.79, 95% CI 1.20-27.85) were significantly associated with increased odds of medication adjustments following FB.
Conclusion:
In pediatric Aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia, FB and BAL are high-yield and clinically impactful procedures.
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