Evaluation of Swallowing Function in Patients With H-type Tracheoesophageal Fistula

Although esophageal atresia (EA) patients can present with dysphagia, the swallowing function of patients with H-type tracheoesophageal fistula (H-TEF) has not been systematically assessed. Therefore, a retrospective study was carried out to evaluate the swallowing function of patients with H-TEF.

Children operated for H-TEF with videofluoroscopic swallowing evaluation (VFSE) were included. Penetration-aspiration score, oral phase efficacy, delay in swallowing reflex, velopharyngeal closure, and esophageal dysmotility during liquid and solid food swallowing were assessed by using VFSE recordings. Penetration-aspiration score <6 was considered as 'no aspiration', whereas scores ≥6 was assessed as 'aspiration'. Oral phase efficacy, delay in swallowing reflex and esophageal dysmotility were scored as 0 (normal) to 3 (severe problem), and delay in swallowing reflex was ranged from 0 (no delay) to 3 (severe delayed, >5 s).

Among eleven patients, ten patients who met the inclusion criteria were included. The mean age of the patients was 3.4 years (min = 1, max = 9). Two (20 %) patients had aspiration in liquids and none of them had in solids. One patient had minimum and the other one had mild problem in oral phase efficacy (n = 2, 20 %). Delay in swallowing reflex and velopharyngeal closure were normal in all patients. In five of the patients (50 %), there was mild (n = 1) to severe (n = 4) esophageal dysmotility.

Children with H-TEF had modest swallowing impairment in all phases. Although, it is not as severe as in EA patients, evaluation of the swallowing function should be part of the clinical practice of patients with H-TEF.