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Published on: November 21, 2013
Clinical and Electromyographic Characteristics of Pediatric Laryngeal Dyskinesia
Nasser W Alobida1, Ameen Binnasser2, Aleksandra King3
1Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, The Stollery Children's Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada.
Insights
Laryngeal dyskinesia (LD) is common in children with laryngeal mobility disorder (LMD), often self-limiting with improved symptoms. Diagnosis requires endoscopic examination and laryngeal electromyography (LEMG).
Area of Science:
- Pediatric Otolaryngology
- Neurology
- Speech-Language Pathology
Background:
- Laryngeal dyskinesia (LD) is a motility disorder affecting the larynx.
- It is often misdiagnosed or conflated with other laryngeal conditions, impacting its known prevalence and natural history.
- Understanding LD's clinical and electrophysiological parameters is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the clinical and laryngeal electromyographic (LEMG) characteristics of pediatric laryngeal dyskinesia (LD).
- To establish the prevalence of LD among children with laryngeal mobility disorder (LMD) requiring a full airway examination.
- To analyze associated functional deficits in sleep and swallowing.
Main Methods:
- Retrospective uncontrolled study at a tertiary pediatric center.
- Included children (<17 years) with suspected LMD and diagnosed LD, assessed endoscopically and with LEMG.
- Analyzed LEMG scores, clinical resolution, and functional outcomes (swallowing, snoring).
Main Results:
- LD represented 18.58% of LMD cases requiring airway examination.
- Asymmetry in laryngeal movement and LEMG was observed, with the right side more affected.
- Most patients (27/29) experienced symptom improvement, with 17 having swallowing difficulties and 27 snoring.
Conclusions:
- Laryngeal dyskinesia (LD) is a prevalent condition among pediatric laryngeal mobility disorders (LMD) and is typically self-limiting.
- Key findings include LEMG asymmetry, male predominance, and associated sleep and swallowing issues.
- Accurate diagnosis necessitates comprehensive endoscopic evaluation and LEMG, differentiating it from bilateral vocal cord paralysis.
Objective:
To report the clinical and laryngeal electromyographic (LEMG) parameters of children with laryngeal dyskinesia (LD) and its prevalence among laryngeal mobility disorder (LMD) requiring full airway examination.
Study Design:
Retrospective uncontrolled study.
Setting:
Tertiary pediatric center.
Methods:
Eligible children (<17 years old) were stridulous patients suspected of LMD (16 years period). We included those diagnosed with LD according to previously described criteria by Denoyelle et al, followed up for at least 3 months, who were assessed endoscopically and LEMG.
Primary Outcome:
LEMG scores, and the prevalence of LD in all LMD who required airway exam under anesthesia.
Secondary Outcomes:
clinical resolution, McGill scores, and instrumental swallowing test.
Results:
A total of 44 patients (<17 years) were identified. Of these, 29 were included (25 boys; median age: 9.83 months [0.42-116.58]). LD constituted 18.58% of all patients during the study period. Asymmetry of movement and LEMG between the 2 sides was noted (the right side was more affected). Seventeen had swallowing difficulties (13 abnormal instrumental tests), and 27 snored (mean McGill score 3). The median follow up was 49.96 months (range: 5.25-243.25). Symptoms improved in all patients, but one, by the last follow-up date.
Conclusion:
LD is prevalent among LMD and is mostly self-limiting. We noted asymmetry of LEMG grades between the 2 sides of the larynx, male predominance, and functional deficits in sleep and swallowing. The diagnosis requires a complete endoscopic exam with LEMG. Conflating this entity with bilateral laryngeal paralysis has likely impacted the documented epidemiology and natural history.
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