Diagnosis and management of aspiration using fiberoptic endoscopic
evaluation of swallowing in a pediatric pulmonology unit
Abstract
Background and Objectives: Swallowing disorders lead to chronic lung
aspiration. Early detection and treatment of aspiration in children with
dysphagia is important to prevent lung damage. Diagnosis of aspiration,
which may be silent, requires an instrumental study such as fiberoptic
endoscopic evaluation of swallowing (FEES). Despite its usefulness, it
is rarely practiced by pediatric pulmonologists. This study aimed to
evaluate the feasibility and utility of FEES performed in the pediatric
respiratory unit of a tertiary hospital, analyze the clinical
characteristics, endoscopic findings and proposed treatments, and
identify the factors associated with penetration or aspiration. Methods:
Medical records of 373 children with suspected aspiration who were
referred to the pediatric respiratory unit for FEES were reviewed
retrospectively. Clinical characteristics, FEES findings, and the
proposed treatments were analyzed. Results: Aspiration was seen in
47.9% of the patients. The most common associated conditions were
neurological disease and prematurity. The most frequently observed
endoscopic finding was altered laryngeal sensitivity (36.5%).
Intervention was recommended in 54.2 % of the patients. Complications
were not seen during any of the procedures. Conclusions: The FEES
procedure performed by pediatric pulmonologists is a reliable method for
diagnosing aspiration in children. It can be safely executed by trained
pulmonologists, and significant endoscopic signs other than aspiration
can guide in the diagnosis and management recommendations.