Vocal cord dysfunction following esophageal atresia and tracheoesophageal fistula (EA/TEF) repair

Samuel W Fung; Eveline Lapidus-Krol; Monping Chiang; Erica M Fallon; Beth Haliburton; Evan J Propst; Priscilla Pl Chiu

doi:10.1016/j.jpedsurg.2018.08.041

Vocal cord dysfunction following esophageal atresia and tracheoesophageal fistula (EA/TEF) repair

J Pediatr Surg. 2019 Aug;54(8):1551-1556. doi: 10.1016/j.jpedsurg.2018.08.041. Epub 2018 Sep 9.

Authors

Samuel W Fung¹, Eveline Lapidus-Krol¹, Monping Chiang¹, Erica M Fallon¹, Beth Haliburton¹, Evan J Propst², Priscilla Pl Chiu³

Affiliations

¹ Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, ON, Canada.
² Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, ON, Canada.
³ Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, ON, Canada. Electronic address: priscilla.chiu@sickkids.ca.

PMID: 30274710
DOI: 10.1016/j.jpedsurg.2018.08.041

Abstract

Background: The purpose of this study was to determine risk factors and long-term outcomes in patients with esophageal atresia +/-tracheoesophageal fistula (EA/TEF) with vocal cord dysfunction (VCD) owing to recurrent laryngeal nerve (RLN) injury.

Method: A retrospective chart review was performed for EA/TEF patients repaired at our institution from 1999 to 2014 (REB #1000032265).

Results: Of 197 patients, 22 (11.2%) were diagnosed with VCD by indirect laryngoscopy following EA/TEF repair. Aspiration was documented on video swallow study for 21 patients, and as a result, 13 required thickened feeds and 8 required gastrostomy tube feeds. Of the 16 H-type TEF patients, 8 (50%) had VCD. Following discharge, 20 (90.9%) patients with VCD eventually tolerated full feeds orally without aspiration but only 8 (36.4%) had documented recovery of vocal cord movement at long-term follow up (mean 452 days). Overall, patients with VCD were more likely to have feeding modifications, increased exposure to radiological studies, and increased frequency of Otolaryngology follow-up compared to EA/TEF patients without VCD.

Conclusion: EA/TEF patients are at risk for VCD. Clinical improvement did not always correlate with recovery of VC motion. Strategies to minimize RLN damage will improve outcomes and quality of life for EA/TEF patients.

Level of evidence: Level III.

Keywords: Aspiration; Esophageal atresia; Palsy; Recurrent laryngeal nerve; Tracheoesophageal fistula; Vocal cord.

MeSH terms

Digestive System Surgical Procedures / adverse effects*
Esophageal Atresia / surgery*
Humans
Laryngoscopy
Recurrent Laryngeal Nerve Injuries*
Retrospective Studies
Risk Factors
Tracheoesophageal Fistula / surgery*
Vocal Cord Dysfunction*