Airway findings in children with tracheostomies: When is diagnostic bronchoscopy and laryngoscopy indicated?

OBJECTIVES: To determine the utility of diagnostic laryngoscopy and bronchoscopy in children with tracheostomies and to describe the incidence of airway findings. METHODS: Retrospective cohort study examining children with tracheostomies who underwent direct laryngoscopy and bronchoscopy (DLB) at Duke University Hospital between 2008 and 2016. RESULTS: A total of 81 patients who underwent 114 bronchoscopies met inclusion criteria. The median time between tracheostomy and first DLB was 13 months (IQR 4.25-14.75). Sixty-six patients were diagnosed with findings on DLB (81.5%). Suprastomal granulation tissue was the most common complication (59.0%), followed by increased tracheal secretions (23%), stomal and peristomal granulation (13.2%), tracheal ulcer (3.3%), and suprastomal collapse (1.6%). The proportion of patients with airway findings who underwent endoscopy >6 months post-tracheostomy was higher than those <6 months post-tracheostomy, although this did not reach statistical significance (90.6% vs. 75.5%, p = 0.087). However, when examining tracheostomy-related findings, the proportion of patients with airway findings who underwent DLB >6 months post-tracheostomy (61%) compared to <6 months post-tracheostomy (36%) was significantly different (p = 0.026). Patients who were symptomatic before bronchoscopy were more likely to have positive findings (91.9% vs. 72.7%, p = 0.027) and patients were more likely to be symptomatic if they had DLB >6 months after tracheostomy versus <6 months after tracheostomy (68.8% vs. 30.6%; p < 0.001). CONCLUSION: The high incidence of airway findings, especially tracheostomy-related findings, noted on DLB supports the continued use of airway endoscopies in children post-tracheostomy. Timing of DLB may play a role in determining utility with evaluation and symptomatic patients should be more closely monitored as they demonstrate higher rates of airway findings.

Longitudinal evaluation of quality of life in Laryngeal Cancer patients treated with surgery.

BACKGROUND: There is insufficient prospective data on quality of life outcomes for laryngeal cancer patients undergoing surgery, especially in low- and middle-income countries. This limits clinical and patient decision-making, and survivorship expectations. This research aimed to define longitudinal changes in quality of life in patients with laryngeal cancer from the pre-operative to post-operative period. MATERIALS AND METHODS: A prospective cohort with primary laryngeal cancer treated with standard-of-care surgery who have completed a minimum follow-up of 1 year were evaluated. Patients underwent one of three standard-of-care surgical treatments: transoral laser microsurgery, open partial laryngectomy and total laryngectomy. Patients completed the EORTC-C30 quality of life questionnaire and associated Head and Neck module (EORTC-H&N35) pre- and post-operatively at 1, 3, 6, and 12 months. Global, functional- and symptom-related domains were assessed. RESULTS: 140 patients participated in the study (135 males and 5 females, mean [SD] age 57.0 [7.8] years). Patients were grouped based on primary surgical treatment: (Group 1-transoral laser microsurgery; Group 2-open partial laryngectomy; Group 3-total laryngectomy). In Group 1, a significant decline at 3 months was reported in all five functional scales and five symptom scales: speech, social eating, cough, appetite, and fatigue. In Group 2, significant decline at 1 month post-operative period was seen in the global health scale, all five functional scales and six symptom scales: speech, social eating, cough, appetite, sexuality, and feeling ill. In Group 3, significant decline without return to baseline was seen in the global health scale, all five functional scales and six symptom scales: speech, sense, cough, sticky saliva, sexuality, and social contact. These scores were lowest at 1 month post-op. CONCLUSIONS: Significant changes in quality of life domains after laryngeal cancer surgery were identified. This research provides critical information for improving clinical and patient decision-making and for informing survivorship expectations for those undergoing surgery for laryngeal cancer.