Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P290

P290
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
Speech and Language Outcomes in Children
With Auditory Neuropathy Spectrum
Disorder Managed Without Amplification
Chengetai Ruvimbo Mahomva, MD (Presenter);
Yi-Chun Carol Liu, MD; Samantha Anne, MD

Pediatric

Objectives: The veritable impact of auditory neuropathy
spectrum disorder (ANSD) on speech and language development in children is difficult to delineate because of the heterogeneous presentation and comorbidities often present. The
objective of this study was to evaluate speech and language
outcomes in children with ANSD who were not treated with
amplification for a prolonged time after diagnosis.
Methods: A retrospective chart review of all children with
ANSD at 2 tertiary care institutions was conducted from 2010
to 2019. Inclusion criteria were patients who did not receive
any hearing amplification for a minimum of 2 years and
underwent speech and language testing. Average audiogram
thresholds, results of speech and language testing, and comorbidities were evaluated.
Results: We reviewed 145 patients with ANSD; 10 patients
met the inclusion criteria. The average time these patients
were managed without amplification was 4.49 years. Overall,
80% of the patients had speech and language delay (SLD). In
children with an average of mild-to-moderate hearing thresholds on audiometry, 4 of 6 had SLD. All 4 of the children with
an average of severe-to-profound hearing thresholds had
SLD. All patients with unilateral ANSD had SLD; in bilateral
ANSD patients, 72% had SLD. Comorbidities in patients
with SLD included prematurity, congenital, neurologic, and
cardiopulmonary disorders. In patients without SLD, comorbidities included prematurity, hypothyroidism, and twin-twin
transfusion.
Conclusions: This series of children with ANSD not treated
with amplification for a prolonged time after diagnosis
showed a high incidence of SLD, regardless of comorbidities
and audiologic thresholds. Close surveillance of speech and
language development and early amplification should be
considered.
Surgical Treatment of Type III
Laryngotracheoesophageal Clefts:
Techniques and Outcomes
Yann-Fuu Kou, MD (Presenter); Andrew J. Redmann, MD;
Meredith E. Tabangin, MPH; Matthew Smith, MD;
Charles M. Myer, MD; Catherine K. Hart, MD; Michael J.
Rutter, MD, FRACS; Alessandro de Alarcon, MD
Objectives: This study was conducted to determine surgical
and swallowing outcomes in the treatment of type III laryngotracheoesophageal clefts (LTECs).
Methods: A retrospective chart review was performed on
patients with a diagnosis of type III LTEC between 2010 and
2019. Demographics, comorbidities, surgical outcomes, surgical approach, revision status, and swallowing outcomes were
collected and analyzed.

Results: Thirty-three patients met the inclusion criteria (29
open and 4 endoscopic repairs). The mean age was
34.8 months (range, 1-247 months), and 76% were male.
Sixteen (48%) patients had a syndromic diagnosis, most
commonly Opitz syndrome (7 patients) and trisomy 21 (5
patients). The mean follow-up was 31 months. Thirteen
(39.4%) patients had a previous repair attempt before repair
at our institution. Twenty-one (64%) patients had a tracheostomy at the time of initial repair, and 3 required tracheostomy at the time of repair. Nine patients (27%) required a
revision cleft repair, and 4 (12%) required 2 revisions.
Thirty-one patients had an intact repair at last follow-up
(94%), and 13 patients (39%) remained tracheostomy dependent. One patient died remotely 6 months after cleft repair.
Preoperatively, 13 of 17 patients with swallowing evaluations performed at our institution aspirated. After repair, 17
of 19 patients with swallowing evaluations were deemed
safe for oral intake. Endoscopic approaches were all performed during the last 2 years of the study and had a significantly lower operative time (591 vs 286 minutes).
Conclusions: Endoscopic and open approaches are effective
for the treatment of type III LTECs, with 27% requiring revision and 94% of repairs intact. Of patients with objective postoperative swallow evaluation, 89% were deemed safe to
swallow.
Tongue Base Advancement With Siesta
Encore Suspension System in a 3-Year-Old
Patient
Lara K. Reichert, MD (Presenter); Taher Valika, MD
Objectives: To a complex pediatric patient who underwent
multiple airway interventions, including the youngest known
tongue base suspension.
Methods: Case report.
Results: A 3-year-old patient with history of nonaccidental
trauma, seizure disorder, hydrocephalus, dysphagia with
chronic aspiration, global developmental delay, nocturnal
desaturations, and prior adenotonsillectomy was seen by the
ear, nose, and throat team for airway assessment after polysomnography demonstrated severe mixed sleep apnea with
hypercarbia. Her adoptive family was very interested in
improving her respiratory status and quality of life but hoped
to avoid tracheostomy if possible. Drug-induced sleep endoscopy demonstrated significant tongue base collapse and tight
aryepiglottic folds. She subsequently underwent suprag-
lottoplasty with tongue base suspension using the Encore
tongue-mandible suture suspension system. Subsequent polysomnography showed no obstructive sleep apnea. The patient
continued to require nocturnal supplemental oxygen due to
chronic lung disease from chronic aspiration and hypotonia. To
improve tolerance to nocturnal continuous positive airway pressure therapy, the family ultimately elected for tracheostomy.
Conclusions: This report demonstrates the youngest known
application of the tongue base suspension system for obstructive airway pathology.

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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