6 / 20
Page 74
Volume 09
Otolaryngology: Open Access
ISSN: 2161-119X
ENT 2019
Craniofacial Surgery 2019
August 15-17, 2019
JOINT EVENT
conferenceseries
.com
August 15-17, 2019 Rome, Italy
&
3
rd
International Conference on
Craniofacial Surgery
4
th
European Otolaryngology-ENT Surgery Conference
Speech-Therapy Performance with Laryngomalacia patients
Roseane Rebelo S. Meira
University of Campinas, Brazil
Introduction:
The dysphagia is a symptom that is characterized by the difficulty in the bolus transit between the
mouth and stomach, which may cause deviations in this path, with obstruction or not of the respiratory passages. The
causes that affect the coordination sucking-swallowing-breathing are numerous. Among these causes of pediatric
dysphagia there are the abnormalities of the upper airway, as the laryngomalacia (LM). The LM is a laryngeal
malformation that affects the supraglottic area and is characterized by the colapse of the laryngeal supraglottic
structures, epiglottis, arytenoid mucosa and aryepiglottic folds during the inhalation. This is the most commom
cause for childhood laryngeal rattling (50 to 70%) and the biggest cause for larynx congenital abnormality. The LM
diagnosis is accomplished through a nasofibrolaryngoscop exam, carried out by the otolaryngologist that detects the
characteristic abnormalities, besides excluding other pathologies. The symptoms should disappear between 18 – 24
months and 10% of the cases need surgical treatment. Besides the rattling, patients with LM can present alimentary
difficulties, with weight gain, dysphagia, aspiration, apnea, cyanosis, gastro-oesophageal reflux, obstructive sleep
apnea and, in the severe cases, pulmonar hypertension. The gastro-oesophageal reflux disease is an important
comorbidity of LM. The LM cause is not clear yet. Nowadays, the most accepted theory suggests that children with
LM perform an alteration of the laryngeal tônus and of the integrative function sensorimotor. The LM is classified
in three degrees: slight, mild and severe, and it’s based only on the symptomatic performance. In slight cases only
the rattling is involved. As to the mild cases, it also occurs chokes and alimentary difficulties. During the swallowing
occurs the interruptions of breathing. Therefore children with airway impairment or others respiratory difficulties
may not be able to safely coordinate the suction, swallow and breath functions, leading into a dysphagia and a
possible aspiration. In these cases, it’s possible to exist cough, chokes, cyanosis and respiratory sounds, which can be
related to the laryngotracheal penetration or aspiration. There is also the possibility of having an increased time in
the ingestion of food and difficulty in weight gain.
Objective:
To emphasize the necessity of speech therapy assistance in the LM cases.
Method:
The evaluation of swallowing is held according to the symptoms, clinical evaluations of swallowing carried
by a speech therapist and instrumental studies of objective evaluations of swallowing, including VF and VED.
In the LM cases, 50,3% of the patients report dysphagia symptoms or alimentary difficulties and 9,6% of the patients
have difficulty in weight gain. When these patients are clinically evaluated and with complementary exams, this
incidence increases, thus suggesting cases of silent aspiration.
Result:
The main objective of the speech-therapy intervention in these cases is to promote a safe feeding, efficient
and pleasant. In this regard, it is necessary to have a therapy with the focus on orofacial motricity aiming to have an
adequacy of the orofacial musculature (sensitivity, tonus and force) and its orofacial functions, therefore improving
the standard of sucking-swallowing-breathing. Besides that, in some cases it is necessary to make an adaptation of
consistencies and tools to improve the control of the flow and of the food volume.
Biography
Dr Roseane Rebelo S. Meira is a speechtherapist specialized in swallowing disorders with several international courses. She has been seeing baby pacients
for 27 years with large experience in breastfeeding and cheewing issues. She has been teaching in neonatology courses for speechtherapists for 15 years,
contributing to the training of new professionals.
Roseane Rebelo S. Meira, Otolaryngol (Sunnyvale) 2019, Volume 09