PEDOT-4062; No of Pages 7 Type 1 laryngeal cleft: Establishing a functional diagnostic and management algorithm Wade Chien a,b , Jean Ashland d,f , Kenan Haver c,f , Stephen C. Hardy c,f , Paula Curren e,f , Christopher J. Hartnick a,b,f, * a Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, MA 02114, United States b Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States c Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States d Department of Speech-Language Pathology, Massachusetts General Hospital, Boston, MA, United States e Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, United States f Pediatric Airway, Voice, and Swallowing Center, Massachusetts Eye & Ear Infirmary and Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, United States Received 30 March 2006; received in revised form 21 July 2006; accepted 23 July 2006 International Journal of Pediatric Otorhinolaryngology (2006) xxx, xxx—xxx www.elsevier.com/locate/ijporl KEYWORDS Laryngeal cleft; Aspiration; Cough; Laryngoplasty; Functional endoscopic evaluation of swallow; Modified barium swallow Summary Objectives: To report our experience with all patients diagnosed with type 1 lar- yngeal cleft over a period of 3 years in our referral practice and to describe a functional diagnostic and management algorithm for children with this disorder. Methods: A prospective longitudinal study in a tertiary care referral center. Twenty pediatric patients diagnosed with type 1 laryngeal cleft in a 3-year period (5/1/2002— 5/1/2005) were included in this study. The incidence, presenting symptoms, diag- nostic procedures, medical and surgical interventions performed, and clinical out- comes were evaluated. Results: The incidence of type 1 laryngeal cleft was 7.6%. Among the 20 patients in this study, aspiration with thin liquids was the most common presenting symptom (18 patients, 90%). Three patients underwent modified barium swallow (MBS) alone, 3 patients underwent functional endoscopic evaluation of swallow (FEES) alone, and 11 patients underwent both MBS and FEES prior to intraoperative endoscopic evaluation. Four patients (20%) were successfully treated with conservative therapy. Sixteen patients (80%) required endoscopic surgical repair after failing a course of conserva- tive measures. The success rate of surgical repair was 94% (15 out of 16 patients). Conclusions: Type 1 laryngeal cleft can be challenging diagnostically. We propose a functional diagnostic and management algorithm that includes MBS, FEES, suspension laryngoscopy with bimanual interarytenoid palpation, and a trial of conservative * Corresponding author at: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, United States. Tel.: +617 573 4206; fax: +617 573 6845. E-mail address: wadechien@hotmail.com (W. Chien). 0165-5876/$ — see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2006.07.021 Please cite this article as: Wade Chien et al., Type 1 laryngeal cleft: Establishing a functional diagnostic and management algorithm, International Journal of Pediatric Otorhinolaryngology (2006), doi:10.1016/j.ijporl.2006.07.021