Voice, Airway, and Swallowing Function in Patients With Smoke Inhalation Injury to the Upper Airway-A Single Institution Review.

Voice and swallowing dysfunction are common after smoke inhalation injury; however, burn survivors often do not seek follow-up for ongoing dysphonia, dysphagia, or exercise intolerance, which may be a result of undiagnosed airway scarring or stenosis. The aim of this study is to evaluate trends in dysphonia, dysphagia, and upper airway injury after smoke inhalation injury. A retrospective case series with chart review was performed of all patients admitted with smoke inhalation injury from 2018 to 2022. Patient demographics, injury patterns, voice, airway, and swallowing symptoms, laryngoscopic findings, swallowing evaluations, and hospital course were collected. Fifty patients met inclusion criteria, of whom 36 (72%) were males and 14 (28%) were females. Ages ranged from 20 to 79 (mean 48.2) years. Forty patients (80%) underwent flexible laryngoscopy during admission, of which 80% had abnormalities. Patient-reported dysphonia had a positive predictive value of 76% for abnormal laryngoscopic findings. Patient-reported dysphagia had a positive predictive value of 100% for abnormalities on clinical or instrumental swallowing evaluation but a < 30% negative predictive value. Eight patients were seen in follow-up by Otolaryngology, of whom 75% had abnormal laryngoscopic findings and 50% required surgery for airway stenosis. Although patient symptoms were highly predictive of abnormal findings on laryngoscopy and swallowing evaluation, objective evidence of dysphagia was also very common in asymptomatic patients. Universal Speech-Language Pathology assessment would allow for early detection of swallowing dysfunction in this patient population and long-term follow-up is warranted to avoid missed injuries or delays in care.