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Scientific Oral Presentation

Pediatric Otolaryngology

Dysphagia Severity and Aspiration Outcomes After Chiari I Decompression in Children

Monday, October 19, 2026
9:48 AM - 9:54 AM PT
Location: 409AB

    Presenting Author(s)

  • Ammar M. Hudefi, BS

    Medical Student
    University of Arkansas for Medical Sciences
    Little Rock, AR, United States

    • Co-Author(s)

  • KN

    Kenny Nguyen, MD, MEd

    ENT Clinical Research Fellow
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

    • Co-Author(s)

  • SR

    Sebastian Rodriguez-Torres, MD

    Otolaryngology Resident
    University of Arkansas for Medical Sciences, United States

    • Senior Author(s)

  • Adrian Williamson, IV, MD

    Attending Physician
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

  • SG

    Stephanie Greene, MD

    Chief of Pediatric Neurosurgery
    Duke Children’s Hospital, United States

Disclosure(s):
Adrian Williamson, MD, IV:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Dysphagia is a clinically significant but underrecognized manifestation of Chiari I malformation in children, with potential consequences including feeding difficulty, aspiration, and airway compromise. Although posterior fossa decompression is routinely performed for neurologic indications, its impact on swallow function and aspiration risk in pediatric patients remains poorly characterized.

Methods: A retrospective review was performed of children with Chiari I malformation who underwent decompression at a single tertiary pediatric center and had pre- and postoperative videofluoroscopic swallow evaluation. Swallow studies closest to surgery were graded by worst observed impairment, including across consistencies, with dysphagia analyzed as an ordinal outcome. Demographic and perioperative variables were collected. Multivariable logistic and ordinal regression models adjusted for age, sex, body mass index, and reflux status were used to assess postoperative changes.

Results: Forty-nine patients met inclusion criteria (median age 6.3 years; 44.9% male). Preoperative swallow studies demonstrated dysphagia in 54.5% of patients, with penetration and aspiration observed across thin and thickened liquids; gastroesophageal reflux was present in 43.9%, vocal cord dysfunction in 14.6%, and laryngomalacia in 9.8%. After CD, proportion of patients with dysphagia decreased to 18.2% (odds ratio [OR] 0.02; 95% confidence interval [CI], 0.00-0.42; p=0.040). Ordinal analysis demonstrated a significant postoperative shift toward less severe swallow dysfunction (OR 0.07; 95% CI, 0.00-0.68; p=0.041). Among patients with paired swallow studies, penetration and aspiration events were reduced following decompression.

Conclusions: Chiari I decompression is associated with significant improvement in swallowing function and aspiration risk in children with dysphagia. These findings support the role of objective swallow evaluation in symptomatic patients and suggest that decompression may confer meaningful aerodigestive benefits in addition to neurologic symptom improvement.