What to Know About Complex Airway Procedures for Kids
When infant snoring crosses into “noisy breathing”—high-pitched, squeaky sounds, and choking while feeding—it’s time for a trip to the pediatric ear, nose, and throat specialist, saysSteven Rosenblatt, MD.
Physicians may want to rule out acomplex airway conditionthat would require more intervention.
To find the source ofthe baby’snoisy breathing,also called stridor,ENT specialists evaluate the child’s upper airway with an endoscope—a flexible tube that goes through the nose toviewthe airway, saysDr. Rosenblatt,assistantprofessorin thedepartment of otolaryngology-head and neck surgery atNewYorkPresbyterian-Ƶ.
Common causes of stridor
Theofstridoris acondition calledlaryngomalacia.Itoccurswhen thesupportive cartilage of the voicebox is soft and floppy, and there isexcessor“feathering”of mucosaltissue, whichlines the mouth and throat.
“Most kids with this condition need supportive care in the form of feeding modifications,feeding therapy or diet modifications,” Dr. Rosenblatt explains. “And some will needasurgerycalled asupraglottoplastyto correct the conditionby removing the redundant tissue.”
Children typically stay in the hospital for one night following the procedure.
Treatingsubglottic stenosis
Dr. Rosenblatt alsotreats patientswho are experiencing a narrowing below the vocal cordscalled subglottic stenosis.
“This can be the result of scar tissueleft behindby a previous, or sometimes it can be congenital,”Dr. Rosenblatt explains. “A breathing tube is life-saving, but when there has been prolonged intubation,we sometimes have to managethescar tissue.”
Surgeonsuse two methods to enlargetheairway.One involves using anendoscope and tiny camerasthat gothrough the mouth,with no surgical cuts on the outside. If thechild’sairway isparticularlysmall,theycan perform an open surgery that enlarges the airway with a graft—in this case, a piece of cartilage from the neck or a rib.
“We use the child’s own tissue, rather than foreign material to augment or enlarge that narrowing and allow the child to breathe,”Dr. Rosenblatt adds.
Treating aspiration
He also notes that—whenfood or liquids goes through the vocal cords into the airway, instead of going down the esophagus and into the stomach—is another condition that he sees in his pediatric practice,thoughanyonecan experience it.
“But if parents notice that a child is routinely coughingwhen drinkingthin liquids, and suffering from recurrent pneumonia or lung infections, the cause cansometimesbe silent aspiration,” he says.
Some patients have a small divot in the back of the larynx and vocal cords that are causing aspiration.
“We all think that the most important job of the vocal cords is toproduce voice, but the most primitive purpose isfor itto keep things from going down the wrong pipe,” Dr. Rosenblattsays. “When kids are aspirating, wewouldwant torule out laryngeal cleft, and only makethatdiagnosis in an operating room by looking directlyat the larynxand touching it with different types of instruments to see if it’sthere.”
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