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The faculty of the MEEI Otolaryngology Service care for children with a variety of airway, voice, and swallowing disorders. The following is a short list of some of the particular problems treated.
Pediatric airway anomalies require comprehensive diagnostic evaluation and management. The MEEI Pediatric Otolaryngology division utilizes state-of-the-art equipment and has extensive capacity for video documentation. In providing for the comprehensive management of pediatric airway disease, we use a multidisciplinary team approach. In addition, facilities also exist for extensive support services, including pediatric polysomnography, audiology, speech therapy, and swallowing evaluation.
This is the most common cause of stridor (noisiness with breathing) that affects
children. Laryngomalacia generally develops over the first several months
of life and then resolves by eighteen months to two years of age. Children
need to be evaluated if they are having difficulty breathing or if the breathing
pattern is interfering with the ability to eat and drink and therefore to
gain weight.
This is the second most common cause of stridor in children. Treatment for
this disorder varies and depends upon whether one or both vocal cords are
affected and how severe the child's breathing disorder is.
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Children may be born with narrowing of their airway just below the vocal cords
(the area called the subglottis) or they may develop this form of narrowing
due to being on a ventilator and needing to have a breathing tube (an endotracheal
tube) for a prolonged period of time. Treatment of this disorder depends on
the severity of the stenosis. Options include watchful waiting, tracheotomy,
anterior cricoid split, laryngotracheal reconstruction, and cricotracheal
resection. An accurate diagnosis by means of bronchoscopy is essential in
order to develop an appropriate and individualized plan of action. This is
an area of active and clinical research interest within the Pediatric Otolaryngology
division.
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Tracheostomy resource website: www.tracheostomy.com
Children may be born with a variety of other congenital anomalies that effect their ability to breathe. The most important first step is an accurate diagnosis in order to develop a comprehensive plan of action. Laryngeal Clefts are uncommon disorders that generally present with a combination of airway issues such as recurrent pneumonias as well as with various degrees of feeding issues. Subglottic Hemangiomas generally present during the first months of life and can vary in their severity. Tracheoesophageal fistulae also present with a combination of breathing and feeding symptoms. Tracheal stenosis is likewise rare; such children demonstrate activity limitations or experience difficulties with intubation if anesthesia is required for other reasons.
- are uncommon airway findings that present with stridor usually from birth.
-
are uncommon disorders that generally present with a combination of airway
issues such as recurrent pneumonias as well as with various degrees of feeding
issues.
-
are uncommon airway findings that present with stridor usually from birth.
The severity of breathing depends upon the extent of the web.
- generally present during the first months of life and can vary in their
severity.
- also present with a combination of breathing and feeding symptoms. These
fistulae are associated with a significant incidence of tracheomalacia (see
photo).
Abnormalities of voice (dysphonias) are common in children of all ages. Hoarseness and nasality are particularly prevalent. Sometimes these problems are evident as soon as the child begins to use their voice, even in infancy. Sometimes they are not evident until the child begins speaking.
Drs. Cunningham, Hartnick, and Mankarious, treat children with voice disorders as an important part of the care offered at Massachusetts Eye and Ear Infirmary, in concert with both the Voice and Speech Laboratory at the MEEI as well as with the Speech and Language Pathology division within Massachusetts General Hospital. Particular areas addressed include the diagnosis and treatment of laryngopharyngeal reflux disease (heartburn that affects the voice box), the diagnosis and treatment of vocal cord nodules and cysts, and the diagnosis and treatment of hypernasality due to velopharyngeal insufficiency (VPI). VPI is a condition where there is incomplete closure of the nasal passages from the oral passages with speech. Children can either be born with this or, rarely, it can develop after surgical procedures such as an adenoidectomy.
Evaluation of children with voice disorders requires a combination of careful
assessment and then endoscopy. Parents also are closely questioned for their
perceptions of the problem. Treatment is individually tailored.
Children may present with a variety of feeding issues that may be behavioral or may be due in part to anatomic abnormalities such as relating to cardiopulmonary, neurologic, or gastrointestinal systems. A careful history is necessary to differentiate between these causes.
Evaluation then is facilitated by both radiographic imaging as well as by direct observation of the swallowing process. Dr. Hartnick works closely with the Speech and Swallowing Team at Massachusetts General Hospital to perform FEES (Functional Endoscopic Evaluations of Swallowing) evaluations. Modified Barium swallows are also performed.
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