The Aerodigestive Program focuses on the treatment of complex and often interrelated disorders of the aerodigestive tract, which includes the throat, lungs, esophagus and stomach. The following are airway, breathing, digestive and swallowing disorders seen in our program:
Conditions We Treat
Esophagus achalasia is a rare, progressive disorder caused by nerve damage. It is characterized by an enlarged esophagus, impaired ability to swallow and failure of the lower esophageal sphincter to relax. Malnutrition, chest pain and respiratory difficulties are among the complications. Specific treatments meant to relieve symptoms do not cure achalasia.
A child’s airway includes the trachea. Due to its small size, it can easily become blocked by objects such as food and coins that restrict breathing. It is possible the child may cough up the item. However, seek emergency care if your child is struggling to breathe or turning blue.
Apnea is a sleep disorder in which breathing stops and starts causing sleep disruption and a decrease in oxygen levels. Central sleep apnea happens when the muscles that control breathing do not receive the proper signals from the brain. Obstructive sleep apnea occurs more commonly due to relaxed throat muscles blocking airflow. Many effective treatments are available, including steroids, use of a CPAP, and surgery to remove the tonsils or adenoids.
Asthma is the most common chronic disease among children in the U.S. It causes the airways in the lungs to narrow and swell, which results in repeated episodes of wheezing, breathlessness and coughing. While it can’t be cured, it can be managed with medication and avoidance of everyday triggers such as allergens, dust and pet dander.
Bronchomalacia is the collapse of the airways that branch to each lung from the trachea. Due to narrowing of the trachea, exhalation is difficult, which results in coughing, noisy breathing, respiratory infections and other problems. Surgery may be necessary if the child still has difficulty breathing, problems with choking or other concerns after medical treatments.
Bronchopulmonary dysplasia is a chronic lung disease faced by premature babies. Breathing support with oxygen or mechanical ventilation is required to assist their under-developed lungs with providing oxygen to the body, which in turn may scar the lungs. Babies with BPD may continue to have persistent breathing issues and an increased risk for respiratory infection.
Caustic substances include chemicals in household cleaning products such as bleach and oven cleaner. When children ingest these materials, acute esophageal and gastric injury can result and with them long-term complications. The resulting tissue damage is referred to as stricture and causes difficulty breathing. Call 911 if your child is having difficulty breathing.
In children with dysphagia (difficulty swallowing food and liquids), chronic aspiration occurs when the child repeatedly gets food, drink or undigested stomach contents back up into their airway and lungs. Chronic aspiration can cause several respiratory issues such as chronic cough, bronchiolitis or pneumonia. Depending on what is causing the chronic aspiration, a feeding plan might be the first step in treatment. Surgery may be needed if the cause is due to an anatomic problem.
For most children, a cough will go away within two weeks, depending on the underlying cause. A cough that lasts four weeks or more is considered a chronic cough. Among the many causes are protracted bacterial bronchitis, asthma and/or an anatomical abnormality. A child should be seen by a doctor to find the underlying cause.
Abnormalities of the face and skull present at birth fall into categories of craniofacial syndromes, which generally result in distinctive facial abnormalities. The two major categories are craniosynostosis (a congenital disorder affecting cranial fusion) and those connected to clefts. Craniofacial malformations range from mild or severe, therefore surgical treatments require a multidisciplinary approach due to potential complications.
This problem occurs when the cricopharyngeal muscle at the top of the esophagus, also called the upper esophageal sphincter (UES), cannot relax, which can cause difficulty swallowing (dysphagia), choking, regurgitation of food and drink, and breathing difficulties. Treatment may include muscle myotomy in which the UES is cut, Botox injections and dilation.
Dysphagia is a painful condition that causes difficulty with swallowing foods and liquids; in some cases, swallowing is impossible. Treatments include medicines to treat acid reflux, swallowing therapy and a feeding tube. If your child is having trouble swallowing or breathing, call for emergency help right away.
Eosinophilic esophagitis is a chronic inflammatory condition of the esophagus that causes difficulty swallowing, which can lead to a variety of symptoms including discomfort and vomiting. Treatments to reduce inflammation include dietary changes, medication, or both.
This rare birth defect results in a malformed esophagus with two separate segments that do not connect. Esophageal atresia (EA) and tracheoesophageal fistula (TEF) – an abnormal connection between the esophagus and the trachea – often occur together along with other birth defects. These potentially life-threatening conditions must be treated shortly after birth so the child will be able to receive nutrition by mouth.
Esophageal webs and strictures are conditions that restrict the flow of foods and liquids during swallowing. Esophageal webs refer to thin bands of scar tissue in the lining and stricture refers to narrowing of the esophagus. The main treatment method is dilation. If not effective, surgery may be recommended.
Inadequate nutrition causes decelerated or arrested physical growth referred to as failure to thrive. More than one complex medical, social and environmental issue may contribute to this condition. Once these are determined, a treatment plan can be developed.
Children with food intolerances have difficulty digesting certain foods caused by problems in the digestive system, such as insufficient or lack of digestive enzymes. An elimination diet can test which foods cause problems for the child. So that nutrition intake isn’t limited by cutting out certain foods, patients are advised to work with a physician and registered dietician
Gastroesophageal reflux disorder is a digestive problem caused by acidic gastric contents traveling from the stomach back into the esophagus. Children often outgrow GERD. If it remains an issue, reflux can cause esophageal damage, poor weight gain and pain if not treated with medication, dietary changes or possible surgery.
Glottic stenosis is a narrowing of the larynx due to the scarring together of the vocal cords impedes their movement; this in turn causes respiratory distress. It is most commonly the result of prolonged endotracheal intubation. Related conditions include posterior glottic stenosis (narrowing in the back of the vocal fold area) and subglottic stenosis (a narrowing of the airway below the vocal cords). Treatment to cut or divide the scar band may include use of an endoscopic or surgery.
This relatively uncommon birth defect is characterized by incomplete development of the lungs that not only affects breathing but also the overall development of the child. Hypoplastic lung often accompanies other malformations including those of the heart, gut, and genital and urinary organs. A multidisciplinary team of perinatologists, pulmonologists, cardiac surgeons and others will likely be involved in determining which treatment options will be best.
In infants and children, hypoventilation syndromes are rare respiratory disorders that involve inadequate breathing, both during sleep and while awake. Congenital central hypoventilation syndrome (CCHS) is the most common example; another is obesity-related. Treatment involves the use of a respirator or ventilator to support breathing, for some only when sleeping and for others 24 hours per day. Breathing may possibly be controlled by a surgical implant in the diaphragm muscle.
This group of disorders mostly result in progressive scarring of lung tissue, which affects the child’s ability to breathe and oxygenate their blood. Among the diseases are those with genetic and developmental causes. Treatment options may include preventing low oxygen, making it easier for the child to breathe and preventing further damage to the lungs. Lung transplantation may be considered.
A number of eating and breathing problems result from a laryngeal cleft, which is an opening between the child’s larynx and esophagus that allows food and liquid to pass into the lungs. Laryngeal clefts are classified from mild to severe. If medical management strategies are not successful, the child will likely need surgery.
A laryngeal web is generally a congenital abnormality of a fibrous layer of tissue that develops in the larynx, restricting the trachea and causing airway obstruction, respiratory distress and substantial hoarseness. Treatment at an early age is generally successful.
Papillomas are benign, wart-like tumors generally caused by infection with or exposure to certain types of the human papillomavirus (HPV). Such tumors in the larynx are called laryngeal papillomatosis. The tumors may spread elsewhere in the respiratory tract, including the trachea and air passages to the lungs. Depending on the quantity and size of the tumors, they may obstruct breathing. Treatment with laser surgery removes the papillomas; however, they are likely to grow back.
This common condition results from a birth defect that causes a partially collapsed larynx. This can result in a high-pitched sound upon inhaling. Most cases resolve over time; surgery may be necessary to open the area above the vocal cords.
Primary ciliary dyskinesia is a group of rare and debilitating genetic disorders in which the cilia – the microscopic hair-like cells that line the upper and lower respiratory tract – are impaired or don’t function properly. PCD can also affect the reproductive organs and the ventricles of the brain. A diminished quality of life is inherent with these conditions to due to chronic respiratory disease and debilitating lung, sinus and ear infections that may damage these areas and possibly result in respiratory failure.
Croup results from an infection that causes a narrowing of the airways. Recurrent croup – more than two episodes per year – may mean the narrowing of the airway is due to a cause other than infection, including anatomic abnormalities such as subglottic stenosis, vocal cord paralysis and laryngotracheal cleft. Treatment will depend on the underlying diagnosis.
Pneumonia is a serious lung infection that causes inflammation of the air sacs; recurrent pneumonia is a potentially dangerous condition in children. It is defined as two or more episodes of pneumonia in one year or three episodes separated by one month asymptomatic. Antibiotics are a common treatment regimen; a child should be hospitalized if experiencing rapid heart rate, difficulty breathing or a low temperature.
This wide spectrum of sleep-related breathing problems includes heavy snoring, breathing through the mouth and sleep apnea (when breathing ceases). Such breathing disorders can adversely affect the child’s quality of life. Treatment options can be behavioral, physical or dietary, or the use of a CPAP or surgical procedures.
Subglottic stenosis is a narrowing of the airway below the vocal cords and above the trachea often caused by scarring in the larynx. It often affects the child’s vocal cords. Treatment depends on the condition’s severity. If the child does not outgrow the problem, endoscopic or open surgery may be required.
Tracheal stenosis is the narrowing of the cartilage that supports the trachea, either because it is congenital or due to injury. If the child does not outgrow the problem, endoscopic or open surgery may be required.
A tracheoesophageal fistula is the abnormal connection between the esophagus and the trachea that results in improper swallowing and the aspiration of liquids and food into your child's lungs. TEF and esophageal atresia (EA) – a malformed esophagus with two separate segments that do not connect – often occur together along with other birth defects. These potentially life-threatening conditions must be treated shortly after birth so the child will be able to receive nutrition by mouth.
Tracheomalacia is the collapse of the trachea when the child exhales, making it difficult to breathe. Recurring respiratory illnesses are common in children with this condition. Although it has mild forms, for some children the condition can life threatening. Call 911 if your child need intervention to breathe properly.
When vocal cords do not move, they are considered paralyzed. Vocal cord paralysis can result from injury to the nerve to the vocal cords or the presence of a growth; either can affect voice production. This sometimes results in swallowing and breathing problems. Treatment options depend on whether one or both of the vocal cords are paralyzed.
