Research by Dr. John McClay has resulted in extensive publications on the management of pediatric airway pathology. A customized treatment approach is developed for each child to address minor variances that occur. Your child will be evaluated by Dr. McClay and his experienced staff which includes experts in speech and swallowing and the leading consultants in airway care.
What are Pediatric Voice and Airway Disorders?
Pediatric airway disorders can result from pathology to the nose, throat (pharynx), trachea (major windpipe) and bronchi (branches of the trachea to the lungs).
Diagnosis and Treatment of Pediatric Airway Disorders
Dr. McClay is an internationally recognized leader in the diagnosis and treatment of airway disorders in children. His extensive experience in pediatric airway surgery has culminated in numerous peer-reviewed research articles
Signs and Symptoms of Pediatric Airway Disorders
Symptoms of pediatric airway disorders can vary by type. Some of the common symptoms include noisy breathing (stridor), coughing, wheezing, shortness of breath with or without exertion and seeing your child not keep up physically with their peers.
Prolonged and unaddressed pediatric airway disorders can lead to adverse effects on a child’s body including the cardiovascular system, neurocognitive function, growth, and behavior.
Dr. McClay provides highly-specialized care for children with a wide variety of airway disorders, including:
- Congenital airway defects – present at birth
- Nasal obstruction – choanal atresia
- Pyriform aperture stenosis
- Airway foreign bodes
- Laryngomalacia – a congenital laryngeal anomaly
- Laryngeal clefts
- Tracheal disorders – subglottic stenosis
- Airway problems due to prolonged tracheal intubation with an endotracheal tube
- Tracheal trauma
- Voice disorders – vocal cord paralysis
- Swallowing disorders
- Esophageal foreign bodes
Pediatric Airway Surgery
If Dr. McClay determines that your child’s condition requires surgery, he performs both complex and common pediatric airway surgeries along with ear, nose, throat and sinus surgeries. He performs state-of-the-art airway reconstructive procedures utilizing advanced equipment in endoscopic and laser surgery. He performs these procedures at the local children’s hospitals utilizing board certified pediatric anesthesiologists and experienced staff. Management is tailored to each condition and its degree of severity.
- Endoscopic Direct Laryngscopy and Bronchoscopy (DLB)
- Laryngotracheal reconstruction
- Cricotracheal resection
- Laryngotracheal cleft repair
- Nasal surgery
- Ear surgery
- Sinus Surgery
Laryngomalacia is a congenital condition in which the larynx does not fully develop causing the tissue above the vocal cords to be floppy and fall into the airway. Children with laryngomalacia often exhibit noisy breathing when inhaling (stridor). While the majority of babies outgrow laryngomalacia, other problems can accompany laryngomalacia if it is moderate to severe, including:
- Failure to thrive
- Choking on or vomiting up food
- Gastroesophageal reflux (GER): Condition in which food or stomach acid comes back up into the esophagus, larynx, or throat
- Chest/neck retraction
For mild symptoms, treatment may not be necessary, however, if laryngomalacia is severe, surgery to trim the floppy tissue (supraglottoplasty) may be required.
Airway Obstruction in Children
Airway obstruction in children can be caused by various congenital disorders, as well as inflammatory conditions. Causes of airway obstruction can include:
- Subglottic stenosis (SGS): Narrowing of the airway just below the vocal cords
- Laryngomalacia: Underdeveloped larynx causes the tissue to block the airway
- Foreign bodies: Aspirated or swallowed material
- Allergic reaction
Treatment for airway obstruction will depend on the cause, severity, and urgency involved.
A tracheostomy is a small opening performed surgically in the front of the neck into the windpipe (trachea) in which a special tube (tracheostomy tube) is inserted to assist in breathing. Pediatric tracheostomy is typically performed on children with severe breathing difficulties due to narrowing or obstruction of the upper airway. Tracheostomy is often recommended for patients who require prolonged ventilation.
Voice Disorders/Hoarseness in Children
Voice disorders in children often present as hoarseness or harshness in the voice or a voice which sounds too high, low, loud, raspy, or nasally. Most voice disorders are caused by overusing the voice and are usually harmless and can be treated with resting the voice and avoiding the activity which caused the hoarseness. Some medical conditions can also cause voice problems, including:
- Infections/inflammation in the throat
- Vocal cord nodules, cysts, or polyps: Benign lesions on the vocal cords
- Rare causes of voice disorders in children are:
- Recurrent respiratory papillomatosis (RRP): Wart-like growths on the vocal cords
- Depending on the cause of the voice disorder, treatment may involve voice therapy or in rare instances, surgery.
Vocal Cord Lesions
Vocal cord lesions, or vocal fold lesions, are noncancerous growths that can form on one or both sides of the vocal cords. Vocal cord lesions in children can form in utero or be caused by overuse or misuse of the voice. Types of vocal cord lesions are:
- Vocal cord lesions usually cause hoarseness and/or change in voice quality and treatment depends on the severity of symptoms.
- Vocal cord nodules: Callous-type growths which typically appear on both sides of the vocal cords at mid-point
- Vocal cord cysts: Firm tissue surrounded by a membrane usually near the surface of the vocal cord ligament
- Vocal cord polyps: Growths which vary in size and usually appear on one side of the vocal cord
Vocal Cord Paralysis
Vocal cord paralysis occurs when the vocal cords, which are connected to the nerves which enable sound, are unable to move. Causes for vocal cord paralysis in children include:
- Delay in nerve development and area of the brain responsible for movement
- Head, neck, or chest trauma
- Masses in head, neck or chest
- Neck or chest surgery
- Previous breathing tube replacement
Vocal cord paralysis may resolve on its own, however, if breathing or swallowing problems occur, voice therapy or surgery can sometimes be necessary.
Speech Problems/Disorders in Children
Problems with speech can be due to hearing problems, a brain disorder, structural malformations or genetics. Common speech disorders include:
- Dysarthria: Characterized by weakness in the lips, jaw, and tongue
- Apraxia (oral motor speech disorder): Condition in which the brain has difficulty coordinating muscles to form words
- Stuttering: Repetition of the first part of a word
- Cluttering: Characterized by disorganized speech which sounds jerky instead of smooth
- Articulation disorders: Substitution, omission, or addition of letters and sounds
- Velopharyngeal insufficiency (VPI): Occurs when too much air escapes while articulating certain “pressure” consonants causing them to resonate nasally or sound like a puff, snort, or squeak
Excessive drooling is often caused by swallowing difficulty, possibly from poor tongue and mouth control, and can also be associated with cerebral palsy and other neurodegenerative diseases. Once a serious medical condition has been ruled out, treatment may involve:
- Use of orthodontics
- Posture improvement
- Treatment for nasal blockage
- Medication to reduce saliva production
- Botox injections in the salivary glands
Surgery to treat excessive drooling could be recommended in extremely severe cases.