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Pediatric otolaryngologists—ear, nose, and throat doctors—at Hassenfeld Children’s Hospital at ºÙºÙÊÓƵ provide expert diagnosis and treatment of many airway abnormalities that affect breathing in children. Our providers offer a compassionate and personalized approach that starts with determining the cause of the airway abnormality. We then create the best treatment plan based on your child’s age and the type of airway obstruction.

If surgery is needed, procedures are performed at Hassenfeld Children’s Hospital—34th Street, which is recognized by the American College of Surgeons as a Level 1 Children’s Surgery Center, the highest designation for surgical care. Patients with airway disorders also see our experts at the Pediatric Aerodigestive Center to help improve airway health.

Conditions We Treat

Airway abnormalities can be congenital, meaning present at birth, or acquired. Symptoms may include stridor, or noisy breathing, along with wheezing, sleep apnea, blue spells, and chest congestion. Our specialists manage the full spectrum of disorders that can block the airway, including these:

• complete tracheal rings, in which the rings of cartilage that form the trachea, or windpipe, are small and O-shaped rather than large and C-shaped
• glottic stenosis, or narrowing of the larynx, commonly known as the voice box
• subglottic stenosis, or narrowing of the airway below the vocal cords
• tracheal stenosis, or narrowing of the trachea
• tracheomalacia, the narrowing or collapse of the airway as your child exhales
• tracheal web, membranous tissue that blocks the trachea
• laryngeal atresia, upper airway blockage that occurs when the larynx does not properly develop in the womb
• laryngeal cleft, an abnormal opening between the voice box and the esophagus
• laryngomalacia, in which tissues located in the throat above the vocal cords are too soft and flop into the airway
• saccular cyst, a cyst that forms in voice box tissue
• subglottic cyst, a cyst that forms just below the vocal cords
• vocal cord paralysis, in which nerve function in one or both vocal cords is disrupted, causing vocal cord tissues to relax and block the airway

Expert Diagnosis

In addition to a medical history and physical exam, our doctors may order imaging tests such as a CT scan or MRI scan to view the structures in your child’s airway to determine what is causing symptoms.

Our doctors may also perform one of the following diagnostic procedures:

• flexible laryngoscopy, in which an endoscope, a thin, flexible tube with a light and camera on the end, is placed through the nose to examine the airway and vocal cords
• microlaryngoscopy, in which an endoscope is placed in the mouth to view the airway and vocal cords
• bronchoscopy, in which an endoscope is inserted through the nose or mouth to examine the lower airways

After a thorough assessment, your child’s doctor can discuss a treatment plan with you.

Personalized Treatment Options

Treatment options vary by condition. Your child’s doctor may recommend watchful waiting to manage laryngomalacia or subglottic stenosis if the condition is mild and does not greatly interfere with breathing. As your child grows, the doctor checks to make sure the airway is enlarging to make more space for airflow.

Other conditions that narrow the trachea or larynx may require surgery. These are some of the surgical procedures our doctors perform:

• laryngotracheal reconstruction, in which surgeons place a graft made from ear, rib, or thyroid cartilage into the airway to make it wider
• cricotracheal resection, in which surgeons remove the narrow part of the airway just below the voice box and then sew the voice box and trachea back together
• slide tracheoplasty, a procedure in which surgeons divide and then make incisions in two sections of the narrow portion of trachea. The surgeons slide one section into the other, creating a shorter but wider airway
• endoscopic airway dilation, in which doctors use an endoscope to insert a balloon that inflates to widen the airway below the vocal cords
• laryngotracheal cleft repair, endoscopic repair of the opening between the voice box and trachea
• supraglottoplasty, a procedure to remove tissue obstructing the upper part of the voice box
• laryngeal reinnervation, to create a nerve supply for a paralyzed vocal cord

If surgery is part of the care plan, child life specialists at Sala Institute for Child and Family Centered Care, are available to provide comfort and support to your child.