Aerodigestive / ENT
Also covered as: esophageal atresia · tracheoesophageal fistula · dysphagia · tracheomalacia · eosinophilic esophagitis · aspiration · laryngeal cleft · subglottic stenosis
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
Content of this collection
Foundations
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QUAD #22: What is CHARGE syndrome? with Dr. Catherine Hart
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In this educational video, Dr. Catherine Hart, ENT surgeon at Cincinnati Children’s, provides an overview of CHARGE syndrome, a rare genetic disorder that affects multiple organ systems. Learn about its diagnosis, clinical features, and the
video · 0:59 · Nov 2024
Diagnosis & Workup
2 items
Aerodigestive & Esophageal Surgery: Dual Endoscopy Discussion
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Dr. Todd Ponsky moderates a discussion on the role that dual endoscopy plays in visualization of tracheoesophageal fistulae.
video · 2:22 · Jan 2019
Aerodigestive & Esophageal Surgery: Aspiration in TEFs
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Dr. Michael Rutter moderates a discussion of tracheal esophageal fistula, aspiration, aspiration testing, and esophageal reflux.
video · 5:28 · Jan 2019
Acute Management
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QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video · 7:35 · Mar 2024
Medical Management
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Pediatric Gastroesophageal Reflux Disease
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This podcast is a multidisciplinary discussion on a controversial topic, management of pediatric Gastroesophageal Reflux Disease, amongst Dr. Todd Ponsky, Dr. Rachel Rosen, and Dr. George "Whit" Holcomb.Dr. Rachel Rosen is Director of the A
podcast · 81:04 · Sep 2018
Gastroesophageal Reflux Disease
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This podcast is a multidisciplinary discussion on a controversial topic, management of pediatric Gastroesophageal Reflux Disease, amongst Dr. Todd Ponsky, Dr. Rachel Rosen, and Dr. George "Whit" Holcomb.Dr. Rachel Rosen is Director of the A
podcast · 81:04 · Dec 2020
QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg
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In this episode, Dr. Greg Burg, a pulmonologist at Cincinnati Children’s, discusses the medical management of minor laryngeal clefts, highlighting a comprehensive approach that includes swallow assessments, pulmonary therapies, and long-ter
video · 7:11 · Feb 2025
Surgical Management
8 items
Pediatric Tracheostomy in a 7 year old child Dr. Tamer Ashraf Wafa
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In this video, Tracheostomy is demonstrated in for a seven year.The indication for the procedure was prolonged intubation. The video shows the surgeon's point of view (POV). This video is intended as an education material ans should not rep
video · 2:53 · Jun 2021
Laryngeal Clefts
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Dr. Michael Rutter is and ENT surgeon and the director of the Aerodigestive Center at Cincinnati Children's Hospital Medical Center. In this podcast, he discusses some surgical approaches to laryngeal clefts. This episode is available as an
video · 14:20 · Jun 2021
Laryngotracheal Stenosis
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The surgical management for laryngotracheal stenosis has changed a lot over recent years. Here, Dr. Michael Rutter, MD – the director of the Aerodigestive Center at Cincinnati Children’s Hospital will discuss the principles of both endoscop
video · 16:20 · May 2022
QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video · 5:26 · Dec 2023
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video · 7:36 · Jan 2024
QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video · 8:10 · Mar 2024
QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video · 7:37 · Mar 2024
QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart
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In this video, Dr. Catherine Hart, ENT surgeon at Cincinnati Children’s, discusses the endoscopic repair of minor laryngeal clefts, highlighting key surgical techniques and considerations. She explains the importance of accurately diagnosin
video · 6:01 · Nov 2024
Complications
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QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video · 7:12 · Mar 2024
Evidence & Research
6 items
Article of Interest: Optimal Timing of Tracheostomy in Injured Adolescents
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Check out this weeks APSA article of interest, that YOU should know!
Butler EK, Killien EY, Groner JI, Arbabi S, Vavilala MS, Rivara FP. Optimal Timing of Tracheostomy in Injured Adolescents. Pediatr Crit Care Med. 2021 Jul 1;22(7):629-6
video · 1:34 · Aug 2022
Quick Literature Updates Episode 8
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We’re back with eighth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review four articles covering the most in
video · Jun 2023
Esophageal Surveillance Practices in Esophageal Atresia Patients
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Another article you should know by Cecilia Gigena
"Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network"
Authors: Malcolm N. Hamilton-Hall III, Dana Jungbauer, Christine
video · Jul 2023
Tracheobronchopexy to Avoid Tracheostomy in Esophageal Atresia Patients With Severe Life-Threatening Tracheobronchomalacia
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Hester F Shieh, Russell W Jennings, Thomas E Hamilton , Shawn Izadi , Benjamin Zendejas , C Jason Smithers
Background: Esophageal atresia (EA) is associated with tracheobronchomalacia (TBM), which in its most severe form, causes blue sp
video · 0:50 · Apr 2025
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025
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We are back with another episode of our Journal of Pediatric Surgery article review podcast. This time we have three publications from the second quarter of 2025, April, May and June issues. This time we're talking to editors Drs. George Ho
podcast · 16:35 · Aug 2025
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Kathleen Heller, Brielle V Ochoa, Stephanie F Brierley, Benjamin E Padilla; Pediatric Inguinal Hernia Collaborative Group; Amir Alhajjat, Emily Byrd, Stephanie D Chao, Christopher Clinker, Jose Diaz-Miron, Goeto Dantes, R Scott Eldredge, El
video · 0:54 · Feb 2026
Case-Based Learning
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Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
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Join the multidisciplinary team from Cincinnati Children's Hospital as they review the complexities in the management of Tracheal Esophageal Fistula (TEF). This fast paced live event will feature case presentations, video, and panel discuss
video · 101:09 · Nov 2018
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
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Dr. Todd Ponsky introduces the seminar covering complexities in the management of Tracheal Esophageal Fistula (TEF). Points of interest will include discussion around the "unsalvageable esophagus" and diagnosis of TEF. Dr. Michael Rutter, P
video · 120:59 · Nov 2018
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
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Dr. Michael Rutter presents multiple case studies of patients with esophageal fistulas and repair approaches to each.
video · 108:11 · Jan 2019
In-Depth Reviews
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Aerodigestive Management of Pediatric Aspiration - FULL SHOW
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The Aerodigestive and Esophageal Center at Cincinnati Children’s is internationally known for our team approach to caring for children with airway and esophageal disorders. We have the multidisciplinary expertise to treat even the most comp
video · 157:09 · Jul 2020
QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team
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In this special episode from the QUAD Conference hosted by Cincinnati Children’s, Lizzy Lee takes us inside one of the world’s largest and most advanced multidisciplinary programs for children with complex airway and digestive conditions: t
video · 10:19 · Apr 2025
Patient & Family Education
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QUAD Conference Commercial
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Join us at the Aerodigestive QUAD Conference event from October 10th - 14th in Cincinnati, Ohio!
video · 1:22 · May 2022
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Common questions
More info about tracheostomy?
Tracheostomy involves creating an opening in the trachea to bypass upper airway obstruction. In pediatric cases, a 2-cm transverse incision is placed midway between the cricoid cartilage and suprasternal notch, with the third and fourth tracheal rings serving as the optimal level. The trachea is sharply incised vertically, and non-absorbable stay sutures are placed bilaterally for postoperative tube reinsertion. After tube insertion, air entry is verified on both lungs. Early tracheostomy (before 7 days of intubation) in children decreases ICU length of stay regardless of traumatic brain injury status. In non-TBI patients, tracheostomy before 3 days reduced ICU stay by approximately 16 days.
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Every statement below comes from the recorded discussions, with its speaker and moment.
Gastroesophageal Reflux Disease
The vast majority of kids who have vomiting, respiratory symptoms, and wheezing are more likely to have oropharyngeal dysphagia and aspiration during swallowing than gastroesophageal reflux
clinicalRachel Rosen3:23 ↗
The peak age of reflux is between 4 and 6 months of age
epidemiologicalRachel Rosen4:32 ↗
Proton pump inhibitors are not beneficial in children under the age of 1 because these kids reflux non-acidic gastric content (milk)
clinicalRachel Rosen5:26 ↗
Normal gastric emptying of infants means they still have milk in their stomach for up to 2 to 3 hours; acid production only starts after the 3 hour mark
clinicalRachel Rosen5:45 ↗
Studies have shown both with H2 blockers and PPIs you can get sepsis, UTIs, necrotizing enterocolitis, pneumonias, pharyngitis, upper respiratory infections, and C. diff in young infants
clinicalRachel Rosen7:21 ↗
In kids under the age of 5 presenting with respiratory symptoms, eosinophilic esophagitis is found in about 10% when endoscopy is performed
epidemiologicalRachel Rosen9:53 ↗
The number one presentation of eosinophilic esophagitis in kids under age 5 is chronic cough, followed by vomiting or failure to thrive
clinicalRachel Rosen9:41 ↗
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has eosinophilic esophagitis
guidelineRachel Rosen10:54 ↗
The most likely allergen in eosinophilic esophagitis is dairy in about 60 to 70% of kids
epidemiologicalRachel Rosen11:57 ↗
Macrolides like erythromycin are motilin agonists that make the antrum contract and help with vomiting, plus have anti-inflammatory benefits for the airway and lungs
clinicalRachel Rosen16:28 ↗
There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult
clinicalRachel Rosen17:48 ↗
Reflux is rarely a cause of failure to thrive and respiratory symptoms in infants, especially at 6 months of age when reflux should be improving as solid food is introduced
opinionRachel Rosen19:18 ↗
An upper GI is not a good study for reflux diagnosis; it only helps identify anatomical problems in about 4% of patients
clinicalWhit Holcomb22:38 ↗
The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age
clinicalRachel Rosen28:21 ↗
About 75% of NICU patients with dysphagia managed with NG tubes will not need to go on to gastrostomy
epidemiologicalRachel Rosen28:42 ↗
When gastrostomy goes in for children who aspirate from oropharyngeal dysphagia, their rates of hospitalization are about 15 times higher than if you just fed them by mouth
epidemiologicalRachel Rosen29:37 ↗
Nasogastric tubes in neonates under 3 months of age don't come out that frequently
clinicalRachel Rosen31:13 ↗
If symptoms go away with nasojejunal feeds, reflux likely is playing a role and Nissen may be an option
clinicalRachel Rosen34:09 ↗
Kids who wretch preoperatively are the most miserable post-Nissen because they wretch a lot postoperatively too
clinicalRachel Rosen35:20 ↗
Rome IV criteria define three categories: non-erosive reflux disease (NERD) with abnormal acid burden, reflux hypersensitivity with normal acid but symptom correlation, and functional heartburn with no correlation
guidelineRachel Rosen40:54 ↗
New GERD guidelines recommend treating with PPI for 2 months then attempting to wean, with goal of weaning ideally 2 times per year
guidelineRachel Rosen44:04 ↗
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term
clinicalRachel Rosen45:31 ↗
In a prospective randomized trial of 107 patients using minimal mobilization technique, neither group required a redo fundoplication for transmigration
clinicalWhit Holcomb46:40 ↗
The primary reason for redo fundoplication historically was transmigration of the wrap into the chest
epidemiologicalWhit Holcomb47:08 ↗
By doing minimal mobilization and placing sutures between esophagus and crura, transmigration rate was reduced from 12% to 5%
clinicalWhit Holcomb57:32 ↗
With minimal mobilization alone (no sutures), there was zero transmigration in prospective trial, with only one wrap loosening
clinicalWhit Holcomb58:23 ↗
Kids who aspirate during swallowing and then get a Nissen have saliva pool in their esophagus over the Nissen, leading to gagging, wretching, and coughing
clinicalRachel Rosen49:02 ↗
Blenderized feeds using table food migrate to the antrum away from the LES and cardia, reducing reflux symptoms in neurologically impaired children
clinicalRachel Rosen52:39 ↗
Pyloric Botox works not only for delayed emptying but also with the sensory component that triggers wretching
clinicalRachel Rosen54:19 ↗
Botox doesn't reliably improve gastric emptying but helps significantly with wretching, possibly by affecting sensory mechanisms
clinicalRachel Rosen68:18 ↗