# CHARGE Syndrome — GCMD Library living collection

Everything in the library about CHARGE syndrome — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 59 cited statements

## Episodes
### Fundamentals
- [QUAD #22: What is CHARGE syndrome? with Dr. Catherine Hart](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458.md)

### Diagnosis & Workup
- [Aerodigestive & Esophageal Surgery: Aspiration in TEFs](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039) — video · 5:28 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039.md)

### In-Depth Reviews
- [Aerodigestive Management of Pediatric Aspiration - FULL SHOW](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796) — video · 157:09 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=0) Framework for aspiration: causes and what children aspirate (Ep 1)
- [2:34](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=154) Testing for food and drink aspiration (Ep 1)
- [4:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=250) Testing for saliva aspiration (Ep 1)
- [4:52](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=292) Testing for gastroesophageal reflux aspiration (Ep 1)
- [0:04](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4) Defining Pediatric Aspiration and At-Risk Populations (Ep 2)
- [4:55](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=295) Pulmonary Perspective on Chronic Aspiration (Ep 2)
- [11:11](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=671) Swallowing Physiology and Dysphagia Causes (Ep 2)
- [20:30](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1230) Diagnostic Approach: What Is Being Aspirated (Ep 2)
- [26:51](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1611) Instrumental Evaluation: VFSS and FEES (Ep 2)
- [37:22](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2242) Differential Diagnosis of Aspiration (Ep 2)
- [52:29](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3149) Tracheostomy and Aspiration Management (Ep 2)
- [57:37](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3457) Medical Management of Functional Aspiration (Ep 2)
- [67:39](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4059) Surgical Management: Drool Procedures and Laryngotracheal Separation (Ep 2)
- [80:08](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4808) Unilateral Vocal Fold Paralysis Management (Ep 2)
- [87:21](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5241) Tracheoesophageal Fistula: Diagnosis and Endoscopic Repair (Ep 2)
- [100:00](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6000) Open TEF Repair Techniques (Ep 2)
- [109:29](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6569) Slide Tracheoplasty for Complex TEFs (Ep 2)
- [125:00](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7500) Laryngeal Cleft Classification and Endoscopic Repair (Ep 2)
- [141:14](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8474) Open Cleft Repair and Type 4 Clefts (Ep 2)
- [152:34](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=9154) Esophageal Pathology and Pharyngeal Stenosis (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=0) CHARGE Syndrome Definition and Diagnostic Criteria (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Most children who aspirate have a functional or neurological problem." (host_summary) [Ep 1 · 0:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=10)
- "Cerebral palsy and CHARGE syndrome are examples of functional/neurological causes of aspiration." (host_summary) [Ep 1 · 0:16](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=16)
- "Anatomical problems causing aspiration include tracheoesophageal fistula and laryngeal cleft." (host_summary) [Ep 1 · 0:22](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=22)
- "Bad pharyngeal scarring can cause aspiration in some children." (host_summary) [Ep 1 · 0:34](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=34)
- "Esophageal stenosis with backup and spillover can cause aspiration." (host_summary) [Ep 1 · 0:39](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=39)
- "For children who aspirate food and drink, nasogastric tube or gastrostomy tube can be considered." (host_summary) [Ep 1 · 0:53](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=53)
- "Robinul (glycopyrrolate) can be tried for saliva management but generally does not work." (host_summary) [Ep 1 · 1:13](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=73)
- "Botox injection of major salivary glands is a temporary solution and serves as a good test for how a child would cope with less saliva." (host_summary) [Ep 1 · 1:19](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=79)
- "A drool procedure involves removing the submandibular glands and ligating the parotid ducts." (host_summary) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=90)
- "Tracheotomy allows suctioning of the airway clear of secretions." (host_summary) [Ep 1 · 1:38](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=98)
- "BiPAP can be placed on a tracheostomy so that secretions are blown up and out of the mouth." (host_summary) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=105)
- "Laryngotracheal separation is the only guaranteed operation to stop aspiration but results in loss of ability to vocalize." (host_summary) [Ep 1 · 1:53](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=113)
- "Nissen fundoplication or any fundoplication may assist with aspiration of gastroesophageal reflux, as may a GJ tube." (host_summary) [Ep 1 · 2:09](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=129)
- "Children with tight fundoplication and non-motile esophagus can develop accumulation and spillover of esophageal contents leading to aspiration." (host_summary) [Ep 1 · 2:21](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=141)
- "In a child with tracheostomy, the simplest test for aspiration is to put colored dye in the mouth and see if it comes out of the trach tube." — Bob (clinical) [Ep 1 · 2:55](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=175)
- "The dye test can be done at home in a normal setting and repeated, and is helpful to convince skeptical parents that the child is aspirating." — Bob (clinical) [Ep 1 · 3:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=185)
- "Video swallow studies and endoscopic swallow studies can be very useful for testing aspiration." — Bob (clinical) [Ep 1 · 3:18](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=198)
- "There are no unequivocal endoscopic markers of aspiration." — Bob (clinical) [Ep 1 · 3:23](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=203)
- "Lipid-laden macrophages are non-specific markers of aspiration." — Bob (clinical) [Ep 1 · 3:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=215)
- "Recovery of lipid-laden macrophages depends on what material was aspirated, how much lipid it contained, the amount aspirated, and how long since the aspiration event." — Bob (clinical) [Ep 1 · 3:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=215)
- "Lots of lipid-laden macrophages in the right clinical setting provide convincing evidence of aspiration, but it is not a black and white yes/no answer." — Bob (clinical) [Ep 1 · 3:57](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=237)
- "For saliva aspiration testing in a child with tracheotomy, a drop of green food dye on the tongue can be used to see if it comes out the trach tube." (host_summary) [Ep 1 · 4:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=250)
- "Green is a good dye color because it is not natural, unlike red or blue which might be confused with body-produced substances." (host_summary) [Ep 1 · 4:24](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=264)
- "For saliva aspiration testing without tracheotomy, a nuclear medicine scan with a drop of radioactive material on the tongue can show if it ends up in the lungs or stomach." (host_summary) [Ep 1 · 4:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=275)
- "As markers for aspiration, reflux tests are not particularly good." — Phil (clinical) [Ep 1 · 5:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=302)
- "Multi-channel intraluminal impedance testing has mostly replaced simple pH testing for detection of reflux." — Phil (clinical) [Ep 1 · 5:08](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=308)
- "Multi-channel intraluminal impedance testing does not add anything to the diagnosis of aspiration itself; it tells whether something is being delivered from the stomach to the esophagus but not what happens after that." — Phil (clinical) [Ep 1 · 5:08](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=308)
- "The CHARGE acronym stands for coloboma, heart defects, atresia of the choana, retardation of growth and development, genital and/or urinary anomalies, and ear malformations." (clinical) [Ep 3 · 0:00](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=0)
- "CHARGE syndrome is caused by a CHD7 mutation on chromosome 8." (clinical) [Ep 3 · 0:11](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=11)
- "A population of children with CHARGE syndrome will have a negative test for CHD7 but can still have CHARGE syndrome based on clinical criteria." (clinical) [Ep 3 · 0:11](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=11)
- "To make the diagnosis of CHARGE syndrome, you must have at least two of the major criteria." (clinical) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=24)
- "The major criteria for CHARGE syndrome are coloboma, choanal atresia or cleft palate, characteristic ear abnormalities, and cranial nerve abnormalities." (clinical) [Ep 3 · 0:28](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=28)
- "If you have the major criteria, you have CHARGE syndrome independent of other clinical features." (clinical) [Ep 3 · 0:37](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=37)
- "To make a definitive clinical diagnosis of CHARGE syndrome, you need either 3 major features and at least 1 minor feature, or 2 major features and 2 minor features, or the CHD7 mutation." (clinical) [Ep 3 · 0:41](https://library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=41)
- "Aspiration is defined as any solid or liquid matter passing below the vocal cords, though some define it as requiring pulmonary compromise in addition to passage below the cords." — Catherine Hart (host_summary) [Ep 2 · 0:16](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=16)
- "Aspiration can be silent with no clinical indication, or obvious with coughing, choking, and sputtering." — Catherine Hart (host_summary) [Ep 2 · 0:39](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=39)
- "Children with CHARGE syndrome have 80 to 90% prevalence of aspiration at some point in their lifetime and should be assumed to aspirate until proven otherwise." — Catherine Hart (host_summary) [Ep 2 · 1:51](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=111)
- "Children with severe neurologic compromise regardless of etiology should be assumed to aspirate until demonstrated otherwise." — Catherine Hart (host_summary) [Ep 2 · 2:01](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=121)
- "The clinical significance of aspiration depends on the quantity—small isolated events are usually cleared by host defenses (cough, mucociliary transport), while large or repeated events overcome host defenses." — Catherine Hart (host_summary) [Ep 2 · 2:32](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=152)
- "A single aspiration event of caustic substance can have lifelong consequences." — Catherine Hart (host_summary) [Ep 2 · 3:06](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=186)
- "Chronic pulmonary aspiration is defined as repeated aspiration into the lower airways causing pulmonary injury or chronic respiratory disease, with consequences determined by frequency, magnitude, nature of material, and effectiveness of host defenses." — Catherine Hart (clinical) [Ep 2 · 3:31](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=211)
- "Four major groups aspirate: premature babies, those with neurologic disabilities, those with airway disease (anatomic, dynamic, or functional), and those with gastrointestinal disorders." — Catherine Hart (clinical) [Ep 2 · 4:34](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=274)
- "Syndromes with significant swallowing dysfunction include CHARGE, Cri-du-chat, Möbius syndrome (cranial nerve abnormalities), and craniofacial defects like Pfeiffer, Crouzon, and Treacher Collins." — Catherine Hart (host_summary) [Ep 2 · 5:02](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=302)
- "Dysphagia can occur in any of the four swallowing phases (oral preparatory, oral transit, pharyngeal, esophageal) and can result in aspiration or retrograde flow into the nasal cavity." — Claudia Schweiger (host_summary) [Ep 2 · 6:09](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=369)
- "Children who aspirate may present with breathing difficulties during feeding (increased respiratory rate, bradycardia, tachycardia, cyanosis, apnea, desaturation), coughing/choking during or after swallowing, frequent congestion after meals, noisy or wet vocal quality, prolonged meal times, food refusal, or vomiting." — Claudia Schweiger (host_summary) [Ep 2 · 6:48](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=408)
- "Children with associated obstructive airway symptoms (snoring, retractions, stridor, desaturation) should undergo airway endoscopy to look for anatomic causes of dysphagia." — Claudia Schweiger (clinical) [Ep 2 · 10:17](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=617)
- "Video swallow study (VFSS) and functional endoscopic evaluation of swallowing (FEES) are complementary tests that show different things and evaluate different parts of the swallow—it is important to explain to families they are not the same test." — Sandra Stinnett (clinical) [Ep 2 · 16:33](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=993)
- "A radionucleotide spit scan (placing radioactive tracer on tongue) can test for saliva aspiration but involves radiation and is a one-off window in time." — Michael Rutter (host_summary) [Ep 2 · 17:21](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1041)
- "Impedance probe is the best test for gastroesophageal reflux but is not necessarily widely available." — Michael Rutter (clinical) [Ep 2 · 18:05](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1085)
- "Medication for reflux generally stops acid but does not stop reflux events." — Michael Rutter (host_summary) [Ep 2 · 18:31](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1111)
- "CT scanning is excellent for evaluating long-term consequences of aspiration but shows damage already done (tells about the past, not the present) and requires anesthesia, radiation, and radiologic expertise." — Michael Rutter (clinical) [Ep 2 · 19:23](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1163)
- "Lipid-laden macrophages are the most commonly used aspiration biomarker, with a lipid-laden macrophage index >90 or >20% of macrophages containing lipid suggesting aspiration." — Catherine Hart (host_summary) [Ep 2 · 44:25](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2665)
- "Elevated lipid-laden macrophages are not pathognomonic of aspiration—they can result from natural airway debris (dead neutrophils, macrophages from inflammation) or circulation after bleeding or airway surgery." — Catherine Hart (clinical) [Ep 2 · 45:56](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2756)
- "Lipid-laden macrophages are a limited tool because aspirated material has variable lipid content (saliva has no lipid), there is variable time between aspiration and BAL sampling affecting lipid metabolism, and individuals have variable rates of lipid catabolism." — Catherine Hart (clinical) [Ep 2 · 46:38](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2798)
- "Having a tracheostomy tube changes the dynamics of laryngeal elevation but most studies show it does not create aspiration." — Catherine Hart (host_summary) [Ep 2 · 48:08](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2888)
- "Decanulation should not proceed until the child has proven capacity to clear their airway through a prolonged capping trial that includes going through illnesses without needing the tracheostomy for clearance." — Catherine Hart (clinical) [Ep 2 · 49:10](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2950)
- "Speaking valves help with airway clearance by allowing glottic closure for better cough and creating positive end-expiratory pressure that distends airways, even if they do not decrease aspiration coming in." — Catherine Hart (clinical) [Ep 2 · 49:56](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2996)
- "CHARGE patients frequently need tracheostomy or interventions for salivary aspiration at young age but often develop compensatory strategies over time and can be decannulated as they mature." — Sandra Stinnett (clinical) [Ep 2 · 50:54](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3054)
- "The pulmonologist's role in the aerodigestive team is to protect children from developing irreversible long-term pulmonary sequelae while managing anatomic abnormalities or waiting for maturity." — Catherine Hart (opinion) [Ep 2 · 51:44](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3104)
- "Medical management of functional aspiration should target five aspects: decrease aspiration events, improve airway clearance, address quality of aspirated material, control inflammation, and treat or prevent infections." — Catherine Hart (clinical) [Ep 2 · 58:16](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3496)
- "Positive pressure ventilation (CPAP or BiPAP) can decrease aspiration events, especially during sleep in patients with reflux aspiration, even in patients who do not need it for gas exchange or ventilation." — Catherine Hart (clinical) [Ep 2 · 65:45](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3945)
- "Cuff tubes cannot stop aspiration because inflating the cuff enough to decrease leak causes unacceptable tracheal injury or dilation." — Catherine Hart (clinical) [Ep 2 · 64:56](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3896)
- "Passy-Muir valves should never be used during sleep because they allow inhalation through the tracheostomy but not exhalation, risking obstruction from mucus accumulation, and they cause over-drying of secretions leading to mucus plugging." — Catherine Hart (clinical) [Ep 2 · 66:39](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3999)
- "For airway clearance, comorbidities that compromise clearance include tracheobronchomalacia, airway compression/stenosis/hypoplasia, restrictive lung disease (neuromuscular, chest wall deformities, scoliosis), and vocal cord or diaphragmatic dysfunction/paralysis from esophageal or cardiac surgery." — Catherine Hart (host_summary) [Ep 2 · 60:11](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3611)
- "Chronic inflammation from aspiration is managed with inhaled steroids and systemic anti-inflammatory medication (azithromycin, not systemic steroids as first-line), with systemic steroids reserved for acute aspiration events to prevent pneumonitis." — Catherine Hart (clinical) [Ep 2 · 62:17](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3737)
- "Patients with bronchiectasis from chronic aspiration should receive longer antibiotic courses (10-14 days instead of 7-10 days) because bronchiectatic cavities have more difficult clearance." — Catherine Hart (clinical) [Ep 2 · 63:30](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3810)
- "Prophylactic inhaled antibiotics (tobramycin or colistimethate, either every other month or 14 days per month) are reserved for patients with severe bronchiectasis and pulmonary injury or significant frequency of infections." — Catherine Hart (clinical) [Ep 2 · 63:42](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3822)
- "Botox for sialorrhea has 90% success rate in the speaker's experience and is first-line treatment." — Hugo Rodríguez (clinical) [Ep 2 · 78:03](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4683)
- "Bilateral submandibular gland excision and bilateral parotid duct ligation (drool procedure) has 60-100% success rate in the literature." — Hugo Rodríguez (host_summary) [Ep 2 · 78:38](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4718)
- "Laryngotracheal separation guarantees no aspiration but eliminates voice, and attempts to restore voice with speaking valves (Blom-Singer) are not effective in children because the larynx remains in the way—complete laryngectomy with cricopharyngeal myotomy is required for voice restoration." — Michael Rutter (clinical) [Ep 2 · 81:41](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4901)
- "The Cincinnati laryngotracheal separation technique involves peeling mucosa up subperichondrially within the cricoid, purse-string closure, splitting cricoid laterally at 3 and 9 o'clock, quilting sutures to sandwich cricoid, tisseal in subglottis, and crisscrossing medial heads of SCM over the laryngeal stump—this has eliminated fistula formation and stomal stenosis." — Michael Rutter (clinical) [Ep 2 · 83:52](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5032)
- "In children, laryngotracheal separation stomas will stenose without a tube until growth stops, so a relatively big, wide, short tube must remain in the tracheal stoma." — Michael Rutter (clinical) [Ep 2 · 85:19](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5119)
- "Temporary laryngeal injection is a useful test-drive procedure before permanent medialization, can be repeated, and serves as a bridge between more permanent operations." — Sandra Stinnett (host_summary) [Ep 2 · 70:04](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4204)
- "Early injection (1-3 months after recurrent nerve injury) may lead to less need for permanent procedures based on adult literature, though pediatric data is limited." — Sandra Stinnett (host_summary) [Ep 2 · 70:28](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4228)
- "For injection materials, radiance gels dissipate within weeks in animal models and do not work well; Restylane is used as a bridge and fat for longer-term injection." — Sandra Stinnett (clinical) [Ep 2 · 71:40](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4300)
- "Reinnervation (ansa-to-recurrent laryngeal nerve) is not a new concept but has gained popularity in the last few years; ideal candidates are <40 years old, within 1-2 years of injury, with known injury location." — Sandra Stinnett (host_summary) [Ep 2 · 72:46](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4366)
- "Reinnervation advantages include single general anesthetic (no awake thyroplasty needed for children), one-and-done if successful, low risk, allows other procedures later, and uses patient's own tissue; disadvantages include lack of long-term pediatric data, 6-9 months to final results, and neck incision." — Sandra Stinnett (clinical) [Ep 2 · 74:11](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4451)
- "Reinnervation is a misnomer—it does not restore movement but provides tone and better closure, with outcomes measured by voice and swallowing improvement." — Sandra Stinnett (clinical) [Ep 2 · 75:46](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4546)
- "Sensory reinnervation (great auricular nerve to superior laryngeal nerve) can restore sensation and is valuable when the sensory component is the primary deficit, allowing recognition of secretions and swallowing." — Sandra Stinnett (clinical) [Ep 2 · 77:07](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4627)
- "Tracheoesophageal fistulas can be surprisingly challenging to find and require high index of suspicion, angled telescopes, probing, and positive pressure breath with endotracheal tube in esophagus to visualize bubbling." — Michael Rutter (clinical) [Ep 2 · 92:40](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5560)
- "Endoscopic TEF repair is ideal for long skinny tracts (usually recurrent TEFs after congenital repair); the concept is to demucosalize the tract with Bugby cautery to get raw-against-raw, inject filler beside the tract to compress it, and place fibrin glue." — Michael Rutter (clinical) [Ep 2 · 98:43](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5923)
- "Endoscopic TEF repair has a recognized failure rate and surgeons must be prepared to repeat the procedure multiple times." — Michael Rutter (clinical) [Ep 2 · 104:26](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6266)
- "Congenital H-type tracheoesophageal fistulas, with very few exceptions, do not do well with endoscopic repairs and typically require open repair." — Michael Rutter (clinical) [Ep 2 · 106:03](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6363)
- "For H-type TEFs, the upper 2/3 of trachea is accessible through the neck, the lower third is easier through the chest, and the middle third is no-man's land where whoever has better expertise (pediatric surgery or ENT) should do it." — Michael Rutter (clinical) [Ep 2 · 106:27](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6387)
- "Slide tracheoplasty technique for large or multiply-failed TEFs involves transecting trachea above and below the hole, peeling trachea off esophagus, using the tracheal segment attached to the hole to repair the esophagus, and reconnecting the trachea over the top with a slide technique that oversizes the airway and reduces tension." — Michael Rutter (clinical) [Ep 2 · 109:45](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6585)
- "For the case of isolated esophagus with multiple TEFs connecting to trachea, leaving the esophagus isolated at both ends prevents aspiration through the holes while the holes prevent mucocele formation by allowing drainage." — Michael Rutter (clinical) [Ep 2 · 120:59](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7259)
- "Flexible bronchoscopy is not a good tool for evaluating posterior laryngeal clefts—rigid bronchoscopy is required for diagnosis." — Michael Rutter (clinical) [Ep 2 · 127:00](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7620)
- "The Cincinnati endoscopic cleft repair technique uses laser (KTP or CO2) to remove a wide swath of mucosa on both sides of the cleft, creating raw-against-raw surfaces, then places 2-3 sutures (60 PDS on bent BV1 for babies, 40 PDS on P2 for older children) and releases aryepiglottic folds." — Sandra Stinnett (clinical) [Ep 2 · 128:10](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7690)
- "Endoscopic cleft repair has become a fellow-level case in Cincinnati due to the volume performed (at least 20, likely way more)." — Sandra Stinnett (clinical) [Ep 2 · 131:18](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7878)
- "Open cleft repair is reserved for failed endoscopic repairs (some type 2s and type 3s), type 4 clefts (cervical approach), and type 4 long clefts (which present anesthetic challenges requiring double lumen tube, single lung ventilation, ECMO, or bypass)." — Sandra Stinnett (host_summary) [Ep 2 · 129:02](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7742)
- "Type 4 long laryngeal clefts have very high mortality rate hovering around 50%, and families must be counseled about this before attempting repair." — Sandra Stinnett (host_summary) [Ep 2 · 129:46](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7786)
- "Almost all children under 4 kg who had type 4 cleft repairs died; waiting until the child is over 5 kg improves outcomes." — Michael Rutter (clinical) [Ep 2 · 137:44](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8264)
- "For long type 4 clefts, the Cincinnati technique involves transecting trachea at cricoid, peeling trachea off esophagus to beyond the cleft, repairing esophagus, placing sternal periosteum interposition graft, reconnecting trachea, and placing tracheostomy 2-3 weeks later after healing." — Michael Rutter (clinical) [Ep 2 · 135:26](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8126)
- "The greatest risk with laryngotracheoesophageal clefts is that the distal end of the repair may form a tracheoesophageal fistula." — Michael Rutter (clinical) [Ep 2 · 139:09](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8349)
- "For severe pharyngeal stenosis, management is a step ladder approach: voice, breathing without trach, no aspiration, swallowing without G-tube—typically cannot achieve all four, usually one or two steps up the ladder, rarely three." — Michael Rutter (clinical) [Ep 2 · 153:04](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=9184)
- "Composite stents (suprastomal stent with silastic sheet wrapped around it supraglottically) are effective for severe pharyngeal stenosis—the stent goes through vocal cords and locks in trachea while the silastic holds open the supraglottic raw areas during re-mucosalization." — Michael Rutter (clinical) [Ep 2 · 154:27](https://library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=9267)

## Changelog
- Sep 12: Published again automatically — condition is back above threshold
- Sep 12: 1 item added automatically
- Sep 12: 2 items no longer name CHARGE syndrome
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 4 items added automatically

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