From
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QUAD #8 EA/TEF Repair– Thoracoscopic vs Thoracotomy, Role of ENT with Dr. Catherine Hart with Dr. Catherine Hart
With Dr. Katherine Hart · hosted by Dr. Kim Priban
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
ENT providers are involved with TEF patients in two different phases: kids involved in the initial repair, and kids encountered later in the aerodigestive program.
Initial airway evaluation is always performed in TEF cases.
Knowing the airway anatomy impacts decisions made in the perioperative or particularly postoperative period in terms of safety for extubation.
The primary role ENT plays in initial TEF repair is placing a Fogarty catheter through the TEF to help pediatric surgery colleagues localize it more easily.
Fogarty catheter placement can be performed over a telescope to ensure the endotracheal tube is positioned beyond the fistula and that anesthesia colleagues can ventilate appropriately.
Recurrent pneumonias in a patient with history of TEF repair should raise suspicion for recurrent or persistent fistula.
Endoscopy for recurrent TEF is typically performed as a triad with GI colleagues and pulmonary colleagues.
For recurrent, persistent, or H-type TEFs at Cincinnati Children's, ENT is often primary in management.
The ENT role in TEF management varies depending on what phase of care the child is in, including diagnosis, management of the airway, and surgical management.
The child's TEF diagnosis is typically known prior to going into the initial repair procedure.
ENT providers are tasked with localization of the fistula and management of the airway during initial repair, both of which are challenging in children with TEF.
CHARGE syndrome is a disorder that affects many areas of the body, abbreviated for coloboma, heart defects, atresia choanae (choanal atresia), growth retardation, genital abnormalities, and ear abnormalities.
Intentional intubation of the esophagus with cuff inflation and positive pressure breaths can be used to diagnose or confirm the presence of a TEF by visualizing air bubbles or jets streaming along the back wall of the trachea.
An area of furring on endoscopy is indicative of a recurrent tracheoesophageal fistula.
Care for TEF patients is highly multidisciplinary, with each specialty contributing at different phases of care.