Airway, Voice and Swallowing Disorders

Many things can affect your child’s airway (trachea), throat (pharynx), food tube (esophagus), voice box (larynx), vocal cords and more.

Some of the more common conditions we treat are:

• Cleft lip and palate.
• Drooling.
• Dysphagia (problems swallowing).
• Enlarged adenoids.
• Gastroesophageal reflux disease (GERD).
• Sleep apnea.
• Sleep disorders.

But there are many others — some you might not have heard much about — that can cause problems with how your child eats and drinks, talks and breathes.

Trouble breathing and swallowing

Problems with your child’s esophagus, trachea and pharynx can make it hard for them to breathe and swallow. They might have:

• Airway obstruction.
• Bronchogenic cysts or bronchopulmonary dysplasia.
• Bronchomalacia.
• Chronic aspiration (from a tracheostomy).
• Esophageal atresia, spasms or strictures.
• Eosinophilic esophagitis.
• Esophageal duplications.
• Glottic stenosis.
• Hypoplastic lung.
• Interstitial lung disease (ILD).
• Laryngeal cleft.
• Silent aspiration.
• Subglottic or tracheal stenosis.
• Tracheoesophageal fistula.
• Tracheomalacia.

Trouble Talking

Problems with your child’s larynx or vocal cords can make it hard for them to talk. They may have:

• Aphonia (loss of voice).
• Vocal cord dysfunction.
• Vocal cord paralysis.

Uncommon Disorders

Some disorders affecting your child’s airway or voice are rare. But they aren’t rare to us. If your child is diagnosed with these uncommon disorders, we can help:

• Congenital central hypoventilation syndrome (CCHS).
• Laryngeal/tracheal/bronchial papillomatosis.
• Pierre Robin Syndrome (PRS).

What to expect at your child’s first appointment

Because there are so many airway, voice and swallowing conditions, our pediatric team will want to spend time with you and your child to better understand what’s been going on. So, we’ll have you come in for an evaluation before we start treatment. An evaluation takes about a half-day.

Your child will see the pediatric providers who’ll make up their care team. Each specialist will meet with you and your child for about 30 minutes. During these short visits, you can expect the providers to ask questions, like:

• When did you first notice your child is having problems?
• What kind of symptoms does your child have?
• How are these symptoms affecting your child’s life?
• Has your child already been diagnosed with any health conditions?

Testing for airway, voice and swallowing disorders in children

Your child’s pediatric care team will also do some tests. We may do imaging tests like X-rays, ultrasounds, MRIs or CT scans. Your child may also need some minimally invasive tests like:

• Airway fluoroscopy.
• Barium swallow (esophagram).
• Bronchoscopy.
• Endoscopy.
• Esophageal manometry.
• Laryngoscopy.
• Lung function tests.
• Sleep study (polysomnography).
• Spirometry.
• Upper GI series.
• Videostroboscopy.

Meet Our Pediatric Airway, Voice and Swallowing Disorders Team

Cleveland Clinic Children’s approaches treatment with team-based care. This means your child will have a dedicated group of providers thoughtfully chosen and personalized to their needs. This team might include:

• Pediatric otolaryngologists.
• Pediatric gastroenterologists.
• Pediatric neurologists.
• Pediatric pulmonologists.
• Pediatric cardiothoracic surgeons.
• Pediatric respiratory therapists.
• Pediatric speech-language pathologists.
• Pediatric nurse practitioners.
• Child life specialists.

Care coordinators

Our compassionate care coordinators are also important members of your team. Often your first point of contact, it’s their goal to make things go as smoothly and easily as possible for you and your child while you’re here. As their name suggests, they help coordinate your child’s care at Cleveland Clinic Children’s. They work with each of your child’s providers to gather information so it’s easier for you to navigate. They help coordinate appointments with multiple providers. They help you avoid duplicate services and unnecessary charges. They answer questions, help you understand your child’s condition and treatments and provide educational materials and resources if needed. You can talk to a care coordinator by calling 216.445.7572.

You may work with:

• Anne Banas, CNP.
• Diane Cowles, RN.

Your child’s pediatric care team works together to build a highly tailored treatment plan. This plan is based onwhat kind of airway, voice or swallowing disorder your child has and their specific needs.

Medications

Many airway disorders can be managed without surgery. Your child may only need medication like bronchodilators to open their airways. Or corticosteroids to reduce swelling (inflammation). Our team may recommend drugs to reduce stomach acid and lessen the effects of conditions like GERD.

Voice and swallowing therapy

We first treat most voice problems with behavioral voice therapy. This involves speech therapy and voice rehabilitation with a pediatric speech-language pathologist (SLP) once or twice a month. Your child’s therapist will also provide activities for you to do with your child at home between appointments.

Speech therapy can also help with swallowing problems. Our pediatric speech-language pathologists can teach your child exercises to help strengthen their swallowing muscles. They may also show you and your child ways to make eating and drinking easier.

Surgery

Some conditions may need surgery to widen a tight or closed-off airway or esophagus. This could be from conditions like stenosis or enlarged adenoids, ongoing dependence on a ventilator or the results of a tracheostomy. We may do surgery to repair a disorder your child was born with (congenital) like a cleft lip or palate. Or we may use surgery to treat damage caused by GERD or cysts in your child’s airways.

Your child’s care team will carefully consider their diagnosis before recommending surgery. And we’ll use minimally invasive techniques whenever possible. This can reduce scarring, pain and recovery time. One type is video-assisted thoracoscopic surgery, or VATS to remove cysts and other blockages. Another, supraglottoplasty, treats voice box problems caused by things like stenosis or strictures.

There are also times when we may need to do open surgery. The most common is a thoracotomy. But no matter the type of surgery your child needs, you can rest assured knowing they’re in the most capable hands.

Taking the Next Step

When your child wheezes, doesn’t speak loudly or won’t eat because it’s too hard to swallow, you may feel helpless. And that’s when you need experts on your team. Cleveland Clinic Children’s has caring providers specializing in airway, voice and swallowing disorders in children. From the moment you reach out to us, we’ll work with you to schedule an evaluation. We’ll coordinate appointments for you — and stay by your child’s side through every step of treatment.