Collection
Aerodigestive / ENT
Also covers: esophageal atresia · tracheoesophageal fistula · aspiration · tracheomalacia · laryngeal cleft · eosinophilic esophagitis · dysphagia · CHARGE syndrome
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
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. QUAD #22: What is CHARGE syndrome? with Dr. Catherine Hart · 0:41
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
video0:59 · Nov 2024
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, Aerodigestive & Esophageal Surgery: Aspiration in TEFs · 3:35
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.
video2:22 · 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.
video5:28 · Jan 2019
Unrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance. — Nathan Tighe, QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe · 5:55
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
video7:35 · Mar 2024
The new GERD guidelines (joint North America and Europe) recommend treating with PPI for 2 months then attempting to wean, with goal of weaning twice yearly. — Rachel Rosen, Gastroesophageal Reflux Disease · 43:42
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
podcast1:21:04 · 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
podcast1:21:04 · 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
video7:11 · Feb 2025
The formula for balloon sizing is to take the outer diameter of an age-appropriate endotracheal tube and add one millimeter for the larynx or two millimeters for the trachea. — Michael Rutter, Laryngotracheal Stenosis · 10:55
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
video2:53 · 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
video14:20 · 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
video16:20 · 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
video5:26 · 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
video7:36 · 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
video8:10 · 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
video7:37 · 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
video6:01 · Nov 2024
Pharyngeal stenosis patients warrant long-term surveillance as there is suggestion they may be at increased risk for malignancy, and surveillance for neoplasm development is helpful — Douglas von Allmen, QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen · 6:11
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
video7:12 · Mar 2024
In experienced hands who have done numerous or hundreds of these type procedures, tracheobronchopexy can have very good outcomes for patients with severe airway collapse symptoms — George W. Holcomb III, Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025 · 3:14
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
video1:34 · 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
video0:50 · 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
podcast16:35 · Aug 2025
Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. — Michael Rutter, Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula · 53:37
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
video1:41:09 · 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
video2:00:59 · 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.
video1:48:11 · Jan 2019
Flexible bronchoscopy is used starting in the nose and ending in the subsegmental bronchi, and bronchoalveolar lavage helps with identification of infections and markers of aspiration. — Sherry Torres Silva, QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team · 8:49
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
video2:37:09 · 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
video10:19 · Apr 2025
Common questions
Tell me more about charge syndrome?
CHARGE syndrome is a rare genetic disorder caused by a CHD7 mutation on chromosome 8. The acronym represents coloboma, heart defects, atresia of the choana, retardation of growth and development, genital and/or urinary anomalies, and ear malformations. Diagnosis can be established based on clinical criteria even without confirmed CHD7 mutation testing. Notably, 80–90% of children with CHARGE syndrome will experience aspiration at some point in their lifetime, making it a significant functional/neurological cause of aspiration risk in the pediatric population.
When is tracheopexy indicated?
Tracheopexy is indicated for patients with tracheomalacia who require surgical intervention. Clinical decision-making has evolved to determine which patients will respond best to tracheopexy versus aortopexy using preoperative dynamic studies. The procedure is primarily used in non-esophageal atresia patients. Both aortopexy and tracheopexy are beneficial for tracheomalacia; preoperative dynamic imaging guides selection of the most appropriate procedure for each patient.
Featured picks for families are being prepared — the summaries above are written for you.
- Infants with vomiting/wheezing more often have oropharyngeal dysphagia than GERD; PPIs are ineffective and harmful under age 1. [e289-c1, e289-c3, e289-c5, e359-c1, e359-c3, e359-c5]
- 10% of children <5 with respiratory symptoms have EoE (chronic cough, not dysphagia); never wrap without scoping. Dairy is the allergen in 60–70%. [e289-c6, e289-c7, e289-c8, e289-c9, e359-c6, e359-c7, e359-c9, e359-c11]
- Flexible bronchoscopy misses laryngeal clefts 95% of the time; rigid bronchoscopy with probing of the posterior commissure is required. [e739-c26]
Expert statements from the recordings in this collection.
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.
A 70-degree endoscope is a difficult tool to use but useful for tracking down hard-to-find tracheoesophageal fistulas.
Routine bronchoscopy is now standard practice for all type C esophageal atresia cases, though this represents a change from earlier training when it was not necessarily performed.
Dan1:13
General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.
Pediatric surgery fellows at this institution complete a one-month attachment with ENT to perform bronchoscopies as part of their training.
Dual scoping (simultaneous bronchoscopy and esophagoscopy) is enormously valuable for complicated TEF patients, providing different information and advantages in visualization.
Dan6:41
During dual scoping, you can see the light from one scope through the epithelium, inject material that may come through subtle holes, or observe bubbles from air insufflation, making simultaneous visualization quite valuable.
Phil7:33
For combined bronchoscopy and esophagoscopy in small children, a 2.8 mm flexible bronchoscope is typically used alongside an infant gastroscope (5.4 or 6 mm outer diameter).
Phil8:19
An infant gastroscope will fit retrograde through a 16 French gastrostomy tube.
Phil8:36
The concept of endoscopic TEF repair is to demucosalize the tract because mucosa is a non-stick surface; you want raw against raw with a tiny bit of fibrin glue to seal it while it scars off.
When using fibrin glue for TEF repair, use a very small amount (about 0.1 ml) via a Duplo double-lumen catheter to avoid forming a foreign body.
Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.
Todd Ponsky12:21
When using bugbee cautery for TEF repair, place something in the esophagus (such as an endotracheal tube) as a spacer to avoid burning the back of the esophageal wall.
A bugbee catheter will go down an EGD scope, allowing cauterization from the esophageal side if the tract angle is favorable.
A 3 French bugbee fits through a 2.8 mm flexible bronchoscope with a 1.2 mm suction channel, providing precise control of the tip.
Bob Wood15:10
When passing a bugbee through a rigid scope, bending the end at a slight angle before insertion allows steering by rotation.
Endoscopic TEF repair often needs to be performed more than once; the average is approximately 2 procedures, with some requiring 1 and others 3-4 attempts.
The success rate for endoscopic TEF closure is running about 80%, not 100%.
After 3 or 4 failed endoscopic TEF repair attempts, it is typically time to give up and discuss alternative approaches.
When cauterizing a TEF, you should particularly try to get the edges and sides because as they scar in, that will narrow the whole mouth, making re-intervention easier if needed.
To reduce airway fire risk during bugbee cautery, insufflated oxygen should be kept at 30% or less.
Patients can tolerate a minute or two of lower oxygen saturation during cautery procedures to maintain safe oxygen levels below 30%.
Bob Wood26:10
Radiance voice gel (used for vocal cord injection) can be injected into the wall beside a TEF to obliterate the potential space and hold raw surfaces together; it only lasts a few weeks.
For TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.
Todd Ponsky1:09:25
Thoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.
Slide tracheoplasty is a useful technique for big complex TEF holes, using part of the trachea to repair the esophageal defect.
Sternal periosteum is an excellent interposition graft material—it is like Kevlar, bulletproof, abundant, and very strong, though almost impossible to suture.
Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation, unlike many operations where the surgeon does not matter long-term.
Expert opinion57:09
Button batteries are extremely dangerous and can cause ongoing tissue damage that extends beyond what is visible and beyond the expected time frame.
Dan43:17
The institutional protocol for button battery ingestion is to remove them within 2 hours of identification, as it is considered a medical emergency.