Greg Burg

46 statements · 2 topics

Aerodigestive / ENT · guest expert

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I would theorize that patients that have significant tracheal bronchoalacia or upper airway obstruction from things like tonsils and adenoids, they sometimes have to generate greater forces with their respiratory mechanics, and that pushes. More air across the glottis and can increase the risk of aspiration
quote · Aerodigestive / ENT
So you can aspirate from 3 different locations, things that start in your upper airway, things you put in your upper airway, and things that come up from your GI system
quote · Aerodigestive / ENT
Patients with significant tracheobronchomalacia or upper airway obstruction from tonsils and adenoids may generate greater respiratory forces that push more air across the glottis and can increase aspiration risk.
clinical · Laryngeal Cleft
For non-operative monitoring, pulmonologists track clinical symptoms, hospitalization frequency, response to interventions, and may repeat bronchoscopy and swallow assessments to guide further management.
clinical · Laryngeal Cleft

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Greg's statements about Aerodigestive / ENT 23 statements

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QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg

Quotation This is a 5 year old trach dependent patient who had encephalopathy, wants to get her trach out, does OK with capping, and it's mainly fed PO has a G tube in place though, and they came to us to look at getting decannulated. Open
Quotation This patient has. Secretions in the lower airway and there's a diffuse mucopurulent bronchitis looking at the MLMB portion and we'll come back and check for a cleft here. Open
Quotation This child had a very inflammatory pattern on the bronchoalveolar lavage, did not have any lipolaid macrophages despite being orally fed, so that was interesting. Open
Statement The case patient had a very inflammatory pattern on bronchoalveolar lavage but did not have lipid-laden macrophages despite being orally fed. Open
Quotation So in terms of what we do with these clefts, I think a lot of it has to do with how bad is the chow, and that a lot of that comes down to the degree of aspiration. Open
Statement Management of laryngeal clefts depends heavily on the degree of aspiration. Open
Statement Patients with significant tracheobronchomalacia or upper airway obstruction from tonsils and adenoids may generate greater respiratory forces that push more air across the glottis and can increase aspiration risk. Open
Quotation I would theorize that patients that have significant tracheal bronchoalacia or upper airway obstruction from things like tonsils and adenoids, they sometimes have to generate greater forces with their respiratory mechanics, and that pushes. More air across the glottis and can increase the risk of aspiration Open
Statement BAL analysis examines inflammatory cell types, culture results, and macrophage contents. Open
Statement Parental report of choking and coughing with water intake raises suspicion for a minor cleft. Open
Quotation A Kid comes to clinic and the parents say every time they have a cup of water they choke and cough. You're already suspecting that there may be a minor cleft. Open
Statement A child with a deepened interarytenoid notch plus evidence of aspiration on BAL or other assessments plus bronchiectasis on imaging warrants consideration for surgical repair. Open
Statement For patients with an interarytenoid notch and genetic components with concern for central swallowing control, brain MRI may be checked to assess neurologic and functional comorbidities. Open
Statement Safe swallowing techniques include thickening, pacing, and volume modification. Open
Quotation So you can aspirate from 3 different locations, things that start in your upper airway, things you put in your upper airway, and things that come up from your GI system Open
Statement Aspiration can occur from three locations: things that start in the upper airway, things put in the upper airway, and things that come up from the GI system. Open
Statement Medical management addresses excessive drooling and esophageal or GI motility issues that increase vomiting and reflux aspiration risk. Open
Statement Pulmonary therapies are mostly considered reactive band-aids. Open
Statement Inhaled steroids may be tried to reduce inflammation. Open
Statement Albuterol may be used for bronchodilation if there is a reactive airway component to aspiration pneumonitis. Open
Statement Airway clearance augmentation is needed for neurodevelopmentally limited or musculoskeletally limited patients who lack effective cough or airway clearance ability. Open
Statement Health maintenance for aspiration-risk patients includes vaccination against respiratory illnesses and reducing environmental hazards including smoke exposure. Open
Statement For non-operative monitoring, pulmonologists track clinical symptoms, hospitalization frequency, response to interventions, and may repeat bronchoscopy and swallow assessments to guide further management. Open
Greg's statements about Laryngeal Cleft 23 statements

Open the Laryngeal Cleft collection →

QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg

Quotation This is a 5 year old trach dependent patient who had encephalopathy, wants to get her trach out, does OK with capping, and it's mainly fed PO has a G tube in place though, and they came to us to look at getting decannulated. Open
Quotation This patient has. Secretions in the lower airway and there's a diffuse mucopurulent bronchitis looking at the MLMB portion and we'll come back and check for a cleft here. Open
Statement The case patient had a very inflammatory pattern on bronchoalveolar lavage but did not have lipid-laden macrophages despite being orally fed. Open
Quotation This child had a very inflammatory pattern on the bronchoalveolar lavage, did not have any lipolaid macrophages despite being orally fed, so that was interesting. Open
Quotation So in terms of what we do with these clefts, I think a lot of it has to do with how bad is the chow, and that a lot of that comes down to the degree of aspiration. Open
Statement Management of laryngeal clefts depends heavily on the degree of aspiration. Open
Statement Patients with significant tracheobronchomalacia or upper airway obstruction from tonsils and adenoids may generate greater respiratory forces that push more air across the glottis and can increase aspiration risk. Open
Quotation I would theorize that patients that have significant tracheal bronchoalacia or upper airway obstruction from things like tonsils and adenoids, they sometimes have to generate greater forces with their respiratory mechanics, and that pushes. More air across the glottis and can increase the risk of aspiration Open
Statement BAL analysis examines inflammatory cell types, culture results, and macrophage contents. Open
Statement Parental report of choking and coughing with water intake raises suspicion for a minor cleft. Open
Quotation A Kid comes to clinic and the parents say every time they have a cup of water they choke and cough. You're already suspecting that there may be a minor cleft. Open
Statement A child with a deepened interarytenoid notch plus evidence of aspiration on BAL or other assessments plus bronchiectasis on imaging warrants consideration for surgical repair. Open
Statement For patients with an interarytenoid notch and genetic components with concern for central swallowing control, brain MRI may be checked to assess neurologic and functional comorbidities. Open
Statement Safe swallowing techniques include thickening, pacing, and volume modification. Open
Quotation So you can aspirate from 3 different locations, things that start in your upper airway, things you put in your upper airway, and things that come up from your GI system Open
Statement Aspiration can occur from three locations: things that start in the upper airway, things put in the upper airway, and things that come up from the GI system. Open
Statement Medical management addresses excessive drooling and esophageal or GI motility issues that increase vomiting and reflux aspiration risk. Open
Statement Pulmonary therapies are mostly considered reactive band-aids. Open
Statement Inhaled steroids may be tried to reduce inflammation. Open
Statement Albuterol may be used for bronchodilation if there is a reactive airway component to aspiration pneumonitis. Open
Statement Airway clearance augmentation is needed for neurodevelopmentally limited or musculoskeletally limited patients who lack effective cough or airway clearance ability. Open
Statement Health maintenance for aspiration-risk patients includes vaccination against respiratory illnesses and reducing environmental hazards including smoke exposure. Open
Statement For non-operative monitoring, pulmonologists track clinical symptoms, hospitalization frequency, response to interventions, and may repeat bronchoscopy and swallow assessments to guide further management. Open