Ear, Nose and Throat / ENT Medical Programs
At Cincinnati Children's Hospital Medical Center, the Pediatric Otolaryngology / Head and Neck Surgery Division is involved in the following specialized clinics / medical programs:
The Aerodigestive and Sleep Center at Cincinnati Children's is the first pediatric center in the nation to take a comprehensive, interdisciplinary approach to caring for chronically ill children with complex airway, pulmonary, sleep and upper digestive tract disorders.
This coordination is essential for the children's well-being, since all require care from more than one pediatric specialist. Our team members work in collaboration to determine the best solution for each child. We work with a wide range of specialists to provide the most comprehensive assessment and treatment plan. This multidisciplinary team brings together subspecialists from:
Consultation from other medical experts as appropriate, including:
In addition, the family is considered to be an integral part of the team.
The goal of the Aerodigestive and Sleep Center is to improve the clinical outcomes for patients by coordinating patients' evaluations, as well as operative and diagnostic procedures, in a time-efficient manner. To do this, a weekly integrated meeting is held to determine patient treatment plans and evaluate patient progress.
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The Ear and Hearing Center was established with two specific missions:
- To improve the care and quality of life for children with hearing impairment by providing optimal and innovative medical and surgical management
- To advance our understanding of the biological basis for normal hearing and deafness through cutting-edge molecular research
To address our first purpose, to better care for children with hearing impairment, several clinical programs have been established at the Ear and Hearing Center.
As a management option for children with irreversible nerve deafness, the Ear and Hearing Center staff provides cochlear implantation services for patients meeting eligibility criteria.
For children with handicapping hearing losses and failing to progress adequately with routine hearing aid use, cochlear implants present an excellent option for families and patients desiring an auditory / oral communication mode.
Recent advances in the technology and performance of cochlear implants now make them a very routine, "standard of care" management choice for severely to profoundly deafened patients. Ear and Hearing Center staff also routinely provides care for children with congenital ear malformations.
Comprehensive care includes management of ear problems both from a functional (hearing) perspective, as well as the aesthetic (appearance) perspective.
Problems such as microtia (failure of the external ear to develop properly) can be managed with reconstructive techniques using either a patient's own tissues (e.g., rib cartilage and skin grafts) or prosthetic ear techniques combined with bone-anchored prosthetics.
Congenital abnormalities of the ear canal (aural atresia) and middle ear are also routinely managed by Ear and Hearing Center faculty in order to offer patients the opportunity to improve hearing if at all possible.
Importantly, Ear and Hearing Center staff also routinely handles the very common problems of chronic ear infections and cholesteatoma.
Cholesteatoma refers to a common condition affecting children in which a skin cyst develops within the middle ear and mastoid cavities. Recurrent ear infections, drainage, pain and hearing loss are the consequences of such cholesteatomas.
While a benign process, cholesteatomas are extremely difficult to completely eradicate and often require multiple procedures in order to completely remove such cysts from the ear.
Ear and Hearing Center staff are experienced in the tertiary care of such complex cases and often specialize in the management of multiple treatment failure cases.
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Research Efforts
On the basic research front, the Ear and Hearing Center laboratory programs have been developed to study the molecular and genetic processes underlying problems such as congenital ear malformations and deafness, as well as other causes of hearing loss.
Several federally funded research programs have been established and are now identifying or examining the genes important for normal hearing and proper development of the ear.
Additional laboratory programs are investigating the importance of DNA mutations in predisposing individuals to drug-induced hearing loss. Investigations are also underway to examine the possible utility of new functional imaging techniques in assessing children with hearing impairment.
The end goal of these research programs is to generate novel information that may someday improve the manner in which we care for children with ear and hearing problems.
By being involved in these cutting-edge research endeavors, Ear and Hearing Center faculty remains on the forefront and apprised of the latest innovations and strategies to optimize patient care.
A noteworthy factor in Ear and Hearing Center clinical and research care remains the interdisciplinary approach made feasible in part by the resources available within the Cincinnati Children's medical community.
Drawing on the expertise and resources available across the Cincinnati Children's campus, Ear and Hearing Center professionals are able to provide comprehensive care for children with both simple as well as complex problems related to the ear, hearing and associated communication problems.
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One in three children are born with a vascular birthmark with about 1% of cases requiring medical evaluation due to either cosmetic or functional concerns. Many of these cases are of a complex nature and require numerous modalities for proper diagnosis and treatment. These lesions include:
- Lymphangiomas
- Hemangiomas
- Vascular malformations
The Vascular Malformation Team will provide a convenient format for families to obtain the multidisciplinary care these children require. The core team is made up of specialists in the areas of:
Many consultants are available for special cases, such as Ophthalmology, Endocrinology and Pathology.
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Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Endoscopic evaluation of swallowing was adapted to swallowing problems associated with the pediatric age group at Cincinnati Children's in 1993. It is a study requiring the services of both Pediatric Otolaryngology and Speech Pathology.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a study that allows an assessment of the anatomy of the areas surrounding the voice box and opening of the esophagus through the use of a small flexible telescope.
The telescope is passed through the nose after anesthetizing this area to minimize any pain or discomfort. Once the telescope is in position the child is given various food materials and the swallowing process is evaluated.
Developmental aspects of swallowing are evaluated, and the structural aspects of the upper aerodigestive tract are assessed to determine the safety of swallowing.
Specific recommendations can be made to improve the safety and efficacy of swallowing from the information gained during the examination.
The endoscopic swallow study is just one way to assess the safety and integrity of the swallow mechanism. It:
- Clearly defines the anatomy
- Clearly demonstrates the safety of swallowing
- Is extremely useful in those patients who will not accept food material into their mouth
- Is very helpful in patients where questions of aspiration of saliva are being entertained
- Is useful as a preoperative evaluation prior to the reconstruction of the airway to predict which patients will be at risk for aspiration during the postoperative period
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Neurosensory Testing
Neurosensory testing can be performed as a sub-test of the endoscopic swallow study. A small puff of air is used to stimulate the voice box and the airway protection mechanism is then evaluated.
This is a painless study which correlates well with aspiration potential in children. It is also useful to follow patients who have had neurologic problems and are undergoing treatment.
This treatment has been used to help children who:
- Exhibit failure to thrive and weight loss.
- Experience frequent gagging or choking episodes associated with feeding.
- May be highly selective about the foods they will ingest.
- Have a history of recurring pneumonia or chronic lung disease. These may be secondary to swallowing disorders.
The endoscopic swallow study is but one test in a series of examinations that may be necessary to completely characterize the feeding issues associated with a particular child.
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