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Special Considerations in the Management of the Pediatric Voice and Airway Patient

University of Cincinnati, Cincinnati Children's Hospital Medical Center
Cincinnati, OH

Alessandro de Alarcon, MD

Cincinnati Children's Hospital Medical Center
Cincinnati, OH

Barbara Weinrich and Susan Baker Brehm

Miami University
Oxford, OH
Cincinnati Children's Hospital Medical Center
Cincinnati, OH

Children who need or have undergone airway reconstruction often present challenges for the treating otolaryngologist and speech-language pathologist. Crucial care issues include establishing a patent laryngeal and tracheal airway that meets the demands of childhood development. Related concerns, such as maintaining functional and structural support for voicing and active airway protection, require specialized management approaches.

The pediatric airway reconstruction literature is limited, given that this is a relatively low incidence population and the fact that there are few pediatric airway/voice centers who manage large numbers of these children. Most published articles highlight the success of the various surgical procedures to accomplish reconnection of the upper and lower airway and, thus, decannulation, while others also have attempted to characterize voice outcomes. Frequently, clinical discussions lament the airway/voice "trade-off" that can occur when trying to expand an airway to achieve comfortable, safe respiration and yet maintain or acquire an acceptable voice quality. As a child grows, these circumstances can complicate management decisions, causing concern for parents, patients, and clinicians alike. The following is an overview of the main issues surrounding the assessment and treatment of the pediatric airway patient from both the physician and speech-language pathologist's perspective.