Airway Disease / Abnormalities

The Throat

The throat is a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. The throat consists of:

  • Larynx – also known as the voice box, the larynx is a cylindrical grouping of cartilage, muscles, and soft tissue which contains the vocal cords. The vocal cords protect the upper opening into the windpipe (trachea), the passageway to the lungs.
  • Epiglottis – a flap of soft tissue located just above the vocal cords. The epiglottis folds down over the vocal cords to prevent food and irritants from entering the lungs.

Tonsils and adenoids – made up of lymph tissue and are located at the back and the sides of the mouth. They have little purpose and often cause medical problems such as obstructed breathing and recurrent infections.

Airway disease can consist of acute conditions such as throat infections, epiglottitis, and laryngitis. These can lead to pain and discomfort on swallowing, accompanied by fever occasionally, and can range from mild-to-severe infections. Usually, those can be treated with supportive measures alongside antibiotics and other medications as deemed necessary. However, children can suffer from a variety of chronic conditions or even congenital abnormalities in the airway such as a narrowed passage at the level of the larynx or subglottis which can lead to chronic issues with noisy breathing, stridor, shortness of breath, and even the necessity to establish an alternative airway such as tracheostomy. As a pediatric ear, nose, and throat surgeon, Dr. Shinhar is specifically trained to treat all varieties of chronic and congenital upper airway abnormalities. He will diagnose the underlying cause of your child’s breathing disorder and recommend appropriate treatment. Surgical treatments can be divided into endoscopic treatments, which are done with special instrumentation through the mouth under general anesthesia. Those utilize special lasers and equipment to dilate and enlarge the airway enabling the child to restore proper breathing. In more severe cases, open procedures such as reconstructions of the trachea and larynx are necessary.

Foreign Bodies in the Nose

Objects that are put into the child’s nose are usually soft things. These would include, but are not limited to, tissue, clay, and pieces of toys, or erasers. Sometimes, a foreign body may enter the nose while the child is trying to smell the object. Children often place objects in their noses because they are bored, curious, or copying other children.

The Symptoms

The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object and often has a bad odor. In some cases, the child may also have a bloody nose.

The Treatment

Treatment of a foreign body in the nose involves prompt removal of the object by your child’s physician. Sedating the child is sometimes necessary in order to remove the object successfully. This may have to be performed in the hospital, depending on the extent of the problem and the cooperation of the child. The following are some of the techniques that may be used by your child’s physician to remove the object from the nose:

  • Suction machines with tubes attached
  • Instruments may be inserted in the nose

After removal of the object, your child’s physician may prescribe nose drops or antibiotic ointments to treat any possible infections.

Foreign Bodies in the Airway

Foreign bodies in the airway constitute a medical emergency and require immediate attention. The foreign body can get stuck in many different places within the airway. Foreign bodies in the airway account for nearly 9 percent of all home accidental deaths in children under 5 years of age.

As with other foreign body problems, children tend to put things into their mouths when they are bored or curious. The child may then inhale deeply and the object may become lodged in the “airway” tube (trachea) instead of the “eating” tube (esophagus). Food may be the cause of obstruction in children who do not have a full set of teeth to chew completely, or those children who simply do not chew their food well. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Children between the ages of 7 months and 4 years are in the greatest danger of choking on small objects, including, but not limited to, the following:

  • Nuts, especially peanuts
  • Hot dogs
  • Seeds (watermelon, sunflower)
  • Toy parts (usually plastic)
  • Grapes
  • Pebbles
  • Buttons

Children need to be watched very closely to avoid a choking emergency.

The Symptoms

Foreign body ingestion requires immediate medical attention. The following are the most common symptoms that may indicate a child is choking. However, each child may experience symptoms differently. Symptoms may include:

  • Choking or gagging when the object is first inhaled
  • Coughing at first
  • Wheezing (a whistling sound, usually made when the child breathes out)

Although the initial symptoms listed above may subside, the foreign body may still be obstructing the airway. The following symptoms may indicate that the foreign body is still causing an airway obstruction:

  • Stridor (a high pitched sound usually heard when the child breathes)
  • Cough that gets worse
  • Child is unable to speak
  • Pain in the throat area or chest
  • Hoarse voice
  • Blueness around the lips
  • Not breathing
  • The child may become unconscious

The Treatment

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care. Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.