Pediatric Otolaryngology - Aerodigestive Tract Disorders

The upper aerodigestive tract is involved in feeding and breathing. Feeding and breathing evolve from an infantile reflex behavior to a mature cortically regulated behavior with concurrent development and maturation of the central nervous system and the anatomy of the upper aerodigestive tract. Normal neurologic and anatomic development of the upper aerodigestive tract is essential for normal breathing and feeding. Laryngeal reflexes are involved in normal breathing, feeding and protection of the lower airway against aspiration. Disorders that affect laryngeal reflexes can interfere with normal feeding and breathing. Alteration of laryngeal reflexes has been implicated in breathing problems such as infant apnea and laryngomalacia. Clinical investigative efforts involve testing the laryngeal adductor reflex by laryngopharyngeal stimulation testing to determine if testing the threshold of the reflex helps determine infants and children at risk for respiratory complications of apnea, and respiratory and feeding complications of laryngomalacia and extraesophageal gastroesophageal reflux (GER). In conjunction with Dr. Gary Sieck and the Department of Anesthesia Research, projected basic science research will include evaluation of the chemical and neuropeptide and immunologic modulation of neurotransmission of the nerves, tissue and muscles involved in the laryngeal adductor reflex at the cellular level. The translational research component will involve evaluating specific chemical or pharmaceutical agents to reverse the properties that may be involved in adverse modulation the laryngeal reflexes implicated in apnea and airway reactivity and other disorders of the larynx.

Gastroesophageal reflex (GER) is increasingly implicated in diseases outside of the native gastrointestinal tract. In children, gastroesophageal reflux has been implicated in a variety of extraesophageal disorders, namely otitis media, recurrent rhinosinusitis, swallowing disorders, apnea, alteration in airway protection with aspiration pneumonia and laryngomalacia. Prospective clinical trials will be developed to evaluate role of medical and surgical and treatment of extraesophageal reflux in these disorders. Areas of collaboration will include Pediatric Gastroenterology, Pediatric Pulmonology, and Pediatric Surgery.

The areas of aerodigestive tract research in children will parallel the development of a multidisciplinary, comprehensive, aerodigestive disorders center for the evaluation of children with complicated breathing, feeding and swallowing disorders.