Pediatric Ear, Nose and Throat

Pediatric Breathing, Voice and Swallowing

The Mass Eye and Ear-Massachusetts General Hospital Pediatric Aerodigestive Center for Children opened in 2004. Since then, the center has operated under the mission of treating pediatric breathing disorders, the etiologies of which intersect across the disciplines of pediatric otolaryngology–head and neck surgery, pulmonology and gastroenterology.

The center is an integrated practice unit (IPU), which is a team of specialists from different disciplines who deliver care for complex diseases requiring multiple subspecialists, diagnostic tests and procedures. As an IPU, the center addresses how aerodigestive disorders (such as airway narrowing) or a variety of airway symptoms (chronic cough, aspiration, stridor, difficulty breathing, swallowing, speaking or feeding) can be caused by anatomic anomalies along with associated esophageal inflammation, food allergies or eosinophilic esophagitis. By alleviating the underlying problem, clinicians can better streamline and optimize care.

Patients and caregivers who visit the center consistently report markedly improved patient experiences, even after a long day visiting multiple providers. A recent multi-center study demonstrated that integrated pediatric aerodigestive centers improve clinical outcomes and lower costs of care¹.

The impact of interdisciplinary care

From 2020-to-2021, of the patients who visited the Pediatric Aerodigestive Center for Children for the first time or for a follow-up appointment, only 18.9 percent needed an interventional triple endoscopy or additional intervention. A team-based medical solution was identified in all other cases.

Patients who needed an interventional triple endoscopy or additional intervention upon visiting the center

Of the 18.9 percent of children who underwent a triple endoscopy (a triple scope, or rigid and flexible bronchoscopy with esophagoduodenoscopy), 73.3 percent resulted in a positive finding, which allowed for optimization of the child’s care and medical plan.

A positive finding was defined as an anatomic abnormality such as an identified laryngeal cleft, positive bacterial growth on a respiratory culture or the identification of either gastroesophageal reflux (GER) or eosinophilic esophagitis (EoE).

Patients who had a positive finding discovered upon interventional triple endoscopy or additional intervention

When a child younger than two years old was identified as having a laryngeal cleft as a cause of their respiratory infections and aspiration, a laryngeal cleft injection could be performed at that same setting.

Patients younger than two years old identified with laryngeal cleft

When a child two years old or older was identified as having a laryngeal cleft as a cause of their respiratory infections and aspiration, a laryngeal cleft injection could be performed at that same setting.

Patients two years old or older identified with laryngeal cleft

Pediatric Audiology and Otology

Audiologists and otologists at the Mass Eye and Ear Pediatric Hearing Center treat a variety of ear, hearing and balance disorders among infants and children. A child's body is constantly changing, which means a world-class expertise of how children hear is necessary.

Ossiculoplasty is the surgical repair of the auditory ossicles, or “bones of hearing.” These bones, the malleus, incus and stapes, form a connection from the eardrum to the inner ear called the ossicular chain. This chain plays a major role in transmitting sound vibrations to the cochlea, where they are converted into nerve signals that are sent to the brain.

An ossiculoplasty is typically performed when the ossicles have been damaged due to infection, inflammatory disease, growths of the middle ear, trauma or prior surgery. The surgery can be performed using tissue from the patient, such as cartilage or bone, or using a prosthesis made of synthetic material such as titanium or hydroxylapatite.

Outcomes for ossiculoplasties in children five years old and younger

The pure tone average and individual change in air-bone gaps were chosen as the standard measured primary outcomes for ossiculoplasties. In the following graphs, a change in pure tone average indicates the effect of surgery on the patients average hearing levels across the range of hearing frequencies.

A change in air-bone gap indicates the effect of surgery on the amount of conductive hearing loss at each frequency. Optimally, the air-bone gap is less than 20 dB. When the air-bone gap is 0 dB there is no longer any conductive hearing loss.

A clinically meaningful difference is considered 10 dB at each frequency for pure tone average and air-bone gap changes.

Air-bone gap measurement at 0.5 kHz

Air-bone gap measurement at 1 kHz

Air-bone gap measurement at 2 kHz

Air-bone gap measurement at 4 kHz

Recorded pure tone average