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BackTable / ENT / Podcast / Episode #169
Navigating Type I Laryngeal Clefts in Children
with Dr. Hamdy El-Hakim
In this episode, Dr. Hamdy El-Hakim, pediatric airway surgeon and Associate Professor at the University of Alberta, joins host Dr. Gopi Shah to review laryngeal clefts in children.
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BackTable, LLC (Producer). (2024, April 30). Ep. 169 – Navigating Type I Laryngeal Clefts in Children [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Hamdy El-Hakim
Dr. Hamdy El-Hakim is the director of pediatric otolaryngology fellowship at the University of Alberta in Canada.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Synopsis
First, Dr. El-Hakim describes the presentation of laryngeal clefts. Affected children have coughing fits bad enough to cause watery eyes and “blue spells.” These fits are sometimes misattributed to other airway abnormalities or GERD. Then, discussion shifts to the workup of laryngeal clefts. All patients with a suspected laryngeal cleft need a comprehensive physical exam, a risk factor assessment and a swallow assessment, most commonly a FEES. Many patients will also require a diagnostic laryngoscopy with bronchoscopy (DLB). Dr. El-Hakim advises listeners on performing this test in children. Treatment of laryngeal clefts include thickened feeds, injection laryngoplasty, or surgical repair. Finally, Dr. El-Hakim advises listeners on compassionate care for families living with this condition.
Timestamps
00:00 - Introduction
03:39 - Laryngeal Clefts in Children: Diagnosis & Classification
06:36 - Presentation of Laryngeal Cleft
12:07 - Risk Factors & Associated Conditions
21:38 - Physical Examination Insights and Diagnostic Approaches
30:15 - The Role of FEES and Modified Barium Swallow in Diagnosis
37:37 - Navigating Pediatric Swallowing Disorders: Strategies and Challenges
41:12 - The Complexities of Diagnosing & Treating Laryngeal Cleft
45:28 - Surgical Techniques & Postoperative Care
01:03:13 - Evaluating Success Post-Surgery
01:09:20 - Final Thoughts: The Impact of Pediatric Dysphagia on Families
Resources
Dr. Hamdy El-Hakim’s University of Alberta Profile:
https://www.ualberta.ca/airway-research/iarc-team/hamdy-el-hakim.html
Article demonstrating superiority of cold steel relative to laser in type I laryngeal cleft repair:
https://pubmed.ncbi.nlm.nih.gov/34184769/
Transcript Preview
[Dr. Hamdy El-Hakim]
I usually start by saying that the esophagus and the trachea or the windpipe and the gullet initially were one project, and they usually decide to split and go their own ways in terms of the role for swallowing and breathing. Laryngeal cleft is essentially a low ramp in between the two entries, and it can get deeper and deeper, and the lesser fortunate are the ones who have a deeper one.
In terms of swallowing, I always like to explain to them that swallowing is a sequential domino-like process that basically starts in the mouth and ends up hopefully in the stomach safely. It has many factors that affect it, and we really need to take a holistic approach to the child. We need to make sure that breathing and swallowing are taken for granted and smooth as vision and hearing and a heartbeat. In terms of the structural abnormality, I don't talk about the structural abnormality until I find one.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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