# CHARGE Syndrome — GCMD Library living collection

Everything in the library about CHARGE syndrome — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 82 cited statements

## Episodes
### Fundamentals
- [QUAD #22: What is CHARGE syndrome? with Dr. Catherine Hart](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458) — video · 0:59 · [machine version](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458.md)

### Diagnosis & Workup
- [Aerodigestive & Esophageal Surgery: Aspiration in TEFs](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039) — video · 5:28 · [machine version](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039.md)

### Medical Management
- [QUAD #24: CHARGE Syndrome, Pulmonary Considerations with Dr. Cherie Torres-Silva](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518) — video · [machine version](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518.md)

### Surgical Management
- [QUAD #23: CHARGE Syndrome, Airway Considerations with Dr. Catherine Hart](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515) — video · [machine version](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515.md)

### In-Depth Reviews
- [Aerodigestive Management of Pediatric Aspiration - FULL SHOW](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796) — video · 2:37:09 · [machine version](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=0) Framework for aspiration: causes and what children aspirate (Ep 1)
- [2:34](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=154) Testing for food and drink aspiration (Ep 1)
- [4:10](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=250) Testing for saliva aspiration (Ep 1)
- [4:52](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=292) Testing for gastroesophageal reflux aspiration (Ep 1)
- [0:04](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4) Defining Pediatric Aspiration and At-Risk Populations (Ep 2)
- [4:55](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=295) Pulmonary Perspective on Chronic Aspiration (Ep 2)
- [11:11](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=671) Swallowing Physiology and Dysphagia Causes (Ep 2)
- [20:30](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1230) Diagnostic Approach: What Is Being Aspirated (Ep 2)
- [26:51](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1611) Instrumental Evaluation: VFSS and FEES (Ep 2)
- [37:22](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2242) Differential Diagnosis of Aspiration (Ep 2)
- [52:29](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3149) Tracheostomy and Aspiration Management (Ep 2)
- [57:37](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3457) Medical Management of Functional Aspiration (Ep 2)
- [67:39](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4059) Surgical Management: Drool Procedures and Laryngotracheal Separation (Ep 2)
- [80:08](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4808) Unilateral Vocal Fold Paralysis Management (Ep 2)
- [87:21](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5241) Tracheoesophageal Fistula: Diagnosis and Endoscopic Repair (Ep 2)
- [100:00](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6000) Open TEF Repair Techniques (Ep 2)
- [109:29](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6569) Slide Tracheoplasty for Complex TEFs (Ep 2)
- [125:00](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7500) Laryngeal Cleft Classification and Endoscopic Repair (Ep 2)
- [141:14](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8474) Open Cleft Repair and Type 4 Clefts (Ep 2)
- [152:34](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=9154) Esophageal Pathology and Pharyngeal Stenosis (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=0) CHARGE Syndrome Definition and Diagnostic Criteria (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=0) Introduction to CHARGE Syndrome Airway Discussion (Ep 4)
- [0:44](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=44) Anatomical Features of the CHARGE Larynx (Ep 4)
- [3:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=180) Feeding Difficulties and Aspiration in CHARGE Syndrome (Ep 4)
- [5:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=300) Medical Management of Aspiration (Ep 4)
- [7:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=420) Surgical Management of Secretions and Aspiration (Ep 4)
- [9:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=540) Tracheotomy and Laryngotracheal Separation (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=0) Introduction to QUAD Conference and Topic (Ep 5)
- [0:37](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=37) Case Presentation: 3-Year-Old with CHARGE Syndrome (Ep 5)
- [4:09](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=249) Relationship Between OSA and Aspiration (Ep 5)
- [4:31](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=271) Management Strategy for CHARGE Pulmonary Complications (Ep 5)
- [8:39](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=519) Summary and Closing (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In a child with tracheostomy, the simplest test for aspiration is to put colored dye in the mouth and see if it comes out of the trach tube. — Bob (clinical) [Ep 1 · 2:55](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=175)
- The dye test can be done at home in a normal setting and repeated, and is helpful to convince skeptical parents that the child is aspirating. — Bob (clinical) [Ep 1 · 3:05](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=185)
- Video swallow studies and endoscopic swallow studies can be very useful for testing aspiration. — Bob (clinical) [Ep 1 · 3:18](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=198)
- There are no unequivocal endoscopic markers of aspiration. — Bob (clinical) [Ep 1 · 3:23](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=203)
- Lipid-laden macrophages are non-specific markers of aspiration. — Bob (clinical) [Ep 1 · 3:35](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=215)
- Recovery of lipid-laden macrophages depends on what material was aspirated, how much lipid it contained, the amount aspirated, and how long since the aspiration event. — Bob (clinical) [Ep 1 · 3:35](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=215)
- Lots of lipid-laden macrophages in the right clinical setting provide convincing evidence of aspiration, but it is not a black and white yes/no answer. — Bob (clinical) [Ep 1 · 3:57](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=237)
- As markers for aspiration, reflux tests are not particularly good. — Phil (clinical) [Ep 1 · 5:02](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=302)
- Multi-channel intraluminal impedance testing has mostly replaced simple pH testing for detection of reflux. — Phil (clinical) [Ep 1 · 5:08](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=308)
- Multi-channel intraluminal impedance testing does not add anything to the diagnosis of aspiration itself; it tells whether something is being delivered from the stomach to the esophagus but not what happens after that. — Phil (clinical) [Ep 1 · 5:08](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=308)
- The CHARGE acronym stands for coloboma, heart defects, atresia of the choana, retardation of growth and development, genital and/or urinary anomalies, and ear malformations. (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=0)
- CHARGE syndrome is caused by a CHD7 mutation on chromosome 8. (clinical) [Ep 3 · 0:11](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=11)
- A population of children with CHARGE syndrome will have a negative test for CHD7 but can still have CHARGE syndrome based on clinical criteria. (clinical) [Ep 3 · 0:11](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=11)
- To make the diagnosis of CHARGE syndrome, you must have at least two of the major criteria. (clinical) [Ep 3 · 0:24](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=24)
- The major criteria for CHARGE syndrome are coloboma, choanal atresia or cleft palate, characteristic ear abnormalities, and cranial nerve abnormalities. (clinical) [Ep 3 · 0:28](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=28)
- If you have the major criteria, you have CHARGE syndrome independent of other clinical features. (clinical) [Ep 3 · 0:37](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=37)
- To make a definitive clinical diagnosis of CHARGE syndrome, you need either 3 major features and at least 1 minor feature, or 2 major features and 2 minor features, or the CHD7 mutation. (clinical) [Ep 3 · 0:41](https://origin-library.globalcastmd.com/watch/quad-22-what-is-charge-syndrome-with-dr-catherine-hart-9458?t=41)
- Chronic pulmonary aspiration is defined as repeated aspiration into the lower airways causing pulmonary injury or chronic respiratory disease, with consequences determined by frequency, magnitude, nature of material, and effectiveness of host defenses. — Katherine Hart (clinical) [Ep 2 · 3:31](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=211)
- Four major groups aspirate: premature babies, those with neurologic disabilities, those with airway disease (anatomic, dynamic, or functional), and those with gastrointestinal disorders. — Katherine Hart (clinical) [Ep 2 · 4:34](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=274)
- Children with associated obstructive airway symptoms (snoring, retractions, stridor, desaturation) should undergo airway endoscopy to look for anatomic causes of dysphagia. — Claudia Schweiger (clinical) [Ep 2 · 10:17](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=617)
- Video swallow study (VFSS) and functional endoscopic evaluation of swallowing (FEES) are complementary tests that show different things and evaluate different parts of the swallow—it is important to explain to families they are not the same test. — Sandra Stinnett (clinical) [Ep 2 · 16:33](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=993)
- Impedance probe is the best test for gastroesophageal reflux but is not necessarily widely available. — Michael Rutter (clinical) [Ep 2 · 18:05](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1085)
- CT scanning is excellent for evaluating long-term consequences of aspiration but shows damage already done (tells about the past, not the present) and requires anesthesia, radiation, and radiologic expertise. — Michael Rutter (clinical) [Ep 2 · 19:23](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1163)
- Elevated lipid-laden macrophages are not pathognomonic of aspiration—they can result from natural airway debris (dead neutrophils, macrophages from inflammation) or circulation after bleeding or airway surgery. — Katherine Hart (clinical) [Ep 2 · 45:56](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2756)
- Lipid-laden macrophages are a limited tool because aspirated material has variable lipid content (saliva has no lipid), there is variable time between aspiration and BAL sampling affecting lipid metabolism, and individuals have variable rates of lipid catabolism. — Katherine Hart (clinical) [Ep 2 · 46:38](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2798)
- Decanulation should not proceed until the child has proven capacity to clear their airway through a prolonged capping trial that includes going through illnesses without needing the tracheostomy for clearance. — Katherine Hart (clinical) [Ep 2 · 49:10](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2950)
- Speaking valves help with airway clearance by allowing glottic closure for better cough and creating positive end-expiratory pressure that distends airways, even if they do not decrease aspiration coming in. — Katherine Hart (clinical) [Ep 2 · 49:56](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2996)
- CHARGE patients frequently need tracheostomy or interventions for salivary aspiration at young age but often develop compensatory strategies over time and can be decannulated as they mature. — Sandra Stinnett (clinical) [Ep 2 · 50:54](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3054)
- The pulmonologist's role in the aerodigestive team is to protect children from developing irreversible long-term pulmonary sequelae while managing anatomic abnormalities or waiting for maturity. — Katherine Hart (opinion) [Ep 2 · 51:44](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3104)
- Medical management of functional aspiration should target five aspects: decrease aspiration events, improve airway clearance, address quality of aspirated material, control inflammation, and treat or prevent infections. — Katherine Hart (clinical) [Ep 2 · 58:16](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3496)
- Positive pressure ventilation (CPAP or BiPAP) can decrease aspiration events, especially during sleep in patients with reflux aspiration, even in patients who do not need it for gas exchange or ventilation. — Katherine Hart (clinical) [Ep 2 · 65:45](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3945)
- Cuff tubes cannot stop aspiration because inflating the cuff enough to decrease leak causes unacceptable tracheal injury or dilation. — Katherine Hart (clinical) [Ep 2 · 64:56](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3896)
- Passy-Muir valves should never be used during sleep because they allow inhalation through the tracheostomy but not exhalation, risking obstruction from mucus accumulation, and they cause over-drying of secretions leading to mucus plugging. — Katherine Hart (clinical) [Ep 2 · 66:39](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3999)
- Chronic inflammation from aspiration is managed with inhaled steroids and systemic anti-inflammatory medication (azithromycin, not systemic steroids as first-line), with systemic steroids reserved for acute aspiration events to prevent pneumonitis. — Katherine Hart (clinical) [Ep 2 · 62:17](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3737)
- Patients with bronchiectasis from chronic aspiration should receive longer antibiotic courses (10-14 days instead of 7-10 days) because bronchiectatic cavities have more difficult clearance. — Katherine Hart (clinical) [Ep 2 · 63:30](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3810)
- Prophylactic inhaled antibiotics (tobramycin or colistimethate, either every other month or 14 days per month) are reserved for patients with severe bronchiectasis and pulmonary injury or significant frequency of infections. — Katherine Hart (clinical) [Ep 2 · 63:42](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3822)
- Botox for sialorrhea has 90% success rate in the speaker's experience and is first-line treatment. — Hugo Rodríguez (clinical) [Ep 2 · 78:03](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4683)
- Laryngotracheal separation guarantees no aspiration but eliminates voice, and attempts to restore voice with speaking valves (Blom-Singer) are not effective in children because the larynx remains in the way—complete laryngectomy with cricopharyngeal myotomy is required for voice restoration. — Michael Rutter (clinical) [Ep 2 · 81:41](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4901)
- The Cincinnati laryngotracheal separation technique involves peeling mucosa up subperichondrially within the cricoid, purse-string closure, splitting cricoid laterally at 3 and 9 o'clock, quilting sutures to sandwich cricoid, tisseal in subglottis, and crisscrossing medial heads of SCM over the laryngeal stump—this has eliminated fistula formation and stomal stenosis. — Michael Rutter (clinical) [Ep 2 · 83:52](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5032)
- In children, laryngotracheal separation stomas will stenose without a tube until growth stops, so a relatively big, wide, short tube must remain in the tracheal stoma. — Michael Rutter (clinical) [Ep 2 · 85:19](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5119)
- For injection materials, radiance gels dissipate within weeks in animal models and do not work well; Restylane is used as a bridge and fat for longer-term injection. — Sandra Stinnett (clinical) [Ep 2 · 71:40](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4300)
- Reinnervation advantages include single general anesthetic (no awake thyroplasty needed for children), one-and-done if successful, low risk, allows other procedures later, and uses patient's own tissue; disadvantages include lack of long-term pediatric data, 6-9 months to final results, and neck incision. — Sandra Stinnett (clinical) [Ep 2 · 74:11](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4451)
- Reinnervation is a misnomer—it does not restore movement but provides tone and better closure, with outcomes measured by voice and swallowing improvement. — Sandra Stinnett (clinical) [Ep 2 · 75:46](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4546)
- Sensory reinnervation (great auricular nerve to superior laryngeal nerve) can restore sensation and is valuable when the sensory component is the primary deficit, allowing recognition of secretions and swallowing. — Sandra Stinnett (clinical) [Ep 2 · 77:07](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4627)
- Tracheoesophageal fistulas can be surprisingly challenging to find and require high index of suspicion, angled telescopes, probing, and positive pressure breath with endotracheal tube in esophagus to visualize bubbling. — Michael Rutter (clinical) [Ep 2 · 92:40](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5560)
- Endoscopic TEF repair is ideal for long skinny tracts (usually recurrent TEFs after congenital repair); the concept is to demucosalize the tract with Bugby cautery to get raw-against-raw, inject filler beside the tract to compress it, and place fibrin glue. — Michael Rutter (clinical) [Ep 2 · 98:43](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=5923)
- Endoscopic TEF repair has a recognized failure rate and surgeons must be prepared to repeat the procedure multiple times. — Michael Rutter (clinical) [Ep 2 · 104:26](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6266)
- Congenital H-type tracheoesophageal fistulas, with very few exceptions, do not do well with endoscopic repairs and typically require open repair. — Michael Rutter (clinical) [Ep 2 · 106:03](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6363)
- For H-type TEFs, the upper 2/3 of trachea is accessible through the neck, the lower third is easier through the chest, and the middle third is no-man's land where whoever has better expertise (pediatric surgery or ENT) should do it. — Michael Rutter (clinical) [Ep 2 · 106:27](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6387)
- Slide tracheoplasty technique for large or multiply-failed TEFs involves transecting trachea above and below the hole, peeling trachea off esophagus, using the tracheal segment attached to the hole to repair the esophagus, and reconnecting the trachea over the top with a slide technique that oversizes the airway and reduces tension. — Michael Rutter (clinical) [Ep 2 · 109:45](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=6585)
- For the case of isolated esophagus with multiple TEFs connecting to trachea, leaving the esophagus isolated at both ends prevents aspiration through the holes while the holes prevent mucocele formation by allowing drainage. — Michael Rutter (clinical) [Ep 2 · 120:59](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7259)
- Flexible bronchoscopy is not a good tool for evaluating posterior laryngeal clefts—rigid bronchoscopy is required for diagnosis. — Michael Rutter (clinical) [Ep 2 · 127:00](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7620)
- The Cincinnati endoscopic cleft repair technique uses laser (KTP or CO2) to remove a wide swath of mucosa on both sides of the cleft, creating raw-against-raw surfaces, then places 2-3 sutures (60 PDS on bent BV1 for babies, 40 PDS on P2 for older children) and releases aryepiglottic folds. — Sandra Stinnett (clinical) [Ep 2 · 128:10](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7690)
- Endoscopic cleft repair has become a fellow-level case in Cincinnati due to the volume performed (at least 20, likely way more). — Sandra Stinnett (clinical) [Ep 2 · 131:18](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7878)
- Almost all children under 4 kg who had type 4 cleft repairs died; waiting until the child is over 5 kg improves outcomes. — Michael Rutter (clinical) [Ep 2 · 137:44](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8264)
- For long type 4 clefts, the Cincinnati technique involves transecting trachea at cricoid, peeling trachea off esophagus to beyond the cleft, repairing esophagus, placing sternal periosteum interposition graft, reconnecting trachea, and placing tracheostomy 2-3 weeks later after healing. — Michael Rutter (clinical) [Ep 2 · 135:26](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8126)
- The greatest risk with laryngotracheoesophageal clefts is that the distal end of the repair may form a tracheoesophageal fistula. — Michael Rutter (clinical) [Ep 2 · 139:09](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=8349)
- For severe pharyngeal stenosis, management is a step ladder approach: voice, breathing without trach, no aspiration, swallowing without G-tube—typically cannot achieve all four, usually one or two steps up the ladder, rarely three. — Michael Rutter (clinical) [Ep 2 · 153:04](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=9184)
- Composite stents (suprastomal stent with silastic sheet wrapped around it supraglottically) are effective for severe pharyngeal stenosis—the stent goes through vocal cords and locks in trachea while the silastic holds open the supraglottic raw areas during re-mucosalization. — Michael Rutter (clinical) [Ep 2 · 154:27](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=9267)
- Patient had more than 12 pneumonias in her lifetime — Cherie Torres-Silva (clinical) [Ep 5 · 0:37](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=37)
- Patient required endotracheal intubation 12 times due to acute respiratory failure — Cherie Torres-Silva (clinical) [Ep 5 · 0:37](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=37)
- At baseline, no positive pressure support was needed — Cherie Torres-Silva (clinical) [Ep 5 · 0:37](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=37)
- CT scan showed consolidation and changes especially on the right upper posterior lobe with mild early bronchiectatic cylindrical changes in central lobes bilaterally — Cherie Torres-Silva (clinical) [Ep 5 · 1:30](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=90)
- Swallow study showed absent swallow onset, severe impairment in management of oral secretions with penetration and silent aspiration — Cherie Torres-Silva (clinical) [Ep 5 · 2:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=120)
- Bronchoalveolar lavage showed elevated lipid laden macrophages of 30% and increased number of squamous cells — Cherie Torres-Silva (clinical) [Ep 5 · 2:30](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=150)
- Patient had chronic and active infection that was both bacterial and fungal — Cherie Torres-Silva (clinical) [Ep 5 · 3:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=180)
- Upper airway obstruction fell into severe category with AHI above 10 — Cherie Torres-Silva (clinical) [Ep 5 · 3:15](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=195)
- Patient had abnormality in right upper lobe bronchus with very cephalic takeoff and collapse in anterior posterior diameter, contributing to mucus clearance limitation — Cherie Torres-Silva (clinical) [Ep 5 · 3:30](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=210)
- There is increased risk of aspiration in patients that have obstructive sleep apnea and gastroesophageal reflux — Cherie Torres-Silva (clinical) [Ep 5 · 4:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=240)
- There is correlation between how deep we're sleeping and the frequency of swallowing - in deeper parts of sleep, we swallow less — Cherie Torres-Silva (clinical) [Ep 5 · 4:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=240)
- In deeper sleep, patients have higher number of obstruction events — Cherie Torres-Silva (clinical) [Ep 5 · 4:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=240)
- Dental decay is directly associated with increased frequency of respiratory infections in patients that have aspiration — Cherie Torres-Silva (epidemiological) [Ep 5 · 6:20](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=380)
- Acid reflux is more injurious for these patients than non-acid reflux — Cherie Torres-Silva (clinical) [Ep 5 · 6:50](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=410)
- Azithromycin shows significant clinical improvement in younger babies with significant CT scan changes and recurrent infections — Cherie Torres-Silva (opinion) [Ep 5 · 7:10](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=430)
- Studies showed that patients can have further prolongation of QT interval on azithromycin — Cherie Torres-Silva (clinical) [Ep 5 · 7:40](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=460)
- Dr. Torres-Silva always gets an EKG before starting patients on long-term azithromycin — Cherie Torres-Silva (opinion) [Ep 5 · 7:40](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=460)
- The more aggressive you are with antibiotics, the more likelihood you will contribute to development of very resistant flora — Cherie Torres-Silva (clinical) [Ep 5 · 8:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=480)
- Inhaled antibiotics are used to decrease systemic effects of antibiotics — Cherie Torres-Silva (clinical) [Ep 5 · 8:20](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=500)
- Tobramycin inhaled is the go-to medication for prophylactic antibiotics, with colistin as second line — Cherie Torres-Silva (opinion) [Ep 5 · 8:20](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=500)
- 14-day antibiotic cycles are used because many babies cannot be 28 days without antibiotics — Cherie Torres-Silva (opinion) [Ep 5 · 8:20](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=500)
- Patients with thoracotomies or progressive scoliosis develop restrictive lung disease that interferes with airway clearance — Cherie Torres-Silva (clinical) [Ep 5 · 5:20](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=320)
- Huff cough mobilizes secretions from peripheral airways to center, making clearance easier — Cherie Torres-Silva (clinical) [Ep 5 · 6:00](https://origin-library.globalcastmd.com/watch/quad-24-charge-syndrome-pulmonary-considerations-with-dr-cherie-torres-silva-9518?t=360)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Most children who aspirate have a functional or neurological problem. — The host summarizing the discussion [Ep 1 · 0:10](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=10)
- Cerebral palsy and CHARGE syndrome are examples of functional/neurological causes of aspiration. — The host summarizing the discussion [Ep 1 · 0:16](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=16)
- Anatomical problems causing aspiration include tracheoesophageal fistula and laryngeal cleft. — The host summarizing the discussion [Ep 1 · 0:22](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=22)
- Bad pharyngeal scarring can cause aspiration in some children. — The host summarizing the discussion [Ep 1 · 0:34](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=34)
- Esophageal stenosis with backup and spillover can cause aspiration. — The host summarizing the discussion [Ep 1 · 0:39](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=39)
- For children who aspirate food and drink, nasogastric tube or gastrostomy tube can be considered. — The host summarizing the discussion [Ep 1 · 0:53](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=53)
- Robinul (glycopyrrolate) can be tried for saliva management but generally does not work. — The host summarizing the discussion [Ep 1 · 1:13](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=73)
- Botox injection of major salivary glands is a temporary solution and serves as a good test for how a child would cope with less saliva. — The host summarizing the discussion [Ep 1 · 1:19](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=79)
- A drool procedure involves removing the submandibular glands and ligating the parotid ducts. — The host summarizing the discussion [Ep 1 · 1:30](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=90)
- Tracheotomy allows suctioning of the airway clear of secretions. — The host summarizing the discussion [Ep 1 · 1:38](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=98)
- BiPAP can be placed on a tracheostomy so that secretions are blown up and out of the mouth. — The host summarizing the discussion [Ep 1 · 1:45](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=105)
- Laryngotracheal separation is the only guaranteed operation to stop aspiration but results in loss of ability to vocalize. — The host summarizing the discussion [Ep 1 · 1:53](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=113)
- Nissen fundoplication or any fundoplication may assist with aspiration of gastroesophageal reflux, as may a GJ tube. — The host summarizing the discussion [Ep 1 · 2:09](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=129)
- Children with tight fundoplication and non-motile esophagus can develop accumulation and spillover of esophageal contents leading to aspiration. — The host summarizing the discussion [Ep 1 · 2:21](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=141)
- For saliva aspiration testing in a child with tracheotomy, a drop of green food dye on the tongue can be used to see if it comes out the trach tube. — The host summarizing the discussion [Ep 1 · 4:10](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=250)
- Green is a good dye color because it is not natural, unlike red or blue which might be confused with body-produced substances. — The host summarizing the discussion [Ep 1 · 4:24](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=264)
- For saliva aspiration testing without tracheotomy, a nuclear medicine scan with a drop of radioactive material on the tongue can show if it ends up in the lungs or stomach. — The host summarizing the discussion [Ep 1 · 4:35](https://origin-library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-aspiration-in-tefs-1039?t=275)
- Aspiration is defined as any solid or liquid matter passing below the vocal cords, though some define it as requiring pulmonary compromise in addition to passage below the cords. — Katherine Hart summarizing the discussion [Ep 2 · 0:16](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=16)
- Aspiration can be silent with no clinical indication, or obvious with coughing, choking, and sputtering. — Katherine Hart summarizing the discussion [Ep 2 · 0:39](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=39)
- Children with CHARGE syndrome have 80 to 90% prevalence of aspiration at some point in their lifetime and should be assumed to aspirate until proven otherwise. — Katherine Hart summarizing the discussion [Ep 2 · 1:51](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=111)
- Children with severe neurologic compromise regardless of etiology should be assumed to aspirate until demonstrated otherwise. — Katherine Hart summarizing the discussion [Ep 2 · 2:01](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=121)
- The clinical significance of aspiration depends on the quantity—small isolated events are usually cleared by host defenses (cough, mucociliary transport), while large or repeated events overcome host defenses. — Katherine Hart summarizing the discussion [Ep 2 · 2:32](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=152)
- A single aspiration event of caustic substance can have lifelong consequences. — Katherine Hart summarizing the discussion [Ep 2 · 3:06](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=186)
- Syndromes with significant swallowing dysfunction include CHARGE, Cri-du-chat, Möbius syndrome (cranial nerve abnormalities), and craniofacial defects like Pfeiffer, Crouzon, and Treacher Collins. — Katherine Hart summarizing the discussion [Ep 2 · 5:02](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=302)
- Dysphagia can occur in any of the four swallowing phases (oral preparatory, oral transit, pharyngeal, esophageal) and can result in aspiration or retrograde flow into the nasal cavity. — Claudia Schweiger summarizing the discussion [Ep 2 · 6:09](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=369)
- Children who aspirate may present with breathing difficulties during feeding (increased respiratory rate, bradycardia, tachycardia, cyanosis, apnea, desaturation), coughing/choking during or after swallowing, frequent congestion after meals, noisy or wet vocal quality, prolonged meal times, food refusal, or vomiting. — Claudia Schweiger summarizing the discussion [Ep 2 · 6:48](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=408)
- A radionucleotide spit scan (placing radioactive tracer on tongue) can test for saliva aspiration but involves radiation and is a one-off window in time. — Michael Rutter summarizing the discussion [Ep 2 · 17:21](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1041)
- Medication for reflux generally stops acid but does not stop reflux events. — Michael Rutter summarizing the discussion [Ep 2 · 18:31](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=1111)
- Lipid-laden macrophages are the most commonly used aspiration biomarker, with a lipid-laden macrophage index >90 or >20% of macrophages containing lipid suggesting aspiration. — Katherine Hart summarizing the discussion [Ep 2 · 44:25](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2665)
- Having a tracheostomy tube changes the dynamics of laryngeal elevation but most studies show it does not create aspiration. — Katherine Hart summarizing the discussion [Ep 2 · 48:08](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=2888)
- For airway clearance, comorbidities that compromise clearance include tracheobronchomalacia, airway compression/stenosis/hypoplasia, restrictive lung disease (neuromuscular, chest wall deformities, scoliosis), and vocal cord or diaphragmatic dysfunction/paralysis from esophageal or cardiac surgery. — Katherine Hart summarizing the discussion [Ep 2 · 60:11](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=3611)
- Bilateral submandibular gland excision and bilateral parotid duct ligation (drool procedure) has 60-100% success rate in the literature. — Hugo Rodríguez summarizing the discussion [Ep 2 · 78:38](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4718)
- Temporary laryngeal injection is a useful test-drive procedure before permanent medialization, can be repeated, and serves as a bridge between more permanent operations. — Sandra Stinnett summarizing the discussion [Ep 2 · 70:04](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4204)
- Early injection (1-3 months after recurrent nerve injury) may lead to less need for permanent procedures based on adult literature, though pediatric data is limited. — Sandra Stinnett summarizing the discussion [Ep 2 · 70:28](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4228)
- Reinnervation (ansa-to-recurrent laryngeal nerve) is not a new concept but has gained popularity in the last few years; ideal candidates are <40 years old, within 1-2 years of injury, with known injury location. — Sandra Stinnett summarizing the discussion [Ep 2 · 72:46](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=4366)
- Open cleft repair is reserved for failed endoscopic repairs (some type 2s and type 3s), type 4 clefts (cervical approach), and type 4 long clefts (which present anesthetic challenges requiring double lumen tube, single lung ventilation, ECMO, or bypass). — Sandra Stinnett summarizing the discussion [Ep 2 · 129:02](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7742)
- Type 4 long laryngeal clefts have very high mortality rate hovering around 50%, and families must be counseled about this before attempting repair. — Sandra Stinnett summarizing the discussion [Ep 2 · 129:46](https://origin-library.globalcastmd.com/watch/aerodigestive-management-of-pediatric-aspiration-full-show-2796?t=7786)
- CHARGE syndrome patients tend to have big bulkier arytenoids positioned more anteriorly, creating a structural difference rather than dynamic obstruction typical of congenital laryngomalacia. — The host summarizing a resource [Ep 4 · 0:44](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=44)
- The vocal folds in CHARGE larynx appear foreshortened but are not actually shorter; less is visible due to anterior positioning of the arytenoids. — The host summarizing a resource [Ep 4 · 2:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=120)
- At least 90% of kids with CHARGE syndrome have some degree of cranial nerve abnormalities, which can greatly impact their swallow function. — The host summarizing a resource [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=180)
- Aspiration is present in about 60% of kids with CHARGE syndrome. — The host summarizing a resource [Ep 4 · 4:30](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=270)
- Kids with CHARGE syndrome are just as likely to aspirate saliva and reflux as they are to aspirate oral feeds. — The host summarizing a resource [Ep 4 · 4:40](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=280)
- Glycopyrrolate when first started in a patient is typically 95% effective, but you have to increase the dose to maintain that efficacy and the side effects often lead to discontinuation at higher doses. — The host summarizing a resource [Ep 4 · 5:30](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=330)
- According to Dr. Hart, glycopyrrolate can make secretions really thick, which in kids who already have issues with airway clearance can significantly worsen the problem. — The host summarizing a resource [Ep 4 · 6:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=360)
- Scopolamine can be very effective for sialorrhea but makes kids very drowsy and can make them unable to accommodate, which is problematic in CHARGE patients with complex vestibular issues. — The host summarizing a resource [Ep 4 · 6:20](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=380)
- In a study of just under 100 kids, Botox was effective in about two-thirds of them and had no impact on about the other third, with effects lasting on average about four months. — The host summarizing a resource [Ep 4 · 6:50](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=410)
- Four-duct ligation only ends up with a 30% long-term satisfaction rate. — The host summarizing a resource [Ep 4 · 8:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=480)
- The drool procedure (bilateral parotid duct ligation and bilateral submandibular gland excision) is almost 90% successful. — The host summarizing a resource [Ep 4 · 8:20](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=500)
- Tracheotomy is thought to be necessary in probably about a third of all kids with CHARGE syndrome, usually for multifactorial reasons. — The host summarizing a resource [Ep 4 · 9:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=540)
- A cuffed tracheostomy tube is not protective from aspiration because the cuff has to be deflated and secretions can still make it down into the airway. — The host summarizing a resource [Ep 4 · 9:20](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=560)
- Laryngotracheal separation renders children unable to talk, and according to Dr. Hart, is typically only offered to children who are already non-verbal or neurologically impaired and only when there is extreme impact on the lungs. — Em Gootee summarizing a resource [Ep 4 · 10:00](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=600)
- Salivary duct relocation is not appropriate for kids who are aspirating because it does not decrease saliva production, only relocates where it drains into the mouth. — The host summarizing a resource [Ep 4 · 7:30](https://origin-library.globalcastmd.com/watch/quad-23-charge-syndrome-airway-considerations-with-dr-catherine-hart-9515?t=450)

## Changelog
- Sep 25: 2 items added automatically
- Sep 12: Published again automatically — condition is back above threshold
- Sep 12: 1 item added automatically
- Sep 12: 2 items no longer name CHARGE syndrome
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 4 items added automatically

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://origin-library.globalcastmd.com/ai