Divisions >> Otolaryngology-Head & Neck Surgery >> Otolaryngology Surgery Update e-newsletter >> May 2016 >> Pediatric Otolaryngology at American Family Children’s Hospital
Pediatric Otolaryngology at American Family Children’s Hospital
Sleep Apnea, Aerodigestion, and New Faces
As the American Family Children’s Hospital has grown by leaps and bounds, reaching a critical mass of pediatric specialists devoted to the care of sick children, the section of Pediatric Otolaryngology has kept pace. It is an exciting time of change, development, and growth.
‘Sick kids can’t wait’
Diane Heatley, MD, continues to stay very active and busy in the section despite also serving as the AFCH Medical Director since 2012 — they say it is good to have friends in high places! She has been a great ally to all of the surgical services at AFCH while simultaneously helping to streamline and improve the overall experience of our pediatric patients and their families. She has been instrumental in developing a culture of commitment to excellence in the care of children. “Sick kids can’t wait.”
Dr. Heatley is an integral part of the Cochlear Implant Team, the Craniofacial Anomaly Clinic, and the Tracheotomy Clinic, and also holds regular office hours at AFCH, the evening AFCH Clinics, and does outreach in Rockford at SwedishAmerican. There really is no slowing her down.
Pediatric obstructive sleep apnea
Tony Kille, MD, has taken the lead in new and exciting evaluation and treatment paradigms. Children with obstructive sleep apnea are often helped with adenotonsillectomy. There are a handful of children, however, who continue to have significant obstructive symptoms, despite resolution of their adenotonsillar hypertrophy. Once the obvious points of obstruction have been resolved, treating these children with continued obstruction can be frustrating for their families and surgeons alike. Difficulty often arises when trying to determine the site of obstruction in these children with continued obstructive sleep apnea. Without an accurate determination of the point of obstruction, no appropriate treatment can be crafted.
Drug Induced Sleep Endoscopy (DISE) has been developed and has been shown to be an extremely useful tool in determining the site of obstruction. Further surgical interventions can then be formulated based on the results. Dr. Kille has been working with AFCH Pediatric Sleep Medicine Specialist Dr. Cami Matthews to identify a number of patients with difficult sleep apnea.
Although the typical sites of obstruction have been treated, these children continued to have obstructive symptoms. With the use of DISE, Dr. Kille was able to determine the site of obstruction and formulate a surgical solution. By working with Sleep Medicine and Craniofacial surgeons, and by looking into approaches to resolve tongue base and supraglottic collapse, Dr. Kille has been instrumental in improving the quality of life of these children.
DISE requires a multidisciplinary approach working closely with the anesthesiologist and the otolaryngologist. Providing a functional assessment while analyzing the airway for sites of obstruction from the nasal cavity to hypopharynx, this operative endoscopy requires skill, team work, and patience. It requires titration of the anesthetic to mimic sleep while safely obtaining optimal visualization of the structures of the airway.
Of the anatomical sites contributing to obstructive sleep apnea in children after adenotonsillectomy, Dr. Kille has found that the tongue base leads the pack. He has been honing his techniques in treating the obstructed tongue base without necessarily requiring tracheotomy or even postoperative intubation. Using the PlamsaBlade, he has been able to safely treat large lingual tonsils.
He has published a description of his technique of lingual tonsillectomy using PlasmaBalde in Operative Techniques in Otolaryngology-Head and Neck Surgery. Using telescopic guidance, he has been able to safely and effectively remove the obstructing lingual tonsillar tissue with the PlasmaBlade.
To improve access to Pediatric Otolaryngology at AFCH, we are actively recruiting another surgical partner. We are also very excited to announce that Brianna Schumacher, RN, NP, has joined our group. She will be seeing new and returning patients in her Pediatric Otolaryngology Clinic at AFCH, and we are confident that Brianna will help us increase our clinic access and decrease wait times. Brianna brings an extensive experience in Pediatric Emergency Medicine, having worked as an RN in the Emergency Department at Denver Children’s Hospital for many years before working in the ED at the Children’s Hospital of Wisconsin while she obtained her Pediatric Nurse Practitioner Certification. We are so pleased that she has joined us. She is loved by parents and patients alike.
UW Pediatric Aerodigestive Clinic
Finally, I have been working to facilitate a formal identity for our UW Pediatric Aerodigestive Clinic Team, also known as UW PACT. Soon, families will be able to come to AFCH for a unified, multidisciplinary evaluation for problems concerning breathing and swallowing. With commitment from Otolaryngology, Pulmonology, Gastroenterology, Speech and Swallow, General Surgery, Anesthesia, and Nutrition, patients and their families will have the opportunity for a one-stop shop for diagnosis and management recommendations. Over a 1- to 3-day period, patients and families will have a multidisciplinary evaluation, directed testing (such as PFTs and Swallow Studies), and operative endoscopy. Following the complete evaluation, the medical team will convene to produce a unified recommendation for the treatment of the aerodigestive problem. Pediatric centers around the country have been developing multi-specialty collaborations for the evaluation of these very complex children. AFCH will soon have a formal identity with the UW PACT to provide this service to the children of our region.
We are excited about the growth and development we are going through. We thank you for your pediatric referrals, and we hope that we can continue to help in the management of your pediatric patients, whether through referral to AFCH or through consultation and discussion by phone.