Airway Disorders

Airway Disorders

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Airway disorders can affect how babies and children breathe, eat, swallow, and sleep. They may be diagnosed before birth or develop over time as the result of an infection or traumatic injury. Duke pediatric otolaryngologists work closely with experts in many pediatric specialties to diagnose and treat your child’s condition. We work with you and your child to help them eat, sleep, swallow, and breathe as normally as possible.

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Understanding Airway Disorders

There are many different conditions that can affect your child’s ability to function normally.

Narrowed Throat, Trachea and Nasal Passages
Children may be born with throat, trachea, or nasal passages that are too narrow to let air and food flow comfortably or allow swallowing to happen naturally. These may include:

  • Subglottic stenosis
  • Pyriform aperture stenosis
  • Choanal atresia and stenosis 
  • Complete tracheal rings

Airway Obstructions
Obstructions in the airways between the nose, throat, and lungs that are present at birth can also have a significant impact, including causing sleep apnea. Examples include:

  • Cysts
  • Floppy tissue around the vocal cords (laryngomalacia)
  • Laryngeal cleft, a rare condition in which the there is a deep groove or opening on the back wall of the voice box that allows food and drinks to pass into the airway (aspiration)
  • Collapsed or weakened windpipe (tracheomalacia or bronchomalacia), which can cause a child to choke while eating and also cause difficulty with breathing normally

Related Medical Conditions
Children can also develop airway disorders as a result of other medical conditions, such as:

  • Cystic fibrosis, which causes mucus to build up in the lungs
  • Vocal cord lesions or paralysis, which may develop following an injury, stroke, tumor, or infections. These can damage the nerve that controls the vocal cords and cause problems with your child's voice. They can also cause problems with swallowing and eating, and allow food and liquids to pass into the windpipe.

Blocked airways can also occur suddenly. If your child experiences a sudden blockage in their airway from an object or allergic reaction, call 911 immediately.

Many Specialists Involved in Your Child's Care
Because these conditions require care from many specialists, your child’s team may include head and neck surgeons, pulmonologists, neurologists, allergists, gastroenterologists, speech pathologists, nutritionists, and social workers who are specially trained to work with children. We coordinate your child’s care and work with your child to help them overcome the challenges they face.

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Children with airway disorders require highly personalized care. Treatments may range from simple, ongoing monitoring to complex surgery.


Antihistamines and epinephrine (EpiPen) can reduce airway swelling and inflammation of the nasal passages, throat, and tongue caused by an allergic reaction. When an infection is to blame, antibiotics and anti-inflammatory medicines can reduce swelling to unblock airways.

EXIT Procedure (Ex-utero Intrapartum Therapy)

Airway disorders that are diagnosed in utero may require this procedure during the baby’s delivery. Pediatric otolaryngologists use it to establish the airway before the umbilical cord is cut. 

Endoscopic Surgery

A lighted tube called an endoscope is inserted through the mouth to access a blocked airway in the nasal passages, windpipe, voice box, or lungs. The endoscope allows for the passage of tiny tools that are used by the surgeon to remove a blockage or inflate balloons to expand narrow passageways.

Open Surgery

In some cases, open surgery (in which an incision is made in the neck to access the airway) is required to clear an airway blockage. Your doctor will discuss the best options for your child, which may include procedures to stabilize the windpipe or a create a new airway (tracheostomy).

Airway Reconstruction Surgery

Certain airway disorders require reconstruction surgery to rebuild or expand parts of the airway, such as the voice box or windpipe. Reconstruction procedures can be performed with endoscopic or open surgical techniques. Conditions that may need reconstruction include laryngeal cleft, laryngomalacia, subglottic or tracheal stenosis, tracheal rings, and tracheomalacia. 

Swallowing and Feeding Therapy

Your child may work with a speech pathologist to improve his or her ability to swallow. The therapist will help your child improve chewing, sucking, and tongue movements and strengthen the muscles in the mouth and throat that are used for swallowing. A dietitian and speech therapist can help your child get the calories and nutrition he or she needs while also learning how to accept foods that look and feel different. Feeding therapy can involve eating different foods at hot and cold temperatures and with varying textures. 

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Tests and Procedures

Diagnosing and ongoing care of children with airway disorders requires many types of imaging. Our pediatric otolaryngologists may request the following tests or procedures.

X-Ray, CT-Scan, or MRI

Imaging of the head, neck, and chest are taken to check for blockages.


A tube called a bronchoscope is inserted through the nose or mouth and into the lower airway, to check for foreign objects and other causes of airway blockages.


A flexible tube called an endoscope is used to examine the voice box (larynx), vocal cords, and throat.

Best Children's Hospital in NC
In addition to being among the best in the country, Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.
Reviewed: 01/19/2018