The Team

Physician - Dr. Charles Bower*(pictured at right with a patient) and the pediatric otolaryngologists at ACH are experts in the diagnosis and surgical management of pediatric airway problems. Dr. Bower is a graduate of the University of Arkansas for Medical Sciences College of Medicine, where he also completed a residency in otolaryngology. Next, he completed a fellowship in pediatric otolaryngology at Cincinnati Children’s Hospital where management of airway problems was emphasized. He has been on the medical staff at ACH for over 10 years where he has managed all pediatric airway problems from the simple to the severe and life threatening.

Specialty Nurses - The specialty nurses at ACH are critical for management of children with airway problems. They are important for the continuum of patient care, education of caregivers and families, and development and dispensation of hospital policy.

Respiratory Therapy - The respiratory therapy department consists of highly skilled individuals trained in the management of the most difficult airway and pulmonary problems.

Anesthesia - ACH has a team of highly-trained pediatric anesthesiologists skilled in the very delicate challenge of providing anesthesia for critically ill infants and children.

The Hospital - With state of the art equipment, ACH is an entire hospital dedicated to care, love and hope for children in Arkansas.

Types of Problems

Airway problems are the most important cause of labored breathing in children and occur on a daily basis. Croup, or airway swelling from infection, can usually be treated medically. Scarring of the larynx, or masses such as papilloma, require surgical excision, often performed by highly accurate laser surgery. Some children require open reconstruction of the larynx or trachea, rebuilding the delicate structures with cartilage from the rib or ear. Surgery on the nose, palate, tonsils and adenoids, or other areas may be helpful for airway function.

Subglottic stenosis is a narrowing of the airway which may have been present at birth or acquired after birth. Treatment is almost always surgical.

Laryngomalacia is an intermittent collapse of laryngeal structures which allows the airway to briefly close causing noisy breathing. Most infants are managed with medications, while a small percent require surgery to prevent collapse of the airway.

Tracheomalacia is a softening of the trachea so that the trachea rings are not able to keep the airway from collapsing on itself, especially during expiration. Surgery is needed in a small number of cases.

Papilloma is a recurring wart growing on the vocal cords, caused by human papilloma virus. Surgery is needed for removal of the warts. Medical therapy is used in some cases. Research is being performed to improve management of children with papillomas.

Vocal cord paralysis is most frequently the result of damage to the nerves of the vocal cords. Surgery is sometimes needed to improve voice and help children breathe better.

Obstructive sleep apnea is a breathing problem occurring while the upper airway is blocked during sleep which causes brief pauses in breathing during sleep. This can be due to many factors such as: facial structure, airway anatomy, muscle tone and large tonsils and adenoids which can make the airway narrow. Comprehensive diagnostic services are available if necessary. Most patients can be cured surgically. Non-surgical alternative such as CPAP (continuous positive airway pressure) are used in some patients.

Choanal atresia is an unusual complete obstruction of the back part of the nose which causes life threatening airway obstruction in infants. Urgent surgery is life-saving. The team at ACH is capable of performing state-of-the-art endoscopic surgery in these young infants.

Pierre Robin Sequence, an unusual variant of cleft palate, is also a life threatening airway problem in infants. Again, the team at ACH provides expert care for these children, drawing in skilled nurses, respiratory therapists, and physicians for management without surgery, in most cases. Advanced surgical techniques are available for the severely affected children which need the most help.

Diagnostic Tools

X-rays are a painless way to allow a picture of a specific site to be made for the doctor to observe and evaluate.

CT scans and MRIs are a way for the doctor to see multiple views of a specific site.

Nasopharyngeal endoscopy is a way for the doctor to see the anatomy of the airway briefly during a regular office visit. To begin, numbing drops are placed in the nostrils. Then, the soft, flexible tubing with a camera is placed in the nose and gently lowered into the airway. This often allows not only for the physician to see, but allows a chance to replay and explain what is seen to the caregivers accompanying the patient to the clinic.

A polysomnogram, or sleep study, is a painless test that examines a person’s sleeping behavior. During this all-night procedure, several electrodes are applied to the scalp, chin, chest and legs. An elastic belt is placed around the abdomen. Two thin wires are placed near the mouth and a small device is placed on a finger.
Following the test, the patient returns to normal activities. The study is analyzed by technologists and doctors specifically trained in sleep disorders. The results will assist the doctor in diagnosing sleep and airway problems.

Surgical Interventions

Microlaryngoscopy and bronchoscopy are surgical procedures performed under general anesthesia. This allows the surgeon to look directly through the mouth at the complete airway without making an incision. Frequently, laser treatment, surgical repair, or dilation can be done during the procedure.

Epiglottoplasty is an endoscopic procedure performed by endoscopes for the treatment of laryngomalacia. The floppy obstructing tissue is
removed with lasers and scissors to open the airway in affected infants.

Laser surgery is also performed endoscopically to open scarred areas, remove masses or otherwise treat abnormal tissue. Lasers are incredibly accurate, bloodless cutting-tools which can safely open abnormal airways even in the smallest of infants.

Reconstructive surgery is sometimes needed to repair extremely damaged airways. Open surgery is performed frequently using grafts of rib or ear cartilage to rebuild narrow airways.

Tonsillectomy and adenoidectomy is the most commonly performed surgery for sleep apnea, and provides a very high cure rate. In more severely affected children, removal of the palate and part of the tonsil pillars (UPPP), tongue surgery (Repose), and other procedures are necessary for sleep apnea.

Tracheostomy, in which a breathing tube is inserted directly through the skin of the neck, is a life-saving procedure required for children with the most severely abnormal airways. Fortunately, the procedure is technically reversible, although airway reconstruction may be necessary before the tracheotomy can be removed. Postoperative education is an important component of the safe management of children with a tracheotomy, a service which is offered by the pediatric otolaryngology specialty nurses.

Contact Info/Referrals
ENT Clinic: 501-364-1225
ENT Office: 501-364-1047

*Dr. Charles Bower, chief of otolaryngology, ACH, associate professor, UAMS.