Pediatric Otolaryngology

Expertise. Education. Research. The Department of Pediatric Otolaryngology at Nationwide Children's encompasses the depth and breadth of ear, nose and throat disorders. Our team of 10 pediatric fellowship-trained surgeons is responsible for more than 25,000 clinic visits and performing over 7,000 surgical procedures annually.

We are committed to providing the best possible care and experience for our patients and their families.
Charles A. Elmaraghy, MD
Chief of Otolaryngology

Our specialized programs provide the comprehensive expertise of a multidisciplinary team with advanced training in specific disorders, including aerodigestive, airway, hearing, rhinology, salivary gland, voice and swallowing.

Integrating clinical care with research advancements allows us to offer unique solutions for the most complex patients. In 2015, Oliver F. Adunka, MD, director of Otology and the Hearing Program at Nationwide Children's, performed the hospital’s first auditory brainstem implant (ABI) to treat a 2-year-old who was born without a cochlear nerve. The child received the off-label device, also known as a humanitarian use device, and is responding to sound.

Our otolaryngologists are actively involved in research to improve patient outcomes and discover new therapies for complex problems. Through tissue engineering research, high-performance computing and collaborations with other specialties such as anesthesiology and critical care, our clinician-scientists are forging the way to best outcomes.

“Through our academic activities, we are also training the next generation of otolaryngologists,” says Dr. Elmaraghy. “We have a responsibility to train medical students, residents and fellows to perform at the highest level, and we offer an incredible experience at Nationwide Children's.”

25,738 Clinic visits in 2015
7,254 Surgical cases in 2015
1 Fellowship/residency programs
10 Number of surgical faculty
Expanding Grant’s Airway

Just home from the hospital, Melissa’s infant son sounded raspy when breathing, as if he constantly fought congestion, even though he didn’t.

Born two and a half months early, Grant was in a regional hospital’s NICU for two months, and during that time he developed an E. coli infection that required him to be intubated with a breathing tube to support his lungs and on an oscillating ventilator for more than three weeks. Once the tube was removed, his breathing sounded labored.

Doctors would later discover that Grant had a narrower than normal subglottis, the smallest part of the airway. A narrow subglottis is not unusual for children born prematurely, and Grant’s was further narrowed by scarring from an extended intubation.

Days before a December surgery to expand Grant’s airway, Melissa became alarmed that her son was gasping and panicking as he tried to breathe.

“I’ve never been more scared in my life,” she says.

Grant was given breathing treatments that stabilized him at a local hospital. Then he was driven by ambulance to Nationwide Children’s Hospital. There Jonathan M. Grischkan, MD, MS, performed the surgery to expand his subglottis by removing a piece of his own rib cartilage and grafting it onto his subglottis to expand the airway size and allow him to breathe more easily. As Grant grows, his subglottis is expected to widen with him.

Now 15 months old, Grant is far more active than he ever was. He crawls, plays, lifts himself up, babbles constantly and screams.

“He doesn’t sound like a raspy little old man anymore,” Melissa says.

Grant’s ability to breathe is no longer a source of constant worry for his mother, who spent nights wondering if her infant son might stop breathing.

The Future of Airway Reconstruction: Tissue Engineered Tracheas

Grant’s airway defect was acquired because he was born prematurely and intubated for an extended period of time. Fortunately, his defect was able to be repaired with a first-line approach.

Many airway defect repairs aren’t so straightforward.

Airway reconstructions are complicated procedures performed to expand or repair the airway anatomy, including the trachea, in a patient whose airway is compromised because of congenital malformation or injury. While congenital malformations of the airway are rare and often caught too late, numerous patients have long-term tracheotomies. Additionally, a catastrophic defect can be acquired through scarring due to intubation, inhalation injuries or trauma.

“When more than 30 percent of a child’s airway is affected, these defects exceed the capabilities of conventional techniques for reconstructing the airway,” says Tendy Chiang, MD, pediatric otolaryngologist at Nationwide Children’s. “When you get to that point, there aren’t a lot of good options, and sometimes, you run out of options entirely.”

But Dr. Chiang and a team of researchers at Nationwide Children’s want to change that. Through regenerative medicine Dr. Chiang is working to develop tissue-engineered airway replacements that would be seeded with the patient’s own stem cells, resulting in a graft that would grow with the patient, permanently fixing the defect.

“We are taking information from our decades of research and the fairly recent human procedures that have been done and working out the problems in the animal models,” says Dr. Chiang, who is also principal investigator in the Tissue Engineering Program in The Research Institute at Nationwide Children’s. “It’s about taking research from the bench to the bedside and back to the bench.”

To build a tissue-engineered trachea, Dr. Chiang and his team use a scaffold produced by Nanofiber Solutions and seed it with bone marrow-derived mononuclear cells. The collection of the cells, the seeding and implantation happens in a matter of hours.

“While there are many approaches to seeding a scaffold and growing a trachea, we are applying easily translatable methods that will permit our procedure to be performed in the operating room,” explains Dr. Chiang, who is also an assistant professor in the Department of Otolaryngology at The Ohio State University College of Medicine. “We are using the body as a bioreactor.”

Dr. Chiang’s trachea research is part of a larger effort in tissue engineering led by Christopher Breuer, MD, pediatric surgeon and principal investigator in the Center for Cardiovascular Research in The Research Institute at Nationwide Children’s.

Simulating Surgery

The purpose of training — whether a fire drill or practicing a surgical technique — is to create successes and avoid failures.

“The impact of training is safety and lives saved,” says Gregory J. Wiet, MD, otolaryngologist and principal investigator at Nationwide Children’s. By creating a robust, high-fidelity, interactive temporal bone surgical simulation system, Dr. Wiet and his team are on the forefront of using high-performance computing to improve surgical education and training. The NIH-funded project is breaking new ground for otolaryngologists, neurosurgeons and others who are training to operate on this delicate anatomy.

According to Dr. Wiet, temporal bone surgery is among the most complex and technically challenging in the field of medicine. Training surgeons to operate in this area is a challenge for the medical community, which currently relies on books, cadaver dissection and observation of more experienced surgeons with gradual transfer of responsibility.

In 2012, Dr. Wiet and his team validated their temporal bone simulation against cadaveric dissections, proving that the method was an effective training tool. Since then, they have further refined the system, including more advanced scoring metrics, haptic feedback and image resolution. The system includes 40 different simulated bones, and the team is currently incorporating the data for a neonatal skull.

“Simulation technology provides technical skills training in the midst of safe and efficient patient care, flexibility to handle changes in specific skills training and development of new techniques, and standardized and objective assessment of technical skills,” says Dr. Wiet, who is also professor of Otolaryngology, Pediatrics and Biomedical Informatics and director of Pediatric Otolaryngology Research at The Ohio State University College of Medicine. “It is also valuable as a means of realistic presurgical planning and rehearsal.”

The current system supports complete mastoidectomy with automated metrics. Once a procedure or training exercise is completed, users receive immediate feedback in the form of a score, which has been calculated based on a rubric ranking the specific points of the procedure. Advances are underway including fidelity to support higher level procedures, fluid simulation and additional standardized metrics.

“A national consortium of 13 institutions is using and testing the simulations. This collaboration gives institutions access to the software, while we have access to more residents to test the software and provide feedback,” says Dr. Wiet. “This involvement contributes to making our program the most advanced of its kind.”

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