Provider News

New Airway and Esophageal Center Offers Coordinated, Multidisciplinary Team Care That Is Unique in the Northwest

April 5, 2023

Seattle Children’s is proud to announce the opening of a new Airway and Esophageal Center serving babies, children and teens through age 20. The center provides seamless, multidisciplinary care from a highly experienced team of experts for patients who have complex conditions affecting their airway, breathing and swallowing.

“Due to these patients’ complexity and need for care from many different specialists throughout their childhood, it’s essential they receive well-coordinated care from experts who are working as an integrated team and communicating regularly,” says Dr. Jake Dahl, an otolaryngologist at the center. “We have created the Airway and Esophageal Center expressly for that purpose, with care coordination and wraparound services built in to ensure our patients don’t just survive, they thrive.”

This highest level of continuous, comprehensive specialty care for children with challenging airway and esophageal issues is unique to Seattle Children’s regionally and hard to find even nationally.

Multidisciplinary Care

The Airway and Esophageal Center team includes experts from many Seattle Children’s specialties: otolaryngology, gastroenterology, pulmonology, sleep medicine, maxillofacial surgery, pediatric surgery, anesthesiology, speech and language pathology, nutrition, feeding therapy, social work, nursing, newborn critical care and pediatric intensive care.

Physicians include:

Otolaryngology: Jake Dahl, MD, PhD, MBA; Kaalan Johnson, MD, Sanjay Parikh, MD
Pulmonary/Sleep: Matthew Abts, MD; Maida Chen, MD; Sarah Hofman DeYoung, MD
Gastroenterology: Marina Panopoulos, MD; Nicole Pattamanuch, MD; Michael Pickens, DO
General Surgery: Matthew Dellinger, MD; Kimberly Riehle, MD

Conditions and Services

The Airway and Esophageal Center sees patients who have highly complex conditions:

Tracheoesophageal fistula (TEF), esophageal atresia (EA), and other congenital airway and esophagus malformations
Airway stenosis
Complex obstructive sleep apnea
Complex swallowing problems
Bronchomalacia
Tracheomalacia
Esophageal injury and trauma
Complete tracheal rings
Vascular rings and slings

Procedures offered include:

Tracheoesophageal fistula (TEF) and esophageal atresia (EA) repair and revision
Airway reconstruction, such as tracheal resection, slide tracheoplasty and laryngotracheal reconstruction (LTR)
Aortopexy
Tracheopexy
Foker procedure
Jejunal interposition
Multilevel airway and jaw (orthognathic) surgery for complex sleep issues
Hypoglossal nerve stimulator

The Airway and Esophageal Center will offer several distinct subspecialty clinics and programs:

TEF and EA. Seattle Children’s has the only team in the Pacific Northwest with expertise in all the clinical areas babies with TEF and EA may need. Our surgeons have deep experience in performing procedures to repair TEF and EA. As a high-volume center, more cases mean greater skill and consistently better outcomes.
Refractory Obstructive Sleep Apnea (ROSA) Clinic. The ROSA Clinic combines medical and surgical expertise to help patients with the most complex obstructive sleep apnea conditions.
The Aerodigestive Program cares for children with complex upper airway, breathing and swallowing programs.

Quality Care at Every Age and Stage

Care for patients in the Airway and Esophageal Center is based on the latest science. “We have created well-defined care pathways for the children we see, with their individual care plans and treatments based on evidence and best practices,” says Dr. Michael Pickens, a gastroenterologist on the team.

Pickens joined Seattle Children’s in 2021 with a deep passion for caring for kids who have complex airway and esophageal conditions, having seen the disparities in outcomes that can result when children don’t receive care in a team-based, multidisciplinary setting.

“Having our specialists talk to each other is built into our mission,” he says. “Our number one goal is to treat the whole child and to improve health problems that are linked to each other.”

This approach creates better outcomes. Patients at Seattle Children’s need fewer separate surgeries, and less time under anesthesia, because their care team is able to combine certain surgeries and procedures through careful multidisciplinary planning. Long-term follow-up care with our providers ensures any future problems are spotted early, or anticipated and circumvented. Children who are part of the Airway and Esophageal Center benefit from having every opportunity to thrive at every age and stage.

The Airway and Esophageal Center is a high-volume center. It is the only one in the Pacific Northwest with the facilities and the depth of multidisciplinary staffing, including a well-established extracorporeal membrane oxygenation program (ECMO) program, to provide comprehensive care for the most complex airway and esophageal patients.

“When you are trying to take care of the most complex and highest-risk patients, who are undergoing the biggest procedures, it’s important to always have a full safety net in place,” says Dahl. “Families can count on that at Seattle Children’s.”

Family-Centered Care That Continues Throughout Childhood

In typical programs for kids with airway and esophageal issues, there is an extensive burden on families to coordinate their child’s care across many specialties and coordinate the communication between providers. This results in an enormous strain on parents and caregivers, and suboptimal outcomes. At Seattle Children’s Airway and Esophageal Center, the team includes complex schedulers, a program coordinator and a nurse coordinator who take the burden off families so they can focus on their child. Families will typically have two 3-hour visits per year at the Airway and Esophageal Center, compared to 20+ separate visits per year if they are not in a center like ours.

Appointments at Seattle Children’s are scheduled to allow the patient to meet with all their team members in a single visit with any necessary procedures scheduled in unison. Appointments are offered via telemedicine when appropriate, to minimize the family’s trips to Seattle Children’s.

The Airway and Esophageal Center provides continuous, multidisciplinary follow-up care throughout childhood, in contrast to many other institutions that, while they may offer surgery to fix the child’s initial airway or esophageal problem, lack the breadth of expertise or resources to offer comprehensive care as the child grows.

“Our team is constantly following up on breathing, swallowing, nutrition, and developmental milestones. One recent patient who had a tracheoesophageal fistula repaired many years ago re-presented with chronic coughing and recurrent respiratory infections. Our team was able to identify a recurrent tracheoesophageal fistula as well as a type 2 laryngeal cleft. Both were repaired without complication. The patient is now thriving and his symptoms are well controlled,” says Dahl. “The only way to know how much follow-up care is needed is to follow them.”

Locations in Bellevue, Seattle and via Telemedicine

The Airway and Esophageal Center sees patients at Seattle Children’s Bellevue Clinic and Surgery Center. Surgery is performed at the main hospital campus in Seattle.

Telehealth visits can be offered when the patient doesn’t need to be seen in-person. We can see patients virtually in Washington, Alaska, Idaho, Montana and Oregon.

Leaders in Research

“The last thing that develops within the evolution of a program is a strong research program and the ability to push the forefront and the boundaries of what’s being done in the field,” says Dr. Kaalan Johnson. “Seattle Children’s is unique in our region for the research we do in this field. It’s what families are searching for when they’re looking for a medical home for their child.”

Doctors in the Airway and Esophageal Center stay at the forefront of innovations in care through research. Seattle Children’s providers are pioneering virtual surgical planning techniques for complex airway and esophageal procedures, including dynamic airway imaging and 3D airway modeling with physical and computational models.

Watch Dr. Kaalan Johnson and scientist Seth Friedman describe how the team uses 3D models to map out and practice life-changing surgeries (3:37).

How to Refer

Patients can be referred to the Airway and Esophageal Center in the usual way, by faxing a referral form to 206-985-3121 or 866-985-3121. Please include any relevant results from biopsies, endoscopies, videofluoroscopic swallowing studies (VFSS, also known as modified barium swallow or MBS), imaging, audiograms or other tests. Referrals are screened by Otolaryngology; referrals for patients who are more appropriate to be seen in a different specialty will be redirected there and the referring provider notified.

Newborns and other patients with urgent conditions are seen right away. Urgent transfer of newborns is arranged through Neonatology and our Critical Care Transport team. Visit the Neonatology Patient Transfer website for more details.

If a referring provider is not sure if the Airway and Esophageal Center is the right place for a patient, they are welcome to call 206-987-2105 and ask to speak with the nurse coordinator or advanced practice provider.

Detailed referral guidelines for the Airway and Esophageal Center are available at our website at seattlechildrens.org/clinics/airway-esophageal-center/refer-a-patient/.