Episode Details

When a child's cancer treatment threatens a child’s ability to speak, eat, or breath, how does a team decide what to address first? On this episode of BackTable ENT, host Dr. Gopi Shah welcomes Dr. Anthony Sheyn, pediatric otolaryngologist at Le Bonheur Children’s Hospital and St. Jude, and Amber Bonner, MS, CCC-SLP, acute care speech-language pathologist at Le Bonheur, to explore how a multidisciplinary team navigates the most challenging functional decisions in pediatric head and neck oncology.

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Timestamps

00:00 - Introduction
03:26 - Treatment Effects vs Tumor Effects
06:30 - Swallow and Airway Evaluation Timing
10:09 - Voice Assessment Protocols
13:13 - Feeding Decisions and Vocal Fold Immobility
17:23 - Vocal Fold Injection and Reinnervation
21:36 - Tracheostomy Timing and Family Teaching
26:08 - Complications and Swallowing Outcomes
29:48 - FEES Collaboration and Voice Prognosis
34:15 - Decannulation and Functional Outcomes
37:40 - Closing Remarks

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More about this episode

They discuss baseline preoperative evaluation, strategies to distinguish tumor effects from treatment complications, and the pivotal role of instrumental swallow studies. The discussion covers standardized voice assessments, decisions around feeding tubes and tracheostomy, early vocal fold interventions, and the realities of family education and post-op rehab. Through real-world examples and collaborative protocols, Dr. Sheyn and Amber Bonner share how teams can set children up for meaningful recovery and long-term survivorship, bringing hope to families facing the toughest cases.

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Resources

Nagy P, Beckmann N, Cox S, Sheyn A. Management of Vocal Fold Paralysis and Dysphagia for Neurologic Malignancies in Children. Ann Otol Rhinol Laryngol. 2019 https://pubmed.ncbi.nlm.nih.gov/31215235/

ASHA Practice Portal: Flexible Endoscopic Evaluation of Swallowing (FEES)
https://www.asha.org/practice-portal/resources/flexible-endoscopic-evaluation-of-swallowing/

ASHA Practice Portal: Videofluoroscopic Swallow Study (VFSS / modified barium swallow)
https://www.asha.org/practice-portal/resources/videofluoroscopic-swallow-study/

Zur KB et al. Pediatric Voice Handicap Index (pVHI): a new tool for evaluating pediatric dysphonia. Int J Pediatr Otorhinolaryngol. 2007
https://pubmed.ncbi.nlm.nih.gov/17046072/

Pediatric Auditory-Perceptual Evaluation of Voice, Part 2: A Protocol. J Speech Lang Hear Res. 2026
https://pubmed.ncbi.nlm.nih.gov/42600142/

Care of Infants and Children with Tracheostomies: An Official American Thoracic Society Clinical Practice Guideline
https://pmc.ncbi.nlm.nih.gov/articles/PMC12618984/

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