Air Apparent

Cincinnati Children’s Hospital Medical Center’s world-renowned team approach to treating pediatric airway disorders flourishes as the program founder gets ready to retire.
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Robin Cotton, M.D.

Illustration by Ben Kirchner

Robin Cotton, M.D.
Director of Aerodigestive & Esophageal
Center, Cincinnati Children’s Hospital
Medical Center
Specialty: Pediatric airway reconstruction
Cincinnati Children’s Hospital Medical Center

—as told to John Fox

A new disease emerged around 1968, when babies born with premature lungs were intubated through the airway to support their lungs and allow them to survive. The larynx was often damaged as a byproduct of that treatment. I was a medical resident in Toronto then, and my mentor said, Let’s figure out an operation to fix this larynx problem, so we did. I moved down here to Cincinnati Children’s [in 1973] and started doing some cases, and that gradually grew over a decade into a big referral practice, which we organized under the Division of Pediatric Otolaryngology, Head and Neck Surgery.

We set up the Aerodigestive & Esophageal Center in 1998 to create a team across multiple disciplines, and it’s grown to be by far the largest such center in the country. The initial goal was to treat a specific injury to the larynx, and it’s snowballed into laryngeal injury in general and congenital problems related to the head, neck, and airway. We focus on coordination of care across ENT, GI, pulmonary, and pediatric surgery. That’s really one of the main reasons for patients to be referred here.

The entire team has a meeting every week to talk about our patients, who are from all over the U.S. and the world. We have a very easy way about us, I think. It’s very collegial, and we rely on each other’s special expertise and really trust each other. The patient families seem to appreciate that we’re all working together as a team.

Patients are generally here for a week to start, and we have everything streamlined so we make the best use of their time. They arrive and have some tests on a Monday, clinic on Tuesday, OR on Wednesday, some recovery on Thursday, and then home on Friday, and then their results are checked out the next week at our meeting and a plan is developed and relayed to the family. When they come back, the treatment could be quick or it could last a month. We work with their home physicians to oversee ongoing recovery and treatment. There are lots of pieces to this puzzle, and you can’t do this in a small institution. That’s why you need institutional support, which Children’s certainly has provided.

We now have research fellows from other countries who come here for a year or two to do research projects, which is important. We’ve also trained more than 100 physicians to do airway work and they’ve populated other hospitals in the U.S., Canada, Israel, South America, Australia, and England, so they can do this good work locally. If they encounter something really difficult, they’ll send their patients here, and now we get the most difficult cases.

I retire in September, so I’m downloading everything and making sure my present patients are well taken care of. When I came here, there was me and my secretary—today we have 15 full-time staff and a total staff of more than 100 across all the disciplines. There are about 25 of these aerodigestive programs now around the country, most developed by our former fellows.

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