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At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this test, and we invite you to participate. Please read the following information to learn about the test and how you can help.
The upper aerodigestive tract consists of the nose, the throat, the voice box, the windpipe, the lungs and the swallowing tube. A doctor might order an upper aerodigestive tract endoscopy if your child has:
An upper aerodigestive tract endoscopy might also be ordered if your child is too young to have — or was unable to tolerate — a flexible laryngoscopy (lair-en-GOSS-co-pee) in the doctor’s office.
To get a good look at the entire aerodigestive tract, the ENT doctor might use a number of different types of scopes. Some of the scopes that are used are "flexible." These soft, thin scopes are able to travel around angled areas, such as the back of the nose, and can even be used in patients when they are awake, allowing the ENT doctor to see things moving (like the vocal cords).
Some of the scopes that are used are "rigid" or hard. These bigger, hollow scopes provide higher quality images (pictures) of the body and allow the ENT doctor to do more tasks through them (such as take biopsies, remove foreign bodies or breathe for the patient). These bigger scopes can be used only when the patient is asleep with anesthesia medication.
During the upper aerodigestive tract endoscopy, the ENT doctor might pass into the nose a flexible scope (flexible rhinoscopy) or a rigid scope (rigid rhinoscopy). Often, a flexible scope passed into the nose is also used to examine the back of the throat (adenoids, soft palate, tonsils, base of tongue) and the voice box. This procedure is called flexible fiber-optic nasopharyngolaryngoscopy (NAY-so-FARE-in-go-LARE-in-GOSS-co-pee). That means a scope of the "naso," meaning nose, "pharyngo," meaning throat and "laryngo," meaning voice box, areas.
To look at the voice box more closely, rigid direct laryngoscopy is performed. The scope used for this part of the test is rigid, and the ENT doctor looks directly through it to actually see the voice box. The rigid laryngoscope consists of an eyepiece and a light that is enclosed in a metal case shaped to fit inside a child’s mouth. Once the laryngoscope is in place, the doctor also can pass a fiber-optic scope through it to take microscopic, magnified pictures of the larynx, if needed.
To see the windpipe, a long fiberoptic scope is placed past the voice box into the windpipe. This procedure is called a tracheoscopy (trake-ee-OSS-co-pee), meaning a scope of the trachea.
To see the food pipe or esophagus, a long tube with a fiber-optic camera is placed into the swallowing tube. This procedure is called esophageoscopy (e-SOFF-uh-gee-OSS-co-pee), or a scope of the esophagus.
To see the lungs, the scope is placed even further, and this procedure is called bronchoscopy (bronk-OSS-co-pee) or a scope of the bronchi, the large tubes of the lungs. The doctor also might perform a procedure called bronchial alveolar lavage (BRONK-ee-ul al-vee-OLE-ar la-vahj) or BAL. Using a sterile saline solution (similar to tears), the doctor will wash the lung area then draw out the solution and send it to the lab to be tested for foreign particles or infection. Sterile saline is completely safe to use inside the body. The doctor may also take an esophageal biopsy.
The scopes the doctor uses for the tracheoscopy, bronchoscopy and esophageoscopy might be flexible or rigid, depending on the size of the child and what the doctor needs to see in those areas of the aerodigestive tract.
Upper aerodigestive tract endoscopy is a safe way for doctors to examine these internal body parts; however, there are some risks involved. Although rare, these risks include possible swelling in the windpipe requiring special treatment and overnight observation; voice box injury; windpipe injury leading to escape of air and requiring a chest tube to re-expand the lungs; or infection in the chest, requiring surgical drainage and antibiotics. Your child’s doctor will discuss these risks with you prior to your child’s test.
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, a surgery nurse will call your home between 1 and 9 p.m. (Surgery nurses do not make these phone calls on weekends or holidays.) Please have paper and a pen ready to write down instructions.
The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.
In upper aerodigestive tract endoscopy, the doctor will be assisted by the pediatric anesthesiologist. The anesthesiologist will monitor your child’s heart rate and breathing during the test and give the oxygen and medications that will keep your child asleep for the test.
When the test is over, the medications will be stopped and your child will be moved to the recovery room. You will be called to the bedside so that you can be there as your child wakes up.
After your child goes home, he or she still might be groggy and should take it easy for the day.
After the test, you might notice some of the following signs. These symptoms are normal:
Although most children recover quickly from the test with no problems, you should immediately call your child’s ENT doctor, pediatrician or Children’s Hospital test nurse if your child has any of these symptoms:
If your child has any special needs or health issues you feel the doctor needs to know about, please call the Division of Pediatric Otolaryngology (ENT) at Children’s Hospital before the test and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
In addition to the main hospital, Children's has many convenient locations in other neighborhoods throughout the greater Pittsburgh region.
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