Akron Children's ENT specialists help toddler find his voice

Hunter Kascsak

Hunter Kascsak

Laughter, they say, is the best medicine. For one family in the Mahoning Valley, there’s simply no sweeter sound in the world.

A series of procedures performed by a team of physicians at the Akron Children’s Hospital Ear, Nose and Throat (ENT) Center allows them to experience something that was once impossible: heart-warming giggles and belly laughs from their son.

Hunter’s Tale

Hunter Kascsak, of Niles, entered the world four months ahead of schedule on Aug. 22, 2008. At 25-weeks and weighing barely more than a pound, Hunter spent four months in Akron Children’s neonatal special care nursery at St. Elizabeth Health Center in Youngstown.

His parents, Melissa and Chadd, brought him home the month he was supposed to be born.

Less than two weeks later, his health diminished and his parents took him to Akron Children’s Beeghly campus in Boardman. They decided to send Hunter to Children’s Akron campus via Air Bear® for observation.

“We spent our first night on a general pediatric floor, and then they moved him to the pediatric intensive care unit (PICU) when he started having breathing difficulties,” said Melissa. “He really started to improve, but not even two minutes after they released him to go back to the pediatric floor, he turned blue.”

Hunter was diagnosed with bronchopulmonary dysplasia (BPD), a lung condition that can occur in premature infants. BPD causes inflammation and scarring within the lungs and makes breathing difficult.

Hunter also had a condition known as secondary pulmonary hypertension, in which the vessels between the right side of the heart and the lungs are narrowed. This triggers a lack of oxygen exchange in the lungs, and blood flows back into the right chamber of the heart, causing it to swell.

“He had to be sedated, paralyzed and put on a ventilator to control both conditions,” Melissa said. “After meeting with his pulmonologist, we made the decision to put a tracheotomy in place to help him breathe.”

The tracheotomy was placed in January 2009, and it took until June of the same year for Hunter to become stable enough to go home. Although 10-months-old, Hunter was like a newborn developmentally.

Uncovering new obstacles

Hunter made great strides in the months following his homecoming. He didn’t require hospital re-admissions and, a year after his discharge, he was taken off the ventilator (breathing machine). With his pulmonologist’s approval, Melissa and Chadd were ready to have their son’s tracheotomy removed.

They contacted the ENT specialists at Akron Children’s to check Hunter’s throat before having his tracheotomy removed.

“Tracheotomies can sometimes cause scarring and tightening of the airways,” said Anton Milo, MD, DDS, director of Akron Children’s ENT Center. “The first step was to ensure Hunter’s airway was entirely clear before we removed the tracheotomy.”

Dr. Milo performed an endoscopy and discovered a rare laryngeal cyst on Hunter’s vocal cord, which obstructed his airway.

“We had no idea it was there,” said Melissa. “In fact, the tracheotomy made breathing a lot easier for him. If he didn’t have the tracheotomy, the cyst could have fully obstructed his airway and cut off his air supply.”

Dr. Milo with Hunter

Dr. Milo with Hunter

Dr. Milo surgically removed the cyst. After Hunter healed from the surgery, he underwent a bronchoscopy to examine his upper, middle and lower airways. Dr. Milo found a large fibrous growth called a fibroma, which is made of dense, scar-like tissue, above Hunter’s tracheotomy.

Working with his airway team of specialists, and over the course of two surgeries, Dr. Milo used specialized tools to remove the fibroma.

“We love Dr. Milo,” said Melissa. “He’s phenomenal at finding the one thing that nobody else expects. His tenacity is the reason that Hunter’s here and doing so well today.”

After his second surgery, however, Hunter had trouble sleeping. Dr. Milo diagnosed him with sleep apnea from overly large tonsils and adenoids, which he removed last November. Hunter healed once more, and was finally able to have his tracheotomy removed.

“We never had to wait, and his surgical scheduling was always handled promptly and efficiently,” Melissa said. “Everyone was always more than personable. We weren’t treated as numbers. We were treated as people.”

The day Hunter was discharged after his tracheotomy removal still resonates in the minds of his parents and Dr. Milo.

“I remember walking into Hunter’s room, and his parents had cell phones in hand and tears in their eyes. I asked if everything was ok. They told me that it was the first time they’d ever heard Hunter laugh – really laugh. They wanted to capture it on video,” said Dr. Milo.

Living, laughing, loving

After taking his first steps in February 2011, Hunter hasn’t stopped running. Melissa said the change has been fantastic for the curious toddler, who started pre-school in the fall and loves playing with his older brother, Christian.

“It’s been such a huge change for all of us,” she said. “We are doing the typical things that so many people take for granted, like bringing both of our boys to the grocery store or taking them to the park. We’re able to be together as a family no matter what we’re doing. ”

Dr. Milo is working with pulmonologists and other specialty areas at Akron Children’s to develop a chronic airway clinic, which will offer a multidisciplinary approach to treatment and support for children like Hunter who suffer from various forms of airway obstruction and may need tracheotomies removed.

“After watching Hunter’s recovery and hearing him laugh for the first time, I thought, ‘This is what it’s all about,’” Dr. Milo said. “Everyone at the ENT center considers it an honor and a privilege to serve every child who comes through our doors. I like to say I have the world’s biggest family, because every child I treat becomes my own.”

Publication: Children's Progress
Issue: Fall

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