On a ‘quest to just breathe’

After enduring close to 100 procedures to keep her airway open, a central Iowa teen is seeing potential for normalcy following a complex throat surgery at the University of Iowa in 2019.

In the predawn hours of Nov. 4, 2019, 17-year-old Nina Alvarez climbed out of bed, said goodbye to her dogs, and drove away from her family home in Winterset, Iowa. Sleepy yet nervous and excited, she had been waiting for this moment her whole life.

Alvarez had never known what “breathe easy” meant because prolonged ventilator use as a preemie and subsequent years of multiple airway dilations had left her throat scarred. But a pediatric otolaryngologist at University of Iowa Stead Family Children’s Hospital was promising to change that.

When Alvarez first met Sohit Kanotra, MD, who had been hired just months earlier to lead Iowa’s pediatric aerodigestive clinic, she felt a resurgence of hope. He had proposed a cricotracheal resection, a surgery to remove a narrowed segment of her windpipe. It was a challenging procedure but one Kanotra had done many times before and usually took him about four hours to complete. This one lasted close to 10 hours.

“It was Nina’s fourth big surgery to open the airway, and her airway had been scarred so much due to previous surgeries that it was hard to distinguish the windpipe from the surrounding structures,” Kanotra says. “I knew it was going to be tough, but I was not expecting it to be as bad as it was.”

It was a high-risk surgery—and a successful one. Within months, Alvarez turned 18 and graduated from high school. She now works full-time at Fareway Grocery as she assesses her career interests before starting college. She enjoys creating art on her iPad and working with kids. Perhaps, she says, she will become a teacher.

Although Alvarez’s voice will likely always sound hoarse, Kanotra says he is pleased by what he has seen in her airway during follow-up appointments and is optimistic about her future.