Introduction: Laryngotracheoesophageal clefts (LTEC) are well-known aspiration-associated lesions. Results of swallow studies, and respiratory, feeding, and swallowing symptoms are commonly used indications for repair, despite being unclear predictors of disease. Although lung inflammation and injury are primary concerns, such findings are uncommonly and inconsistently evaluated and reported and therefore it remains unclear how well swallow studies predict lung disease. Methods: Children seen in our Aerodigestive program 10/1/2012 and 9/30/2023, with a LTEC and a videofluoroscopic swallow study (VFSS) or flexible endoscopic evaluation of swallowing (FEES) were included. Data regarding clinical history and risk factors, BAL, chest CT, and impedance probe results were abstracted, along with VFSS/FEES results and functional oral intake scale (FOIS-P/I) at baseline and follow-up. Results: 82 subjects identified. Lung inflammation and bronchiectasis were common and correlated. Clinical factors, impedance probe, and the presence/severity of swallowing abnormalities on VFSS/FEES were not predictive of lung disease. 57 patients underwent LTEC repair for a range of indications, only 49% based on CT and/or BAL findings. LTEC repair was associated with a trend towards improvement feeding and swallowing, yet none of these met statistical significance. Discussion: Children with LTEC have a high prevalence of inflammatory lung disease and injury and undergo repair for a variety of reasons. The insufficient ability of swallow study to identify patients with lung disease suggests that such studies identify functional abnormalities but not a disease state, per se. Nevertheless, LTEC repair is associated with improvements in feeding and swallowing in a subset of patients.