The otolaryngologic manifestations of gastroesophageal reflux: when is a pH study indicated?

Abstract

PURPOSE:

The aim of this study was to evaluate the pertinence of pH studies for persistent ear, nose, and throat (ENT) symptoms and their eventual relationship to gastroesophageal reflux (GER).

METHODS:

Retrospective analysis was performed of age, reason for referral, pH study, treatment, and follow-up of patients with ENT symptoms suspected to have GER.

RESULTS:

Of 3,000 esophageal pH studies performed over 16 years, 105 children were referred for ENT symptoms by an otorhinolaryngologist to rule out GER. Mean age was 33 months; 65% were boys. Reasons for referral included (number and mean age): stridor (n = 31, 8 months), laryngomalacia (n = 18, 13 months), recurrent otitis (n = 12, 42 months), laryngitis (n = 16, 50 months), dysphonia (n = 14, 59 months), laryngeal papillomatosis (n = 8, 62 months), sinusitis (n = 5, 56 months), and dysphagia (n = 1). Overall, 41% of study results were positive: stridor (58%), laryngomalacia (61%), laryngitis (56%) and sinusitis (40%). Patients with otitis, dysphonia and laryngeal papillomatosis had GER in 1%, 14%, and 25%, respectively. Follow-up in the three larger groups of patients showed resolution of the ENT symptoms after medical treatment of the reflux in 83% of patients with stridor and reflux, 86% with laryngitis and reflux, and 80% with laryngomalacia and reflux. Four fundoplications were performed: one neurologically impaired patient, and four nonresponders.

CONCLUSIONS:

The authors recommend that a pH study be performed in children with stridor, laryngomalacia, laryngitis, and sinusitis when faced with failure of the usual treatment. However, a pH study does not seem as beneficial for recurrent otitis, dysphonia, or laryngeal papillomatosis.

• Authors: S Bouchard, M Lallier, S Yazbeck, A Bensoussan
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 34 Issue 7 Pg. 1053-6 (Jul 1999) ISSN: 0022-3468 [Print] United States
• PMID: 10442586 (Publication Type: Journal Article)

Topics

• Child
• Child, Preschool
• Esophagus (metabolism)
• Female
• Follow-Up Studies
• Gastroesophageal Reflux (complications, diagnosis, therapy)
• Humans
• Hydrogen-Ion Concentration
• Incidence
• Male
• Monitoring, Physiologic (methods)
• Otorhinolaryngologic Diseases (diagnosis, etiology)
• Retrospective Studies
• Risk Factors
• Sensitivity and Specificity