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A Prospective Study

Michele M. Carr, DDS, MD, MEd, FRCSC; Mark L. Nagy, MD; Michael P. Pizzuto, MD; Christopher P. Poje, MD; Linda S. Brodsky, MD

Arch Otolaryngol Head Neck Surg. 2001;127:369-374.

Objective  To correlate direct laryngoscopic and bronchoscopic findings with the presence of positive test results for gastroesophageal reflux disease (GERD) in children.

Design  Prospective collection of structured data.

Setting  An academic pediatric otolaryngology department.

Patients  Seventy-seven consecutive patients who underwent direct laryngoscopy and bronchoscopy between June and October 1999.

Interventions  During direct laryngoscopy and bronchoscopy, descriptions of 7 laryngeal and 6 cricotracheal findings were recorded on a 3-point scale (ie, absent, mild, or severe). Medical records were later reviewed to obtain results of the following tests, if they were part of the record: gastric scintiscan, 24-hour pH probe monitoring, upper gastrointestinal tract series, and esophageal biopsy.

Main Outcome Measures  Correlation of mucosal abnormalities with the presence or absence of a positive test result for GERD.

Results  Fifty (65%) of 77 patients had GERD diagnosed with at least 1 positive test result, 21 (27%) had no clinical symptoms and no positive GERD test results, and 5 (7%) had clinical symptoms but no positive test results. There were significant differences for total laryngeal and cricotracheal scores (P<.001) between the groups with positive and negative results. Significant differences were as follows: in the larynx—large lingual tonsil (P<.001), postglottic edema (P<.001), arytenoid edema (P<.001), ventricle obliteration (P = .03), and true vocal fold edema (P = .001), and in the cricotracheal region—general edema and erythema (P = .003) and blunting of the carina (P<.001). Severe arytenoid edema, postglottic edema, or enlargement of lingual tonsil were pathognomonic of GERD.

Conclusion  Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.

From the Department of Pediatric Otolaryngology, Children's Hospital of Buffalo, Buffalo, NY. Dr Carr is now with the Department of Otolaryngology, Toronto General Hospital, Toronto, Ontario.

Corresponding author: Michele M. Carr, DDS, MD, MEd, FRCSC, EN7-238, Department of Otolaryngology, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4 (e-mail: mm.carr{at}utoronto.ca).

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