Advertisement

Current Otorhinolaryngology Reports

, Volume 6, Issue 1, pp 92–98 | Cite as

The Role of Reflux in Childhood Otorhinolaryngological Disorders

  • Haytham Kubba
Pediatric Otolaryngology (I Bruce, Section Editor)
  • 19 Downloads
Part of the following topical collections:
  1. Topical Collection on Pediatric Otolaryngology

Abstract

Purpose of Review

This article seeks to review the current literature on the role of laryngopharyngeal reflux in the development of various disorders of the ear, nose and throat in infants and children including otitis media, chronic rhinosinusitis and airway disorders. The aim is to guide the otolaryngology clinician in investigation and management of reflux and to identify priorities for future research in this area.

Recent Findings

Many otolaryngological disorders coexist with reflux more often than might be expected by chance, but evidence of causality is weak. Although many otolaryngologists are convinced that treatment of reflux can make a significant difference to the clinical course of many upper airway disorders, the evidence to support this is lacking. In part, this is due to inadequate tools for describing the symptoms and endoscopic signs of laryngopharyngeal reflux and the lack of a sensitive, specific and reliable objective test.

Summary

Further research demonstrating simple associations between otolaryngological diseases and reflux is unlikely to be of much value. Instead, researchers should concentrate their efforts on studies to develop and validate better means of recording symptoms and signs of laryngopharyngeal reflux and investigating the clinical utility of salivary pepsin, oropharyngeal pH monitoring and multichannel intraluminal impedance.

Keywords

Gastro-oesophageal reflux Laryngopharyngeal reflux Otitis media Rhinosinusitis Airway disorders Laryngomalacia Subglottic stenosis Croup 

Notes

Compliance with Ethical Standards

Conflict of Interest

The author declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Dogru M, Kuran G, Haytoglu S, Dengiz R, Arikan OK. Role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion. J Int Adv Otol. 2015;11(1):66–71.  https://doi.org/10.5152/iao.2015.642.CrossRefPubMedGoogle Scholar
  2. 2.
    Salturk Z, Kumral TL, Arslanoglu A, Aydogdu I, Yildirim G, Berkiten G, et al. Role of laryngopharyngeal reflux in complications of tonsillectomy in pediatric patients. Indian J Otolaryngol Head Neck Surg. 2017;69(3):392–6.  https://doi.org/10.1007/s12070-015-0841-8.CrossRefPubMedGoogle Scholar
  3. 3.
    • Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, Pearson JP. Reflux of gastric juice and glue ear in children. Lancet. 2002;359(9305):493. This paper created huge interest by identifying pepsin in middle ear fluid.  https://doi.org/10.1016/S0140-6736(02)07665-1.CrossRefPubMedGoogle Scholar
  4. 4.
    He Z, O'Reilly RC, Bolling L, Soundar S, Shah M, Cook S, et al. Detection of gastric pepsin in middle ear fluid of children with otitis media. Otolaryngol Head Neck Surg. 2007;137(1):59–64.  https://doi.org/10.1016/j.otohns.2007.02.002.CrossRefPubMedGoogle Scholar
  5. 5.
    Al-Saab F, Manoukian JJ, Al-Sabah B, Almot S, Nguyen LH, Tewfik TL, et al. Linking laryngopharyngeal reflux to otitis media with effusion: pepsinogen study of adenoid tissue and middle ear fluid. J Otolaryngol Head Neck Surg. 2008;37(4):565–71.PubMedGoogle Scholar
  6. 6.
    Toros SZ, Toros AB, Ozel L, Catal BE, Kinis V, Zorlu A, et al. Investigation of gastric pepsinogen in middle ear fluid of children with glue ear. Acta Otolaryngol. 2010;130(11):1220–4.  https://doi.org/10.3109/00016481003753448.CrossRefPubMedGoogle Scholar
  7. 7.
    Abdel-aziz MM, El-Fattah AM, Abdalla AF. Clinical evaluation of pepsin for laryngopharyngeal reflux in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2013;77(10):1765–70.  https://doi.org/10.1016/j.ijporl.2013.08.014.CrossRefPubMedGoogle Scholar
  8. 8.
    Gorecka-Tuteja A, Jastrzebska I, Skladzien J, Fyderek K. Laryngopharyngeal reflux in children with chronic otitis media with effusion. J Neurogastroenterol Motil. 2016;22(3):452–8.  https://doi.org/10.5056/jnm16013.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Contencin P, Narcy P. Nasopharyngeal pH monitoring in infants and children with chronic rhinopharyngitis. Int J Pediatr Otorhinolaryngol. 1991;22(3):249–56.  https://doi.org/10.1016/0165-5876(91)90079-Q.CrossRefPubMedGoogle Scholar
  10. 10.
    Bothwell MR, Parsons DS, Talbot A, Barbero GJ, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg. 1999;121(3):255–62.  https://doi.org/10.1016/S0194-5998(99)70181-6.CrossRefPubMedGoogle Scholar
  11. 11.
    Phipps C, Wood W, Gibson W, Cochran W. Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg. 2000;126(7):831–6.  https://doi.org/10.1001/archotol.126.7.831.CrossRefPubMedGoogle Scholar
  12. 12.
    Zagolski O. Subacute rhinitis in infants: gastroesophageal reflux must be considered. Ann Otol Rhinol Laryngol. 2013;122(9):588–94.  https://doi.org/10.1177/000348941312200909.CrossRefPubMedGoogle Scholar
  13. 13.
    Beste DJ, Conley SF, Brown CW. Gastroesophageal reflux complicating choanal atresia repair. Int J Pediatr Otorhinolaryngol. 1994;29(1):51–8.  https://doi.org/10.1016/0165-5876(94)90108-2.CrossRefPubMedGoogle Scholar
  14. 14.
    Teissier N, Kaguelidou F, Couloigner V, Francois M, Van Den Abbeele T. Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Arch Otolaryngol Head Neck Surg. 2008;134(1):57–61.  https://doi.org/10.1001/archoto.2007.20.CrossRefPubMedGoogle Scholar
  15. 15.
    •• Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg. 2012;147(4):619–26 An important systematic review of the evidence supporting an association between laryngomalacia and reflux.  https://doi.org/10.1177/0194599812452833.CrossRefPubMedGoogle Scholar
  16. 16.
    Luebke K, Samuels TL, Chelius TH, Sulman CG, McCormick ME, Kerschner JE, et al. Pepsin as a biomarker for laryngopharyngeal reflux in children with laryngomalacia. Laryngoscope. 2017;127(10):2413–7.  https://doi.org/10.1002/lary.26537.CrossRefPubMedGoogle Scholar
  17. 17.
    Hadfield PJ, Albert DM, Bailey CM, Lindley K, Pierro A. The effect of aryepiglottoplasty for laryngomalacia on gastro-oesophageal reflux. Int J Pediatr Otorhinolaryngol. 2003;67(1):11–4.  https://doi.org/10.1016/S0165-5876(02)00284-7.CrossRefPubMedGoogle Scholar
  18. 18.
    Bouchard S, Lallier M, Yazbeck S, Bensoussan A. The otolaryngologic manifestations of gastroesophageal reflux: when is a pH study indicated? J Pediatr Surg. 1999;34(7):1053–6.  https://doi.org/10.1016/S0022-3468(99)90562-6.CrossRefPubMedGoogle Scholar
  19. 19.
    Halstead LA. Gastroesophageal reflux: a critical factor in pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 1999;120(5):683–8.  https://doi.org/10.1053/hn.1999.v120.a91766.CrossRefPubMedGoogle Scholar
  20. 20.
    Walner DL, Stern Y, Gerber ME, Rudolph C, Baldwin CY, Cotton RT. Gastroesophageal reflux in patients with subglottic stenosis. Arch Otolaryngol Head Neck Surg. 1998;124(5):551–5.  https://doi.org/10.1001/archotol.124.5.551.CrossRefPubMedGoogle Scholar
  21. 21.
    • Rankin I, Wang SM, Waters A, Clement WA, Kubba H. The management of recurrent croup in children. J Laryngol Otol. 2013;127(5):494–500 A large series of children with recurrent croup who all underwent airway endoscopy.  https://doi.org/10.1017/S0022215113000418.CrossRefPubMedGoogle Scholar
  22. 22.
    Hoa M, Kingsley EL, Coticchia JM. Correlating the clinical course of recurrent croup with endoscopic findings: a retrospective observational study. Ann Otol Rhinol Laryngol. 2008;117(6):464–9.  https://doi.org/10.1177/000348940811700610.CrossRefPubMedGoogle Scholar
  23. 23.
    Duval M, Tarasidis G, Grimmer JF, Muntz HR, Park AH, Smith M, et al. Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study. Clin Otolaryngol. 2015;40(3):227–33.  https://doi.org/10.1111/coa.12353.CrossRefPubMedGoogle Scholar
  24. 24.
    Keles B, Ozturk K, Arbag H, Gunel E, Ozer B. Frequency of pharyngeal reflux in children with adenoid hyperplasia. Int J Pediatr Otorhinolaryngol. 2005;69(8):1103–7.  https://doi.org/10.1016/j.ijporl.2005.02.019.CrossRefPubMedGoogle Scholar
  25. 25.
    •• Kleinman L, Rothman M, Strauss R, Orenstein SR, Nelson S, Vandenplas Y, et al. The infant gastroesophageal reflux questionnaire revised: development and validation as an evaluative instrument. Clin Gastroenterol Hepatol. 2006;4(5):588–96 This symptom questionnaire for infants with reflux seems to work well.  https://doi.org/10.1016/j.cgh.2006.02.016.CrossRefPubMedGoogle Scholar
  26. 26.
    Orenstein SR. Symptoms and reflux in infants: Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R)—utility for symptom tracking and diagnosis. Current GastroenterolRep. 2010;12(6):431–6.  https://doi.org/10.1007/s11894-010-0140-1.CrossRefGoogle Scholar
  27. 27.
    Simons JP, Rosen CA, Casselbrant ML, Chi DH, Schaitkin BM, Rubinstein EN, et al. Comparison of pediatric voice outcome survey, reflux symptom index, reflux finding score, and esophageal biopsy results. Arch Otolaryngol Head Neck Surg. 2008;134(8):837–41.  https://doi.org/10.1001/archotol.134.8.837.CrossRefPubMedGoogle Scholar
  28. 28.
    Chiu JY, Wu JF, Ni YH. Correlation between gastroesophageal reflux disease questionnaire and erosive esophagitis in school-aged children receiving endoscopy. Pediatrics Neonatol. 2014;55(6):439–43.  https://doi.org/10.1016/j.pedneo.2014.01.004.CrossRefGoogle Scholar
  29. 29.
    Rosen R, Mitchell PD, Amirault J, Amin M, Watters K, Rahbar R. The edematous and erythematous airway does not denote pathological gastroesophageal reflux. J Pediatr. 2017;183:127–31.  https://doi.org/10.1016/j.jpeds.2016.11.035.CrossRefPubMedGoogle Scholar
  30. 30.
    Carr MM, Abu-Shamma U, Brodsky LS. Predictive value of laryngeal pseudosulcus for gastroesophageal reflux in pediatric patients. Int J Pediatr Otorhinolaryngol. 2005;69(8):1109–12.  https://doi.org/10.1016/j.ijporl.2005.02.022.CrossRefPubMedGoogle Scholar
  31. 31.
    •• May JG, Shah P, Lemonnier L, Bhatti G, Koscica J, Coticchia JM. Systematic review of endoscopic airway findings in children with gastroesophageal reflux disease. Ann Otol Rhinol Laryngol. 2011;120(2):116–22. A systematic review of the findings of airway endoscopy and reflux CrossRefPubMedGoogle Scholar
  32. 32.
    Dave MH, Gerber A, Bailey M, Gysin C, Hoeve H, Hammer J, et al. Prevalence and characteristics of tracheal cobblestoning in children. Pediatr Pulmonol. 2015;50(10):995–9.  https://doi.org/10.1002/ppul.23142.CrossRefPubMedGoogle Scholar
  33. 33.
    Duval M, Meier J, Asfour F, Jackson D, Grimmer JF, Muntz HR, et al. Association between follicular tracheitis and gastroesophageal reflux. Int J Pediatr Otorhinolaryngol. 2016;82:8–11.  https://doi.org/10.1016/j.ijporl.2015.11.025.CrossRefPubMedGoogle Scholar
  34. 34.
    van der Pol RJ, Singendonk MM, Konig AM, Hoeve H, Kammeijer Q, Pullens B, et al. Development of the reflux finding score for infants and its observer agreement. J Pediatr. 2014;165(3):479–84.  https://doi.org/10.1016/j.jpeds.2014.05.022.CrossRefPubMedGoogle Scholar
  35. 35.
    Singendonk MM, Pullens B, van Heteren JA, de Gier HH, Hoeve HL, Konig AM, et al. Reliability of the reflux finding score for infants in flexible versus rigid laryngoscopy. Int J Pediatr Otorhinolaryngol. 2016;86:37–42.  https://doi.org/10.1016/j.ijporl.2016.04.017.CrossRefPubMedGoogle Scholar
  36. 36.
    Chiou E, Rosen R, Nurko S. Effect of different pH criteria on dual-sensor pH monitoring in the evaluation of supraesophageal gastric reflux in children. J Pediatr Gastroenterol Nutr. 2011;52(4):399–403.  https://doi.org/10.1097/MPG.0b013e3181ef378b.CrossRefPubMedGoogle Scholar
  37. 37.
    Little JP, Matthews BL, Glock MS. Extraesophageal pediatric reflux: 24 h double/probe pH monitoring of 222 children. Ann Otol Rhinol Laryngol. 1997;106(Supp):S1–S16.Google Scholar
  38. 38.
    Wenzl TG, Moroder C, Trachterna M, Thomson M, Silny J, Heimann G, et al. Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2002;34(5):519–23.  https://doi.org/10.1097/00005176-200205000-00009.CrossRefPubMedGoogle Scholar
  39. 39.
    Greifer M, Ng K, Levine J. Impedance and extraesophageal manifestations of reflux in pediatrics. Laryngoscope. 2012;122(6):1397–400.  https://doi.org/10.1002/lary.23250.CrossRefPubMedGoogle Scholar
  40. 40.
    Pavic I, Babic I, Cepin Bogovic J, Hojsak I. The importance of combined 24-hour multichannel intraluminal impedance-pH monitoring in the evaluation of children with suspected laryngopharyngeal reflux. Clin Otolaryngol. 2017;42(3):544–9.  https://doi.org/10.1111/coa.12766.CrossRefPubMedGoogle Scholar
  41. 41.
    Chiou E, Rosen R, Jiang H, Nurko S. Diagnosis of supra-esophageal gastric reflux: correlation of oropharyngeal pH with esophageal impedance monitoring for gastroesophageal reflux. Neurogastroenterol Motil. 2011;23(8):717–e326.  https://doi.org/10.1111/j.1365-2982.2011.01726.x.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Wilhelm D, Jell A, Feussner H, Schmid RM, Bajbouj M, Becker V. Pharyngeal pH monitoring in gastrectomy patients—what do we really measure? United European Gastroenterol J. 2016;4(4):541–5.  https://doi.org/10.1177/2050640615617637.CrossRefPubMedGoogle Scholar
  43. 43.
    Farhath S, He Z, Saslow J, Soundar S, Amendolia B, Bhat V, et al. Detection of pepsin in mouth swab: correlation with clinical gastroesophageal reflux in preterm infants. J Matern Fetal Neonatal Med. 2013;26(8):819–24.  https://doi.org/10.3109/14767058.2013.764408.CrossRefPubMedGoogle Scholar
  44. 44.
    • Fortunato JE, D'Agostino RB Jr, Lively MO. Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24-hour esophageal impedance/pH monitoring in pediatric patients. Neurogastroenterol Motil. 2017;29(2):e12936 Is salivary pepsin assay the future for objective testing?  https://doi.org/10.1111/nmo.12936.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyRoyal Children’s HospitalParkvilleAustralia

Personalised recommendations