- Email: [email protected]
Reflux in infants with laryngomalacia: Results of 24-hour double-probe pH monitoring
Otolaryngology Head and Neck Surgery P~
August 1997
Scientific Sessions- - Monday
change in hearing status was a weak predictor (r = 0.33, p = 0.01) of overall satisfaction; rather, satisfaction with behavior change (r = 0.42, p = 0.001) correlated most strongly with overall satisfaction. Conclusions." Parental perception of their child's hearing loss is a poor predictor of objective audiologic findings both before and after treatment with tympanostomy tubes. These findings have important implications concerning the importance of screening for hearing loss in children with otitis media with effusion. 8:08 AM
Gastroesophageal Reflux: A Critical Factor in Pediatric Subglottic Stenosis LUCINDA A. HALSTEAD, MD (presenter), Charleston, S.C.
Objective: Gastroesophageal reflux (GER) plays a causative role in subglottic stenosis (SGS). Laryngeal injury by gastric acid can be a circumscribed event during a period of intubation or a chronic condition, just as in adults. The purpose of this study is to examine the impact of aggressive diagnosis and treatment of GER on the management of children with SGS. Methods: Since 1994, 27 infants and children with SGS were prospectively probed and treated aggressively for GER before undergoing any endoscopic repair. Prior to 1994, only children failing endoscopic management of their SGS, which included a short empiric perioperative reflux regimen, were studied. Fifty-seven children underwent endoscopic management of their SGS. Endoscopic surgery failed in 10 children; they were tracheotomized and further evaluated. Results: Of the 27 children managed prospectively, one has been tracheotomized. Eight children have been managed on antireflux medication alone. Two patients have required Nissen fundoplication. The remainder underwent between one to three endoscopic surgeries, are asymptomatic, and have a normal voice. Of the 10 children treated prior to 1994 for whom endoscopic management failed, all had positive pH probes, four have undergone N i s s e n f u n d o p l i c a t i o n , and four have u n d e r g o n e decannulation. Conclusions: Aggressive diagnosis and management of GER prior to any surgical intervention is essential and greatly facilitates the management of children with SGS. It has allowed some infants and children to be managed without surgery and reduced the number of tracheotomies and endoscopic surgeries. The double pH probe, especially the pharyngeal probe, plays a critical role in determining the presence of GER in children with SGS. The majority of patients were preemies and ex-preemies, which indicates that GER occurs in pathologic form in the preterm and very young infant. Several of the tracheotomized infants have been probed periodically over the course of several years and have continued to have abnormal results, indicating that pathologic GER can persist unabated in some of these patients into childhood.
8:16 AM
Evaluation and Treatment of Obstructive Sleep A p n e a in Children With Achondroplasia ELIZABETH A. SISK, MD (presenter), GLEN LEVERSON, PhD, BRETJ. BOROWSKI, MD, RICHARD M. PAULI, MD, PhD, and DIANE G. HEATLEY,MD, Madison, Wis.
Objective: Airway obstruction is common in persons with achondroplastic dwarfism because of midfacial hypoplasia and hypotonia of respiratory musculature. This study examines the prevalence of obstructive sleep apnea (OSA) in a large pediatric population of achondroplastic dwarfs and evaluates the effectiveness of adenoidectomy and/or tonsillectomy as treatment. Perioperative and anesthesia management are also reviewed. Methods: The records of 95 children with achondroplasia age 1 day to 17 years were retrospectively reviewed. Sequential observations of pertinent history, physical examination findings, diagnostic studies, and operative information were analyzed for visits between 1981 and 1996. Results: Forty of 95 patients (42%) had clinical evidence of OSA, and 24 of these children had polysomnography confirming the diagnosis. The average age of surgical intervention for OSA was 3.3 years for adenoidectomy and 3.8 years for tonsillectomy. Thirty-seven patients underwent surgical intervention, with more than one procedure required in 10 children (27%). Adenotonsillectomy was the initial procedure for 24 of 37 patients, and no further therapy for OSA was required in 83%. Adenoidectomy was the initial procedure for 11 of 37 patients, with 88% requiring further surgery for recurrent OSA. Tonsillectomy alone was done in two patients, and one patient later required adenoidectomy. Endotracheal incubation was accomplished in all patients without complication; 35% of patients required a smaller endotracheal tube than would be predicted by their weight, and 53% required a smaller endotracheal tube than would be predicted by their age. Seven postoperative complications including reintubation (3), fever (1), pneumonia (1), tonsillar hemorrhage (1), and pulmonary edema (1) were recorded. Conclusions: Obstructive sleep apnea is very common in children with achondroplasia. Surgical therapy is effective, but recurrent symptoms are common, particularly when the initial procedure is adenoidectomy. The complication rate is higher than that observed in a general pediatric population but readily managed with standard therapy. 8:30 AM
Reflux in Infants With Laryngomalacia: Results Of 24-Hour Double-Probe pH Monitoring BRIAN L. MATTHEWS, MD (presenter), JOHN P. LITTLE,MD, and WILLIAM F. McGUIRT, Jr., MD, Winston-Salem, N.C.
Laryngomalacia is the most common cause of stridor in children. Previous studies utilizing barium esophagrams or single-probe esophageal pH testing have indicated that 68% to 80% of infants with laryngomalacia have reflux. A recent
August 1997
Scientific Sessions- - Monday
change in hearing status was a weak predictor (r = 0.33, p = 0.01) of overall satisfaction; rather, satisfaction with behavior change (r = 0.42, p = 0.001) correlated most strongly with overall satisfaction. Conclusions." Parental perception of their child's hearing loss is a poor predictor of objective audiologic findings both before and after treatment with tympanostomy tubes. These findings have important implications concerning the importance of screening for hearing loss in children with otitis media with effusion. 8:08 AM
Gastroesophageal Reflux: A Critical Factor in Pediatric Subglottic Stenosis LUCINDA A. HALSTEAD, MD (presenter), Charleston, S.C.
Objective: Gastroesophageal reflux (GER) plays a causative role in subglottic stenosis (SGS). Laryngeal injury by gastric acid can be a circumscribed event during a period of intubation or a chronic condition, just as in adults. The purpose of this study is to examine the impact of aggressive diagnosis and treatment of GER on the management of children with SGS. Methods: Since 1994, 27 infants and children with SGS were prospectively probed and treated aggressively for GER before undergoing any endoscopic repair. Prior to 1994, only children failing endoscopic management of their SGS, which included a short empiric perioperative reflux regimen, were studied. Fifty-seven children underwent endoscopic management of their SGS. Endoscopic surgery failed in 10 children; they were tracheotomized and further evaluated. Results: Of the 27 children managed prospectively, one has been tracheotomized. Eight children have been managed on antireflux medication alone. Two patients have required Nissen fundoplication. The remainder underwent between one to three endoscopic surgeries, are asymptomatic, and have a normal voice. Of the 10 children treated prior to 1994 for whom endoscopic management failed, all had positive pH probes, four have undergone N i s s e n f u n d o p l i c a t i o n , and four have u n d e r g o n e decannulation. Conclusions: Aggressive diagnosis and management of GER prior to any surgical intervention is essential and greatly facilitates the management of children with SGS. It has allowed some infants and children to be managed without surgery and reduced the number of tracheotomies and endoscopic surgeries. The double pH probe, especially the pharyngeal probe, plays a critical role in determining the presence of GER in children with SGS. The majority of patients were preemies and ex-preemies, which indicates that GER occurs in pathologic form in the preterm and very young infant. Several of the tracheotomized infants have been probed periodically over the course of several years and have continued to have abnormal results, indicating that pathologic GER can persist unabated in some of these patients into childhood.
8:16 AM
Evaluation and Treatment of Obstructive Sleep A p n e a in Children With Achondroplasia ELIZABETH A. SISK, MD (presenter), GLEN LEVERSON, PhD, BRETJ. BOROWSKI, MD, RICHARD M. PAULI, MD, PhD, and DIANE G. HEATLEY,MD, Madison, Wis.
Objective: Airway obstruction is common in persons with achondroplastic dwarfism because of midfacial hypoplasia and hypotonia of respiratory musculature. This study examines the prevalence of obstructive sleep apnea (OSA) in a large pediatric population of achondroplastic dwarfs and evaluates the effectiveness of adenoidectomy and/or tonsillectomy as treatment. Perioperative and anesthesia management are also reviewed. Methods: The records of 95 children with achondroplasia age 1 day to 17 years were retrospectively reviewed. Sequential observations of pertinent history, physical examination findings, diagnostic studies, and operative information were analyzed for visits between 1981 and 1996. Results: Forty of 95 patients (42%) had clinical evidence of OSA, and 24 of these children had polysomnography confirming the diagnosis. The average age of surgical intervention for OSA was 3.3 years for adenoidectomy and 3.8 years for tonsillectomy. Thirty-seven patients underwent surgical intervention, with more than one procedure required in 10 children (27%). Adenotonsillectomy was the initial procedure for 24 of 37 patients, and no further therapy for OSA was required in 83%. Adenoidectomy was the initial procedure for 11 of 37 patients, with 88% requiring further surgery for recurrent OSA. Tonsillectomy alone was done in two patients, and one patient later required adenoidectomy. Endotracheal incubation was accomplished in all patients without complication; 35% of patients required a smaller endotracheal tube than would be predicted by their weight, and 53% required a smaller endotracheal tube than would be predicted by their age. Seven postoperative complications including reintubation (3), fever (1), pneumonia (1), tonsillar hemorrhage (1), and pulmonary edema (1) were recorded. Conclusions: Obstructive sleep apnea is very common in children with achondroplasia. Surgical therapy is effective, but recurrent symptoms are common, particularly when the initial procedure is adenoidectomy. The complication rate is higher than that observed in a general pediatric population but readily managed with standard therapy. 8:30 AM
Reflux in Infants With Laryngomalacia: Results Of 24-Hour Double-Probe pH Monitoring BRIAN L. MATTHEWS, MD (presenter), JOHN P. LITTLE,MD, and WILLIAM F. McGUIRT, Jr., MD, Winston-Salem, N.C.
Laryngomalacia is the most common cause of stridor in children. Previous studies utilizing barium esophagrams or single-probe esophageal pH testing have indicated that 68% to 80% of infants with laryngomalacia have reflux. A recent