Abstract
In adults, an estimated 4% to 10% of chronic, nonspecific laryngeal disease seen in otolaryngologic clinics is associated with gastroesophageal reflux disease (GERD). Although no such estimates exist in children, many investigators have reported extraesophageal manifestations of GERD, of which the most common is the association of GERD with asthma and chronic cough. A variety of signs and symptoms of otolaryngologic disease also have been attributed to GERD, including hoarseness, laryngitis, chronic rhinitis, sinusitis, globus pharyngeus, recurrent croup, laryngomalacia, stridor, subglottic stenosis, otalgia, vocal cord granulomas, and oropharyngeal dysphagia. However, proof of the association between these manifestations of otolaryngologic disease and GERD is sparse. Furthermore, the manifestations of otolaryngologic disease often occur in the absence of such classic systems of GERD as heartburn or chest pain. This review explores the role of GERD in otolaryngologic disease in children.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Nebel OT, Fornes MF, Castell DO: Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Digest Dis 1976, 21:953–956.
Gallup Survey on Heartburn Across America. Princeton, NJ: Gallup Organization; 1988.
Shepard RW, Evans JWS, Lander M, et al.: Gastroesophageal reflux in children. Clin Pediatr 1987, 26:55–60.
Nelson SP, Chen EH, Syniar GM, et al.: Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 2000, 154:150–154.
Tolaymat N, Chapman DM: Gastroesophageal reflux disease in children older than 2 years of age. W V Med J 1998, 94:22–25.
Wordsland SL, Dodd WJ, Hogan WJ, et al.: Mechanisms of gastroesophageal reflux in children. J Pediatr 1980, 97:244–249.
Cherry J, Margulies SI: Contact ulcers of the larynx. Laryngoscopy 1968, 78:1937–1940.
Shaker R: Introduction: Symposium on gastroesophageal reflux consensus reports. Am J Med 1997, 103:1S.
El-Serag HB, Gilger MA, Kuebler M, et al.: Extra esophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterol 2001, 121:1294–1299. Case-control study confirming association of GERD with otolaryngologic manifestations in children.
Phipps CD, Wood WE, Gibson WS, et al.: Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg 2000, 126:831–836.
Carr MM, Nguyen A, Poje C, et al.: Correlation of findings on direct laryngoscopy and bronchoscopy with the presence of extra esophageal reflux disease. Laryngoscope 2000, 110:1560–1562.
Putnam PE, Orenstein SR: Hoarseness in a child with gastroesophageal reflux. Acta Pediatr 1992, 81:635–636.
Martin ME, Grunstein MM, Larsen GL: The relationship of gastroesophageal reflux to nocturnal wheezing in children with asthma. Ann Allerg 1982, 49:318–322.
Gustafsson PM, Kjellman NIM, Tibbing L: Bronchial asthma and acid reflux into the distal and proximal esophagus. Arch Dis Child 1990, 65:1255–1258.
Tucci F, Resti M, Fontana R, et al.: Gastroesophageal reflux and bronchial asthma: prevalence and effect of cisapride therapy. J Pediatr Gastroenterol Nutr 1993, 17:265–270.
Laitman JT, Reidenberg JS: The human aerodigestive tract and gastroesophageal reflux: an evolutionary perspective. Am J Med 1997, 103:2S-8S.
Shaker R, Lang IM: Reflex mediated airway protective mechanisms against retrograde aspiration. Am J Med 1997, 103:64S-73S.
Fouad YM, Katz PO, Hatlebakk JG, et al.: Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms. Am J Gastroenterol 1999, 94:1464–1467.
Kahrilas PJ, Dodds WJ, Dent J, et al.: Effect of sleep on spontaneous gastroesophageal reflux and on the upper esophageal sphincter pressure in normal human volunteers. Gastroenterol 1987, 92:466–471.
Euler AR: Upper respiratory tract complications of gastroesophageal reflux in adult and pediatric age patients. Digest Dis 1998, 16:111–117.
Logemann JA, Kahrilas PJ, Cheng J, et al.: Closure mechanisms of laryngeal vestibule during swallow. Am J Physiol 1992, 262:G338-G344.
Rudolph CD, Mazur LJ, Liptak GS, et al.: Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendation of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2001, 32:S1-S31. Comprehensive review of pediatric GERD.
Brouchard S, Lallier M, Yazbec S, et al.: The otolaryngologic manifestations of gastroesophageal reflux: when is a pH study indicated. J Pediatr Surg 1999, 34:1053–1056. Emphasizes indications for pH monitoring in children with ear, nose, and throat disease and potential GERD.
Contencin P, Narcy P: Nasopharyngeal pH monitoring in infants and children with chronic rhino-pharyngitis. Int J Pediatr Otorhinolaryngol 1991, 22:249–256.
Bothwell MR, Parsons DS, Talbot A, et al.: Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg 1999, 1 21:255–262.
Hanson GD, Kambl PL, Kahrilas PJ: Outcomes of anti-reflux therapy for the treatment of chronic laryngitis. Ann Otorhinolaryngol 1995, 104:550–555.
Waki EY, Magdy DN, Belenky WN, et al.: The incidence of gastroesophageal reflux in recurrent croup. Int J Pediatr Otorhinolaryngol 1995, 32:223–232.
Ulualp SO, Toohill RJ, Hoffmann R, et al.: Pharyngeal pH monitoring in patients with posterior laryngitis. Otolaryngol Head Neck Surg 1999, 120:672–677.
Matthews BL, Little JP, McGuirt WF, et al.: Reflux in infants with laryngomalacia; results of 24 hour double probe pH monitoring. Otolaryngol Head Neck Surg 1999, 120:860–864.
Yellon RF: The spectrum of reflux: associated otolaryngologic problems in infants and children. Am J Med 1997, 103:125S-129S.
Little FB, Coufman JA, Kohut RJ, et al.: Effect of gastric acid on pathogenesis of subglottic stenosis. Ann Otorhinolaryngol 1985, 94:516–519.
Zalzal GH, Choi SS, Patel KM: The effect of gastroesophageal reflux on laryngomalacia reconstruction. Arch Otolaryngol Head Neck Surg 1996, 122:297–300.
Gibson WS, Cochran WJ: Otalgia in infants and children: a manifestation of gastroesophageal reflux. Int J Pediatr Otorhinolaryngol 1994, 28:213–218.
Rozmanic V, Velepic M, Ahel V, et al.: Prolonged esophageal monitoring in the evaluation of eophageal reflux in children with chronic tubotympanal disorders. J Pediatr Gastroenterol Nutr 2002, 34:278–280. These authors suggest that pH monitoring for GERD and chronic tubotympanal disorders in children is valuable.
Paralier G, Roger G, Charrritat JL, et al.: Gastroesophageal reflux in infants with subchronic otitis media. Ann Pediatr 1996, 43:177–182.
Bobin S, Attal P: Laryngotracheal manifestations of gastroesophageal reflux in children. Pediatr Pulmonol 1999, 18 (Suppl):73–75. Clear review of pediatric laryngeal disease and GERD.
Gustafsson PM, Tibbling: 24-hour oesophageal two-level pH monitoring in healthy children and adolescents. Scand J Gastroenterol 1995, 23:91–94.
Beuman NM, Bishop WP, Sandler AD, et al.: Value of pH probe monitoring in pediatric patients with extra esophageal manifestations of gastroesophageal disease: a retrospective review. Ann Otohinolaryngol 2000, 109:18–24.
Blecker U, de Pont SM, Hauser B, et al.: The role of ‘occult’ gastroesophageal reflux in chronic pulmonary disease in children. Acta Gastroenterol Belg 1995, 58:348–352.
Contencin P, Narcy P: Gastroesophageal reflux in infants and children. Arch Otolaryngol Head Neck Surg 1992, 118:1028–1030.
Vijayaratnam V, Lin CH, Simpson P, et al.: Lack of significant proximal esophageal acid reflux in infants presenting with respiratory symptoms. Pediatr Pulmonol 1999, 27:231–235.
Working Group of the European Society of Pediatric Gastroenterology and Nutrition: A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992, 14:467–471.
Wong RKH, Hanson DG, Waring PJ, et al.: ENT manifestations of gastroesophageal reflux. Am J Gastroenterol 2000, 95:515–522.
Mittal RK, Stewart WR, Schirmer BD: Effect of a catheter in the pharynx on the frequency of transient lower esophageal sphincter relaxation. Gastroenterology 1992, 103:1236–1240.
Vijayratnam V, Tolia V: Significance of proximal esophageal biopsies in pediatric patients with respiratory symptoms. Gastroenterol 1995, 108:A251.
Yellon RF, Loticcha J, Dixit S: Esophageal biopsy for the diagnosis of gastroesophageal reflux associated otolaryngologic problems in children. Am J Med 2000, 108:1315–1385.
Kamic V, Radzel Z: Acid posterior laryngitis: actiology, histology, diagnosis and treatment. J Laryngol Otol 1984, 98:1237–1241.
McMurray I, Gerber M, Stenn Y, et al.: Role of laryngoscopy, dual pH probe monitoring and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otorhinolaryngol 2001, 110:299–304.
Sifrim D, Holloway R, Silny J, et al.: Acid, nonacid and gas reflux in patients with gastroesophageal disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology 2001, 120:1588–1598.
Wentzl TG, Schenke S, Peschgens T, et al.: Association of apnea and nonacid gastroesophageal in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001, 31:144–149.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gilger, M.A. Pediatric otolaryngologic manifestations of gastroesophageal reflux disease. Curr Gastroenterol Rep 5, 247–252 (2003). https://doi.org/10.1007/s11894-003-0027-5
Issue Date:
DOI: https://doi.org/10.1007/s11894-003-0027-5