Clin Exp Otorhinolaryngol.  2016 Jun;9(2):168-172. 10.21053/ceo.2015.00409.

Oropharyngeal 24-Hour pH Monitoring in Children With Airway-Related Problems

• Mesallam T

• KMID: 2165061
• DOI: http://doi.org/10.21053/ceo.2015.00409

Abstract

OBJECTIVES
Diagnosis and clinical presentation of pediatric laryngopharyngeal reflux (LPR) is still controversial. The aims of this work were to study the possibility of performing 24-hour oropharyngeal pH monitoring for children in the outpatient clinic setup and to explore the results of this test in correlation to airway-related problems.
METHODS
In this descriptive qualitative study, 26 children suffering from airway-related problems were included. Oropharyngeal 24-hour pH monitoring was performed for all subjects in the outpatient clinic setting. The distribution of airway diagnoses among the study group was studied versus the results of the pH monitoring.
RESULTS
There were 16 males and 10 females participated in the study with a mean age of 6.88 (SD, ±5.77) years. Thirty-five percent of the patients were under the age of 3 years (range, 11 months to 3 years). Eight-five percent of the patients tolerated the pH probe insertion and completed 24-hour of pH recording. Laryngomalacia and subglottic stenosis (SGS) were more frequently reported in the positive LPR patients (77%).
CONCLUSION
Oropharyngeal 24-hour pH monitoring can be conducted for children in the outpatient setup even in young age children below 3 years old. Among the positive LPR group, SGS and laryngomalacia were the most commonly reported airway findings.

Keyword

Laryngopharyngeal Reflux; Airway Obstruction; Pediatrics

MeSH Terms

Airway Obstruction
Ambulatory Care Facilities
Child*
Constriction, Pathologic
Diagnosis
Female
Humans
Hydrogen-Ion Concentration*
Laryngomalacia
Laryngopharyngeal Reflux
Male
Outpatients
Pediatrics

Figure

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  Fig. 1. One of the patients of the study (11 months old) having the oropharyngeal pH probe in place.

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  Fig. 2. An oropharyngeal pH graph showing of a negative laryngopharyngeal reflux (LPR) study (A), and an oropharyngeal pH graph showing of a positive LPR study (B).

Reference

1. Stavroulaki P. Diagnostic and management problems of laryngopharyngeal reflux disease in children. Int J Pediatr Otorhinolaryngol. 2006; Apr. 70(4):579–90.

2. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991; Apr. 101(4 Pt 2 Suppl 53):1–78.

3. El-Serag HB, Gilger M, Kuebeler M, Rabeneck L. Extraesophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterology. 2001; Dec. 121(6):1294–9.

4. Yellon RF, Parameswaran M, Brandom BW. Decreasing morbidity following laryngotracheal reconstruction in children. Int J Pediatr Otorhinolaryngol. 1997; Aug. 41(2):145–54.

5. Delahunty JE, Cherry J. Experimentally produced vocal cord granulomas. Laryngoscope. 1968; Nov. 78(11):1941–7.

6. Little FB, Koufman JA, Kohut RI, Marshall RB. Effect of gastric acid on the pathogenesis of subglottic stenosis. Ann Otol Rhinol Laryngol. 1985; Sep-Oct. 94(5 Pt 1):516–9.

7. Jarmuz T, Roser S, Rivera H, Gal A, Roman J. Transforming growth factor-beta1, myofibroblasts, and tissue remodeling in the pathogenesis of tracheal injury: potential role of gastroesophageal reflux. Ann Otol Rhinol Laryngol. 2004; Jun. 113(6):488–97.

8. Merati AL, Lim HJ, Ulualp SO, Toohill RJ. Meta-analysis of upper probe measurements in normal subjects and patients with laryngopharyngeal reflux. Ann Otol Rhinol Laryngol. 2005; Mar. 114(3):177–82.

9. Vaezi MF, Schroeder PL, Richter JE. Reproducibility of proximal probe pH parameters in 24-hour ambulatory esophageal pH monitoring. Am J Gastroenterol. 1997; May. 92(5):825–9.

10. Beaver ME, Stasney CR, Weitzel E, Stewart MG, Donovan DT, Parke RB Jr, et al. Diagnosis of laryngopharyngeal reflux disease with digital imaging. Otolaryngol Head Neck Surg. 2003; Jan. 128(1):103–8.

11. Wiener GJ, Koufman JA, Wu WC, Cooper JB, Richter JE, Castell DO. Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring. Am J Gastroenterol. 1989; Dec. 84(12):1503–8.

12. Wiener GJ, Tsukashima R, Kelly C, Wolf E, Schmeltzer M, Bankert C, et al. Oropharyngeal pH monitoring for the detection of liquid and aerosolized supraesophageal gastric reflux. J Voice. 2009; Jul. 23(4):498–504.

13. Andrews TM, Orobello N. Histologic versus pH probe results in pediatric laryngopharyngeal reflux. Int J Pediatr Otorhinolaryngol. 2013; May. 77(5):813–6.

14. Myer CM 3rd, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994; Apr. 103(4 Pt 1):319–23.

15. van den Abbeele T, Couloigner V, Faure C, Narcy P. The role of 24 h pH-recording in pediatric otolaryngologic gastro-esophageal reflux disease. Int J Pediatr Otorhinolaryngol. 2003; Dec. 67 Suppl 1:S95–100.

16. Contencin P, Maurage C, Ployet MJ, Seid AB, Sinaasappel M. Gastroesophageal reflux and ENT disorders in childhood. Int J Pediatr Otorhinolaryngol. 1995; Jun. 32 Suppl:S135–44.

17. Postma GN, Belafsky PC, Aviv JE, Koufman JA. Laryngopharyngeal reflux testing. Ear Nose Throat J. 2002; Sep. 81(9 Suppl 2):14–8.

18. Little JP, Matthews BL, Glock MS, Koufman JA, Reboussin DM, Loughlin CJ, et al. Extraesophageal pediatric reflux: 24-hour double-probe pH monitoring of 222 children. Ann Otol Rhinol Laryngol Suppl. 1997; Jul. 169:1–16.

19. Brigger MT, Sipp JA, Hartnick CJ. Tracheal pH monitoring: a pilot study in tracheostomy dependent children. Int J Pediatr Otorhinolaryngol. 2009; Jul. 73(7):999–1001.

20. McMurray JS, Gerber M, Stern Y, Walner D, Rudolph C, Willging JP, et al. Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otol Rhinol Laryngol. 2001; Apr. 110(4):299–304.

21. Matthews BL, Little JP, Mcguirt WF Jr, Koufman JA. Reflux in infants with laryngomalacia: results of 24-hour double-probe pH monitoring. Otolaryngol Head Neck Surg. 1999; Jun. 120(6):860–4.

22. Iyer VK, Pearman K, Raafat F. Laryngeal mucosal histology in laryngomalacia: the evidence for gastro-oesophageal reflux laryngitis. Int J Pediatr Otorhinolaryngol. 1999; Aug. 49(3):225–30.

23. Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg. 2012; Oct. 147(4):619–26.

24. Halstead LA. Gastroesophageal reflux: A critical factor in pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 1999; May. 120(5):683–8.

25. Yellon RF, Coticchia J, Dixit S. Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children. Am J Med. 2000; Mar. 108 Suppl 4a:131S–138S.

26. Mitzner R, Brodsky L. Multilevel esophageal biopsy in children with airway manifestations of extraesophageal reflux disease. Ann Otol Rhinol Laryngol. 2007; Aug. 116(8):571–5.

27. Carr MM, Abu-Shamma U, Brodsky LS. Predictive value of laryngeal pseudosulcus for gastroesophageal reflux in pediatric patients. Int J Pediatr Otorhinolaryngol. 2005; Aug. 69(8):1109–12.

28. Giannoni C, Sulek M, Friedman EM, Duncan NO 3rd. Gastroesophageal reflux association with laryngomalacia: a prospective study. Int J Pediatr Otorhinolaryngol. 1998; Feb. 43(1):11–20.