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Epiglottic and base-of-tongue prolapse in children: grading and management

Robert F Yellon1

  • 1Airway and Voice Center, the Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, and the Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA. yellra@chp.edu

The Laryngoscope
|February 10, 2006
PubMed

Insights

Epiglottic and base-of-tongue (EBT) prolapse causes pediatric airway obstruction. A new grading system successfully classified EBT prolapse severity, revealing high rates of swallowing dysfunction and reflux.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Pulmonology
  • Pediatric Gastroenterology

Background:

  • Airway obstruction in children can arise from various causes, including anatomical abnormalities.
  • Epiglottic and base-of-tongue (EBT) prolapse is a recognized, though less common, cause of upper airway obstruction in pediatric patients.
  • Understanding the spectrum and associated comorbidities of EBT prolapse is crucial for effective management.

Purpose of the Study:

  • To define epiglottic and base-of-tongue (EBT) prolapse as a distinct entity causing airway obstruction in children.
  • To describe laryngopharyngeal findings, swallowing dysfunction, and gastroesophageal reflux disease (GERD) in children with EBT prolapse.
  • To introduce and evaluate a novel grading system for EBT prolapse severity.

Main Methods:

  • A prospective study involving 14 pediatric patients diagnosed with EBT prolapse.
  • Flexible fiberoptic nasopharyngolaryngoscopy was utilized for detailed airway assessment.
  • A new grading system (Grade 0-3) was developed to categorize the severity of EBT prolapse based on anatomical obstruction.

Main Results:

  • The study successfully applied the new grading system to 14 children, classifying their EBT prolapse severity.
  • Grade 1 EBT prolapse was observed in 50% of patients, Grade 2 in 29%, and Grade 3 in 21%.
  • High prevalence of associated conditions was noted: swallowing dysfunction in 38% and gastroesophageal reflux disease in 93% of cases.

Conclusions:

  • The developed grading system effectively quantifies the severity and location of airway obstruction in pediatric EBT prolapse.
  • Swallowing dysfunction and GERD are common comorbidities in children with EBT prolapse.
  • While surgical options exist, continuous positive airway pressure (CPAP) or tracheotomy may represent safer management strategies due to inconsistent surgical success and aspiration risks.
Abstract

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