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Synchronous airway lesions and esophagitis in young patients undergoing adenoidectomy
David L Mandell1, Robert F Yellon
1Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA.
Insights
Synchronous airway lesions and esophagitis are common in infants undergoing adenoidectomy for airway obstruction. Endoscopy during adenoidectomy is recommended for this age group to identify these conditions.
Area of Science:
- Pediatric Otolaryngology
- Gastroenterology
Background:
- Adenoid hypertrophy and upper airway obstruction are common in children under 18 months.
- Adenoidectomy is a frequent surgical intervention for this condition.
- The prevalence of concurrent airway and esophageal pathology in this specific age group is not well-established.
Purpose of the Study:
- To determine the prevalence of synchronous airway lesions and esophagitis in children younger than 18 months undergoing adenoidectomy.
- To evaluate the utility of endoscopic evaluation during adenoidectomy in this pediatric population.
Main Methods:
- Retrospective review of 35 children under 18 months who underwent adenoidectomy.
- Simultaneous flexible nasopharyngolaryngoscopy, direct laryngoscopy, rigid tracheobronchoscopy, and esophagoscopy with biopsy were performed.
- Histopathological analysis of esophageal biopsies was conducted.
Main Results:
- Synchronous airway lesions were identified in 59% (19/32) of patients undergoing airway endoscopy.
- Common airway findings included laryngeal edema, laryngomalacia, and tracheal vascular compression.
- Histologic evidence of gastroesophageal reflux disease (GERD) was found in 31% (10/32) and eosinophilic esophagitis in 13% (4/32) of patients.
Conclusions:
- A high prevalence of synchronous airway lesions and esophagitis (GERD and eosinophilic esophagitis) exists in infants undergoing adenoidectomy.
- These findings support the consideration of airway and esophageal endoscopy during adenoidectomy for children under 18 months.
Objective:
To determine the prevalence of synchronous airway lesions and esophagitis in children younger than 18 months undergoing adenoidectomy for adenoid hypertrophy and upper airway obstruction.
Design:
Retrospective review spanning 4.5 years.
Setting:
Tertiary care children's hospital.
Patients:
All children younger than 18 months who underwent adenoidectomy for upper airway obstruction by 2 pediatric otolaryngologists.
Exclusion Criteria:
craniofacial dysmorphism and congenital syndromes.
Interventions:
Simultaneous interventions during adenoidectomy included flexible nasopharyngolaryngoscopy (n = 32), direct laryngoscopy (n = 31), rigid tracheobronchoscopy (n = 30), and esophagoscopy with biopsy (n = 32).
Main Outcome Measures:
Prevalence of synchronous airway lesions and histologic esophagitis.
Results:
Thirty-five children younger than 18 months underwent adenoidectomy for airway obstruction (2 also had simultaneous tonsillectomy). Synchronous airway lesions were found in 19 (59%) of 32 patients who underwent airway endoscopy, including laryngeal edema (n = 9), laryngomalacia (n = 8), tracheal vascular compression (n = 4), subglottic stenosis (n = 4), midmembranous vocal fold lesions (n = 3), bronchial stenosis (n = 1), and true vocal fold immobility (n = 1). Among 32 patients who underwent esophageal biopsy, histologic evidence of gastroesophageal reflux disease was found in 10 patients (31%), and eosinophilic esophagitis was found in 4 patients (13%). Overall prevalence of any synchronous finding (airway and/or esophagus) was 27 (77%) of 35.
Conclusions:
Synchronous airway lesions and esophagitis (both gastroesophageal reflux disease and eosinophilic esophagitis) were prevalent among children younger than 18 months undergoing adenoidectomy for adenoid hypertrophy and upper airway obstruction. The presence of these findings argues for consideration of endoscopy during adenoidectomy for very young children.
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