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Updated: Apr 15, 2026
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Eosinophilic Laryngitis in Children with Aerodigestive Dysfunction
Robert J Yawn1, Sari Acra2, Steven L Goudy1
1Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA.
Insights
Laryngeal eosinophils were found in 11% of children with aerodigestive dysfunction. Posterior arytenoid eosinophils may indicate chronic laryngeal inflammation and are linked to eosinophilic esophagitis.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Otolaryngology
- Allergy and Immunology
Background:
- Eosinophilic inflammation is increasingly recognized in various organ systems.
- Laryngeal involvement in pediatric aerodigestive dysfunction is complex and multifactorial.
- The presence and significance of laryngeal eosinophils in children are not well-established.
Purpose of the Study:
- To investigate the prevalence of laryngeal eosinophils in pediatric patients with aerodigestive dysfunction.
- To correlate laryngeal eosinophil presence with clinical symptoms and other gastrointestinal findings.
- To explore the potential role of laryngeal eosinophils as a marker for chronic inflammation.
Main Methods:
- A retrospective case series involving 81 pediatric patients referred to a multidisciplinary aerodigestive clinic.
- Diagnostic procedures included microlaryngoscopy with posterior arytenoid biopsy, bronchoscopy, esophagogastroduodenoscopy with esophageal biopsy, and impedance probe testing.
- Histopathological analysis of biopsies was performed to identify eosinophils and assess for laryngitis and esophagitis.
Main Results:
- Eleven percent (9/81) of patients exhibited eosinophils in posterior arytenoid biopsies.
- Three of these 9 patients also had biopsy-proven eosinophilic esophagitis.
- Patients with posterior arytenoid eosinophils showed a significantly higher frequency of biopsy-proven eosinophilic esophagitis (33% vs. 6.9%, P = .0408).
Conclusions:
- Eosinophilic inflammation in the larynx is a newly described finding in children with complex aerodigestive complaints.
- Posterior arytenoid eosinophils may serve as a potential marker for chronic laryngeal inflammation in this patient population.
- A threshold of >15 eosinophils/high-powered field in arytenoid biopsies was associated with concomitant eosinophilic esophagitis.
Objective:
To describe the presence of laryngeal eosinophils and associated symptomatology in patients with aerodigestive dysfunction.
Study Design:
Case series with chart review.
Setting:
Single tertiary pediatric referral center.
Subjects:
Eighty-one consecutive pediatric patients referred to a multidisciplinary aerodigestive clinic with upper airway concerns.
Methods:
Microlaryngoscopy and posterior arytenoid biopsy, flexible bronchoscopy, esophagogastroduodenoscopy and esophageal biopsy, and impedance probe testing were performed as indicated by clinical symptoms. Positive versus negative posterior arytenoid biopsy for eosinophils and the presence or absence of concomitant histopathological laryngitis and/or esophagitis were measured.
Results:
Nine of 81 (11%) patients had positive laryngeal biopsy for eosinophils (range, 1-29 eosinophils/high-powered field [HPF]). Three of these 9 patients also had concurrent biopsy-proven eosinophilic esophagitis, while 8 of 81 total patients had biopsy-proven eosinophilic esophagitis. The frequency of biopsy-proven eosinophilic esophagitis was higher in patients with posterior arytenoid eosinophils versus patients without laryngeal eosinophils (33% versus 6.9%, P = .0408).
Conclusions:
Eosinophilic inflammation in the larynx has not been described in children with complex aerodigestive complaints. Posterior arytenoid eosinophils may serve as a marker of chronic laryngeal inflammation in children with aerodigestive dysfunction, although their exact role in this inflammation remains unclear. In our population, >15 eosinophils/HPF within posterior arytenoid biopsies was associated with concomitant eosinophilic esophagitis.
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