Laryngomalacia and Acid Reflux: A Systematic Review

P110

Otolaryngology–Head and Neck Surgery 145(2S)

Pediatric Otolaryngology Laryngomalacia and Acid Reflux: A Systematic Review Trevor Hartl (presenter); Neil K. Chadha, MBChB, MRCS, MSc

ORAL PRESENTATIONS

Objective: Laryngomalacia is widely described as having an association with acid reflux. Many otolaryngologists therefore employ empiric treatment with anti-reflux medication in this setting. This study aims to identify and appraise the evidence for this association, and to explore the potential role for treatment of reflux in the management of laryngomalacia. Method: A predefined protocol was employed to search Medline, EMBASE, the Cochrane Library, and Google Scholar. Included studies were those that explored the potential for an association between laryngomalacia and gastro-esophageal and/or laryngopharyngeal reflux. The Oxford Centre for Evidence Based Medicine (CEBM) guidelines were applied to assess study quality of evidence. Results: A total of 26 studies, representing 1295 neonates with laryngomalacia, were included. Study quality varied from CEBM 2a (n = 3 to 4 (n = 20). No randomized controlled trials were identified. While reflux definitions were diverse, overall reflux prevalence in this group was 59%. Evidence supporting an association between reflux and laryngomalacia included: the near ubiquity of acid reflux in dual-probe pH monitoring in children with laryngomalacia (3 studies); case series and reports of laryngomalacia improvement with anti-reflux therapy (5 studies); histologic evidence of reflux-related laryngeal inflammation in children with laryngomalacia (2 studies); and implication of reflux as a cofactor in laryngomalacia symptom severity (12 studies). Conclusion: The literature shows a co-existence between acid reflux and laryngomalacia, but the evidence for causal association is limited. In view of the widespread use of anti-reflux treatment in laryngomalacia, an RCT of anti-reflux medication vs placebo appears well-justified. This review provides a rational foundation for such an endeavor.

Pediatric Otolaryngology Long-Term Quality of Life Outcomes in Children Undergoing Adenotonsillectomy for Obstructive Sleep Apnea Premjit Singh Randhawa (presenter); Geoffrey Chilvers; Raul Cetto; Antony A. P. Narula, MA, FRCS Objective: Assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years postsurgery for continued and long-term improvement in quality of life using the Child Health Questionnaire Physical Function version 28. We also sought to compare this group of children to a healthy United Kingdom population.

Method: A telephone survey was carried out using the CHQPF28 questionnaire and administered to the primary care giver of 37 patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years after initial surgery at our university hospital tertiary referral center. Results: A total of 33 patients (89.1%) from our initial cohort were contacted. The mean age was 10.6 years (median, 11 years range, 5-16 years). The mean scores from our follow-up study show improvements in 5 subscales and were statistically significant in 2 subscales (role limitations P < .00001; bodily pain P < .002) when compared to values obtained 3 months postoperatively. The 4-year follow-up scores showed further improvement in 5 subscales when compared with a healthy population. All subscales of the CHQ-PF28 improved in the long term when compared to scores preoperatively. Conclusion: Quality of life data are an important measure when deciding on a particular intervention. In the short term quality of life measures have been shown to improve. Our study demonstrates that the benefits of surgery are still persistent, and the children continue to improve in the long term.

Pediatric Otolaryngology Management of Obstructive Sleep Apnea in Children with Cerebral Palsy Patrick D. Munson, MD (presenter); Andrew Dunham; Charles M. Bower, MD; Gresham T. Richter, MD; Larry D. Hartzell, MD; Ryan Guillory, MD Objective: 1) Determine the efficacy of combined surgical techniques for improving obstructive sleep apnea (OSA) in pediatric patients with cerebral palsy (CP). 2) Evaluate the addition of tongue base suspension for children with CP that have moderate to severe OSA. Method: Seven-year retrospective chart review of 14 children with CP undergoing surgical management of OSA, including adenotonsillectomy (T&A) and uvulopalatopharyngoplasty (UPPP), with or without tongue base suspension (TBS). Response to treatment was determined by its impact on PSG parameters: apnea/hypopnea index (AHI) and arousal index (AI). Results: Children with CP who received TBS had a mean preoperative AHI of 27.2 compared with an AHI of 6.8 in the group that underwent only T&A and UPPP (non-TBS). AHI decreased by a mean of 16.5 (TBS) vs 5.0 (non-TBS); (P value .03 vs 04). AI also improved in both groups (33.1 to 20.7 and 11.0 to 5.8); (P value .05 vs 10). Hospital length of stay was slightly longer for the TBS groups than the non-TBS groups (mean 9.3 days and 6.6 days) but was not statistically significant (P = .09). Average length of follow-up was 52 months with no surgical complications. Conclusion: Combined surgical therapy improves OSA in children with CP. Children with CP and moderate to severe OSA (AHI>15) may safely benefit from the addition of tongue base suspension to T&A and UPPP to maximize treatment.

Downloaded from oto.sagepub.com by guest on December 11, 2016