Reflux in infants with laryngomalacia: Results of 24-hour double-probe pH monitoring

Laryngomalacia is the most common cause of strider in children, Previous st udies using barium esophagrams or single-probe esophageal pH testing have i ndicated that 68% to 80% of infants with laryngomalacia have reflux, A rece nt study in a large series of pediatric patients has shown that these 2 tes ting modalities are relatively insensitive in detecting reflux when compare d with 24-hour double-probe pH testing. This study was undertaken to determ ine the incidence and frequency of reflux in children with laryngomalacia b y use of 24-hour double-probe pH monitoring. Twenty-four children with endo scopically diagnosed laryngomalacia underwent 24-hour double-probe pH testi ng, The distal probe was placed in the lower esophagus, and the proximal pr obe was placed just above the cricopharyngeus immediately posterior to the larynx. All 24 (100%) children had pharyngeal acid exposure as judged by th e proximal pH probe. These children had a mean of 15.21 episodes of reflux to the level of the pharynx during the 24-hour study period. In contrast, o nly 16 (66%) children had abnormal acid exposure as measured by the distal esophageal probe. These results indicate that essentially ail children with laryngomalacia have reflux of gastric acid to the pharyngeal level. Multip le authors have documented the detrimental effects of acid and the accompan ying pepsin in the larynx and tracheobronchial tree. Persistent laryngeal e dema is an almost universal finding in patients with reflux to the pharynge al level and is a common finding in children with laryngomalacia, In some p atients with laryngomalacia, reflux may be the primary cause of their airwa y compromise, whereas in others it may be a significant cofactor exacerbati ng a preexisting neurologic or anatomic abnormality.