Laryngeal mucosal histology in laryngomalacia: the evidence for gastro-oesophageal reflux laryngitis

Objective: To describe the histopathological changes of the mucosa in laryn gomalacia; look for any relationship with gastro-oesophageal reflux and to describe the histological changes of reflux laryngitis in laryngomalacia. M ethods: We examined serial histological sections from nine cases of laryngo malacia, who had aryepiglottoplasty and compared the histopathological feat ures with five cases of postintubation inflammatory laryngitis and five age -matched autopsy specimens of normal larynx. Results: Five of the cases of laryngomalacia had mild inflammation in the form of basal cell hyperplasia and chronic inflammation close to the basement membrane. Deeper subepitheli um was oedematous. Two cases had moderate and two cases severe inflammation . The latter showed ulceration and a dense band of chronic inflammation in the immediate subepithelium with underlying oedema. Three of the cases had gastro-oesophageal reflux proven by barium swallow. Two of these showed int raepithelial eosinophils. Conclusions: A band of inflammation of variable i ntensity just beneath the epithelium with oedema deep to it is the most imp ortant histological feature of laryngomalacia. The presence of intraepithel ial eosinophils appears to be a histological indication for reflux aetiolog y of the inflammation. (C) 1999 Elsevier Science Ireland Ltd. All rights re served.