Correlation of findings on direct laryngoscopy and bronchoscopy with presence of extraesophageal reflux disease

Objective: To determine the correlation between findings at direct laryngos copy and bronchoscopy and presence of extraesophageal reflux disease (GERD) . Study Design: Retrospective chart review Methods: Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1 999 for airway symptoms for whom there was a suspicion of EERD were examine d. Gastroesophageal reflux disease (GERD) was considered present if at leas t one test was positive (including upper GI series, pH probe, gastric scint iscan, or esophageal biopsy). Results: A total of 130 (84%) patients had GE RD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnor malities in GERD included postglottic edema, 69%; arytenoid edema, 30%; lar ge lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; vent ricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobron chial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold ed ema, resulting in a sensitivity of 75% and a specificity of 67%. Positive p redictive value was 100% for the combination of postglottic edema and any v ocal fold or ventricular abnormality. Conclusion: Laryngoscopy and bronchos copy can reveal findings with a high positive predictive value for the pres ence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis.