Gastroesophageal reflux and pediatric otolaryngologic disease - The role of antireflux surgery

Objective: To determine the role of antireflux surgery in the treatment of gastroesophageal reflux-induced otolaryngologic disease (GEROD). Design: A retrospective medical record analysis was performed. Patient demo graphics, otolaryngologic disease secondary to gastroesophageal reflux (GER ),method of GER diagnosis, medical treatment used before antireflux surgery , and response to surgical intervention were considered. Setting: Tertiary care children's hospital. Patients Among patients undergoing antireflux surgery between January 1, 19 96, and December 31, 1999, children with GEROD were included in the study. Interventions: Children with GEROD who failed medical therapy underwent ant ireflux surgery. Main Outcome Measures: The demographics of patients requiring antireflux su rgery for treatment of their otolaryngologic disease and their clinical res ponse to surgery were reviewed. Results: Fourteen (17%) of 82 children, ranging in age from 48 days to 3 ye ars (mean age, 9.7 months), who underwent antireflux surgery for GER at our institution between 1996 and 1999 were diagnosed as having GEROD. Twelve ( 86%) of the 14 patients were found to have upper aint-ay abnormalities, inc luding subglottic edema, fixed subglottic stenosis, reflex apnea, and recur rent croup. Two patients (14%) had severe chronic sinusitis and otitis medi a. Nine (64%) of the 14 had normal neurologic function for their age vs 5 ( 36%) who had neurologic impairment. After antireflux surgery, all 14 patien ts with GEROD had complete resolution of clinical symptoms. Conclusions: Gastroesophageal reflux has an important role in the cause of numerous otolaryngologic disorders. Although medical management should rema in the mainstay of GER therapy, antireflux surgery provided definitive and successful treatment of potentially life-threatening manifestations of GERO D.