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Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next? J Clin Med 2023; 12:jcm12041436. [PMID: 36835970 PMCID: PMC9962831 DOI: 10.3390/jcm12041436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Laryngopharyngeal reflux may affect people of any age; still, most of the accumulated knowledge concerns adults, and evidence regarding pediatric populations remains relatively restricted. This study aims to review the most recent and emerging aspects of pediatric laryngopharyngeal reflux from the last ten years. It also attempts to identify gaps in knowledge and highlight discrepancies that future research should urgently address. METHODS An electronic search of the MEDLINE database was conducted, limited to January 2012 through December 2021. Non-English language articles, case reports, and studies that concerned a purely or predominantly adult population were excluded. The information from the articles with the most relevant contribution was initially categorized by theme and subsequently synthesized into a narrative form. RESULTS 86 articles were included, of which 27 were review articles, eight were surveys, and 51 were original articles. Our review systematically maps the research done in the last decade and provides an updated overview and the current state-of-the-art in this subject. CONCLUSIONS Despite discrepancies and heterogeneity in accumulating research, evidence gathered so far endorses a need for refining an escalating multiparameter diagnostic approach. A step-wise therapeutic plan appears to be the most reasonable management approach, starting with behavioral changes for mild to moderate, uncomplicated cases and escalating to personalized pharmacotherapy options for severe or nonresponsive cases. Surgical options could be considered in the most severe cases when potentially life-threatening symptoms persist despite maximal medical therapy. Over the past decade, the amount of available evidence has been gradually increasing; however, its strength remains low. Several aspects remain markedly under-addressed, and further adequately powered, multicenter, controlled studies with uniformity in diagnostic procedures and criteria are urgently needed.
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Landry V, Coburn P, Kost K, Liu X, Li-Jessen NYK. Diagnostic Accuracy of Liquid Biomarkers in Airway Diseases: Toward Point-of-Care Applications. Front Med (Lausanne) 2022; 9:855250. [PMID: 35733871 PMCID: PMC9207186 DOI: 10.3389/fmed.2022.855250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022] Open
Abstract
Background Liquid biomarkers have shown increasing utility in the clinical management of airway diseases. Salivary and blood samples are particularly amenable to point-of-care (POC) testing due to simple specimen collection and processing. However, very few POC tests have successfully progressed to clinical application due to the uncertainty and unpredictability surrounding their diagnostic accuracy. Objective To review liquid biomarkers of airway diseases with well-established diagnostic accuracies and discuss their prospects for future POC applications. Methodology A literature review of publications indexed in Medline or Embase was performed to evaluate the diagnostic accuracy of liquid biomarkers for chronic obstructive pulmonary disease (COPD), asthma, laryngopharyngeal reflux (LPR), and COVID-19. Results Of 3,628 studies, 71 fulfilled the inclusion criteria. Sputum and blood eosinophils were the most frequently investigated biomarkers for the management of asthma and COPD. Salivary pepsin was the only biomarker with a well-documented accuracy for the diagnosis of LPR. Inflammatory blood biomarkers (e.g., CRP, D-dimers, ferritin) were found to be useful to predict the severity, complications, and mortality related to COVID-19 infection. Conclusion Multiple liquid biomarkers have well-established diagnostic accuracies and are thus amenable to POC testing in clinical settings.
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Affiliation(s)
- Vivianne Landry
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- School of Communication Sciences & Disorders, McGill University, Montreal, QC, Canada
| | - Patrick Coburn
- School of Communication Sciences & Disorders, McGill University, Montreal, QC, Canada
| | - Karen Kost
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Xinyu Liu
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Nicole Y. K. Li-Jessen
- School of Communication Sciences & Disorders, McGill University, Montreal, QC, Canada
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- *Correspondence: Nicole Y. K. Li-Jessen,
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Wertz A, Carroll LM, Zur KB. Pediatric laryngopharyngeal reflux: Perceptual, acoustic, and laryngeal findings. Int J Pediatr Otorhinolaryngol 2020; 133:109974. [PMID: 32197186 DOI: 10.1016/j.ijporl.2020.109974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/04/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Describe acoustic and laryngeal findings in pediatric patients with subjective dysphonia attributed to laryngopharyngeal reflux (LPR). Determine the impact of LPR on perceived voice quality using the pediatric Voice Handicap Index (pVHI). Compare these findings with age-matched normative values as well as data on pediatric patients with dysphonia due to other etiologies. METHODS Retrospective case series of pediatric patients (age 2-17 years) evaluated at a specialty pediatric voice clinic at a tertiary care children's hospital from January 1 2007 to December 31 2017 in whom LPR in whom LPR was deemed to be the most significant contributing factor for dysphonia based on physical examination and history. Patients with structural laryngeal abnormalities unrelated to LPR, such as raised lesions, stenosis, papillomatosis, or vocal fold immobility were excluded. RESULTS 163 out of 1195 evaluable patients met inclusion criteria. Of these, 87% had pVHI and 83% had acoustic data available from their first appointment for analysis. Mean total pVHI score was 24 (range: 0-81). Perturbation measures were elevated in both females (jitter 1.38%, shimmer 4.16%) and males (jitter 2.01%, shimmer 5.62%). Laryngologic assessment revealed: vocal fold changes including erythema and/or pre-nodules in 72% of patients. Cobblestoning of any portion of the pharynx was present in 67% with hypopharyngeal cobblestoning the most common, present in 64% of patients. CONCLUSION Pediatric patients with clinically diagnosed LPR have pVHI, jitter, and shimmer scores that are comparable to previously reported patients with raised lesions, scar and immobility, and values that are significantly higher than published normative data. Dysphonic children should be assessed for LPR and treated when indicated. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Aileen Wertz
- Department of Otolaryngology, Geisinger Medical Center, USA
| | - Linda M Carroll
- Division of Otolaryngology, Children's Hospital of Philadelphia, USA
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, USA; Department of Otolaryngology: Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, USA.
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Galluzzi F, Schindler A, Gaini RM, Garavello W. The assessment of children with suspected laryngopharyngeal reflux: An Otorhinolaringological perspective. Int J Pediatr Otorhinolaryngol 2015; 79:1613-9. [PMID: 26279249 DOI: 10.1016/j.ijporl.2015.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022]
Abstract
The assessment of pediatric laryngopharyngeal reflux (LPR) is controversial. Otorhinolaryngologists may play a role in the evaluation of children with suspected LPR detecting typical airway endoscopic findings and/or associated diseases and may help in the selection of children to be subjected to further instrumental tests. In this perspective the present review aims at examining the available evidence in the literature regarding the assessment of LPR in children. After careful literature search there are no current validated symptoms assessment questionnaires for LPR evaluation in children; flexible fiberoptic nasopharyngolaryngoscopy remains controversial as a diagnostic tool in suspect LPR cases; even though the multichannel intraluminal impedance with pH monitoring has been proposed as the instrumental gold standard, further evidence need to be found for validation in children with typical features of LPR.
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Affiliation(s)
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Renato Maria Gaini
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
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Yawn RJ, Acra S, Goudy SL, Flores R, Wootten CT. Eosinophilic Laryngitis in Children with Aerodigestive Dysfunction. Otolaryngol Head Neck Surg 2015; 153:124-9. [DOI: 10.1177/0194599815577568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/24/2015] [Indexed: 01/06/2023]
Abstract
Objective To describe the presence of laryngeal eosinophils and associated symptomatology in patients with aerodigestive dysfunction. Study Design Case series with chart review. Setting Single tertiary pediatric referral center. Subjects Eighty-one consecutive pediatric patients referred to a multidisciplinary aerodigestive clinic with upper airway concerns. Methods Microlaryngoscopy and posterior arytenoid biopsy, flexible bronchoscopy, esophagogastroduodenoscopy and esophageal biopsy, and impedance probe testing were performed as indicated by clinical symptoms. Positive versus negative posterior arytenoid biopsy for eosinophils and the presence or absence of concomitant histopathological laryngitis and/or esophagitis were measured. Results Nine of 81 (11%) patients had positive laryngeal biopsy for eosinophils (range, 1-29 eosinophils/high-powered field [HPF]). Three of these 9 patients also had concurrent biopsy-proven eosinophilic esophagitis, while 8 of 81 total patients had biopsy-proven eosinophilic esophagitis. The frequency of biopsy-proven eosinophilic esophagitis was higher in patients with posterior arytenoid eosinophils versus patients without laryngeal eosinophils (33% versus 6.9%, P = .0408). Conclusions Eosinophilic inflammation in the larynx has not been described in children with complex aerodigestive complaints. Posterior arytenoid eosinophils may serve as a marker of chronic laryngeal inflammation in children with aerodigestive dysfunction, although their exact role in this inflammation remains unclear. In our population, >15 eosinophils/HPF within posterior arytenoid biopsies was associated with concomitant eosinophilic esophagitis.
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Affiliation(s)
- Robert J. Yawn
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Sari Acra
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt Children’s Hospital, Nashville, Tennessee, USA
| | - Steven L. Goudy
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Raina Flores
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher T. Wootten
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
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Baudoin T, Kosec A, Cor IS, Zaja O. Clinical features and diagnostic reliability in paediatric laryngopharyngeal reflux. Int J Pediatr Otorhinolaryngol 2014; 78:1101-6. [PMID: 24833166 DOI: 10.1016/j.ijporl.2014.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to assess the validity of current diagnostic approaches in pediatric laryngopharyngeal reflux (PLPR). Clinical status findings and 24h double probe oesophageal pH monitoring results in children with suspected PLPR and/or GERD were analyzed and a clinically useful probability score was developed. METHODS This is a retrospective longitudinal cohort study including 89 pediatric patients who underwent preliminary oropharyngoscopy, and then nasal fibre optic laryngoscopy and ambulatory 24h oesophageal pH monitoring in a tertiary pediatric and otorhinolaryngology hospital center. The patients' parents gave written informed consent for diagnostic testing. Statistical analysis was performed using standard descriptive statistics. Associations between variables were assessed using Fisher's exact test, Mann-Whitney test and Kruskal-Wallis test for non-parametric paired samples. RESULTS Patients' age spanned 1-18 years with a median of 11.2. Out of the 89 patients, 56 were girls, and 33 were boys. All of the patients underwent nasal fibre optic laryngoscopy and 24h double probe pH monitoring. Out of 89 examined children, 50 had PLPR. Out of the 50 positive for PLPR, 46 had a positive clinical finding, with a sensitivity of 92% (95% CI: 80.75-97.73%) and specificity of 10.26% (95% CI: 2.93-24.24%). Boys have GERD significantly more often than girls (p<0.0001), and have a worse result of pH monitoring (p<0.0001). The most common finding was an injected and granulated oropharynx accompanied by posterior laryngitis (54/89). Patients with leading symptoms of asthma had significantly worse GERD scores (p=0.0493). The patients were then reassigned to newly developed risk categories and a significant correlation with a positive PLPR diagnosis was found (p=0.0262). CONCLUSIONS The significance of a thorough otorhinolaryngologic and paediatric examination and patient history taking is still paramount, with additional benefit in diagnosing the disease arising from 24h oesophageal pH monitoring in select patients. This study brings to light new relationships between clinical symptoms and objective findings and presents a novel attempt to classify the likelihood of diagnosis. Patient stratification could help clinicians in defining groups at high risk and support a timely, cost-effective and precise diagnostic evaluation and proper therapy.
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Affiliation(s)
- Tomislav Baudoin
- Department of Otorhinolarygology and Head and Neck Surgery, Clinical Hospital Centre Sestre milosrdnice, Zagreb University School of Medicine, Vinogradska cesta 29, Zagreb, Croatia.
| | - Andro Kosec
- Department of Otorhinolarygology and Head and Neck Surgery, Clinical Hospital Centre Sestre milosrdnice, Zagreb University School of Medicine, Vinogradska cesta 29, Zagreb, Croatia.
| | | | - Orjena Zaja
- Department of Pediatrics, Clinical Hospital Centre Sestre milosrdnice, Zagreb University School of Medicine, Vinogradska cesta 29, Zagreb, Croatia
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Figuerola Mulet J, Osona Rodriguez de Torres B. What can be expected from laryngoscopy in the study of laryngopharyngeal reflux? Allergol Immunopathol (Madr) 2012; 40:201-3. [PMID: 22682936 DOI: 10.1016/j.aller.2012.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 04/20/2012] [Indexed: 11/19/2022]
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