Nasolaryngoscopic Findings.docx

1、Nasolaryngoscopic FindingsRelationship between Nasolaryngoscopic Findings and pH Probe Esophageal Monitoring in Children with Clinical Manifestations of Extra-esophageal RefluxAbstract:Introduction: The gastroesophageal reflux diagnosis, mainly in patients with atypical manifestations, has been rece

2、iving increasing importance. Objective: To relate the nasolaryngoscopic findings with prolonged pH probe esophageal monitoring in children with clinical manifestations of extra-esophageal reflux. Method: Transversal prospective clinical study, in which we evaluated 44 children from one to 12 years o

3、ld, of both genders, by means of nasolaryngoscopy. All were submitted to pH probe monitoring for research of hidden reflux due to cases of otitis, sinusitis, asthma, laryngitis and/or dysphonia in the last 12 months. Results: Out of 44 children, 15 (34%) presented with normal pH monitoring and 29 (6

4、6%) with altered monitoring. Out of 29 with altered pH monitoring, 19 (65.5%) were boys and 10 (34.5%) were girls. There was no statistically significant difference between gender and the positive results of pH monitoring, in spite of a discreet predominance of occurrence in the male population. All

5、 children had smaller adenoids than 75% of the cavity of concha aerial column. Six presented with purulent secretion in nasal cavity. Eight (18%) had nodes in vocal cords and five (11%) of whom had an altered pH monitoring and three (7%) of whom were normal. We found at least one alteration upon nas

6、olaryngoscopy in 80% of the 15 children with normal pH monitoring and in 89.7% of the 29 who had an altered pH monitoring. Conclusion: The prevalence of gastroesophageal reflux in children with recurrent respiratory and otorhinolaryngological affections was high. However, the data obtained didnt sho

7、w any statistically significant difference (p 14.72). We excluded from the study patients with aerodigestive congenital malformations or who were submitted to digestive system surgery, with airways acute infection, protein allergy from cow milk, who were using oral or inhaled corticosteroid, acid ga

8、stric secretion blockers, procinetic and anti-acids within 14 days before the otorhinolaryngological evaluation.The nasolaryngoscopy were carried out from January 2005 to April 2006 at Clnica Otomed BH. The children were placed sitting on their parents lap in the examination chair. The vasoconstrict

9、ion and nasal anesthesia were made minutes before the procedure (topical lidocaine at 2% and pediatric nasal neosinefrine spray). The endoscopies were carried out by using Machida optic fiber (3.2mm of diameter) and the images recorded in videocassette tapes (VHS) for further analysis. Today there i

10、s no single instrument that has been validated or that is widely used in academic or private contexts (36) and the posterior laryngitis findings are currently accepted as the most common laryngoscopic signals of reflux, based on international research among otorhinolaryngologists (37). The parameter

11、s considered in the nasolaryngoscopic evaluation were:a) presence or absence of purulent secretion in nasal cavity;b) adenoids volume; c) presence or absence of interarytenoid mucosa edema;d) presence or absence of retrocricoid region edema;e) presence or absence of nodes in PPVV.The data collected

12、form individual evaluation protocols were performed using SPSS 11.0.1. For the analyses we considered the patients who had normal pH monitoring (negative) and altered (positive). The hypotheses tested considered p0.05). Out of the 44 children six presented with purulent secretion in nasal cavity. In

13、 Table 1 we may note the distribution of the adenoid volumes. The frequency distributions of presence or absence of edema of the interarytenoid, retrocricoid regions and nodes in PPVV in view of the pH monitoring procedures are shown in Tables 2, 3 and 4.+There was no statistically significant diffe

14、rence (p0.05) as for the parameters evaluated in the nasolaryngoscopy procedures between groups of children with normal and altered pH monitoring results. In the analysis we found at least one sign of posterior laryngitis upon nasolaryngoscopy in 15 (80.0%) children who had normal pH monitoring resu

15、lt and in 29 (89.7%) with altered result.DISCUSSIONIs spite GER is a frequent and generally benignant condition in the childhood, it may relate to several respiratory affections; therefore, the awareness of the several forms of presentation of the extra-esophageal manifestations, associated with a g

16、ood clinical history is very important for a GER diagnosis.In the literature, the most frequently symptoms and affections presented by the children with hidden GER are: crises of asthma, apnea, laryngeal stridor, chronic cough, sinusitis, otitis and recurrent pneumonias etc. (3, 5, 21). Which differ

17、s from the most frequently presented by the adults that are: sensation of globus pharyngeus, chronic cough, hoarseness, persistent raucousness, thoracic pain etc. (22, 23).The GER prevalence of 66.0% in the population studied was very significant, despite the lack of definitive laryngoscopic finding

18、s. In fact, other studies in the literature (24, 25, 26) found similar data. In addition, no matter the direction of the relationship between GER and respiratory affections, non-treated GER has many potential complications (24, 25, 26). A Brazilian study (27) involving adults found a prevalence of 1

19、2.0% of GER among those who presented with typical symptoms of heartburn twice a week. However, this study didnt take into account the atypical manifestations, which, would probably raise such figures.The pH monitoring of the studied patients was carried out by using only a distal sensor. Some authors considered the use