Lack of Association Between Esophageal Biopsy, Bronchoalveolar Lavage, and Endoscopy Findings in Hoarse Children

Abstract

To determine the prevalence of esophagitis (based on esophageal biopsy results) and aspiration (based on bronchoalveolar lavage [BAL]) in children with hoarseness. Design: Retrospective medical chart review spanning 24 months of 127 consecutive children (mean age, 6.9 years; range, 1.8-17 years) who presented with hoarseness to 2 attending otolaryngologists. Setting: Tertiary care children's hospital. Intervention: All subjects underwent direct laryngoscopy, rigid bronchoscopy with BAL, and rigid or flexible esophagoscopy with biopsy. Main Outcome Measures: The BAL result was considered positive if the number of lipid-laden macrophages was "moderate" or "large," and the esophageal biopsy result was considered positive if any 2 of the following 3 histologic criteria were present: basal cell hyperplasia, increased papillary height, and intraepithelial inflammatory infiltrate. Comparisons between subjective endoscopic findings and objective test results were made using the t test and contingency table analysis, where appropriate. Results: Of the 127 children, 104 (82%) had vocal nodules; 53 (43%) had endoscopically visualized laryngitis; 36 (28%) had tracheobronchial inflammatory changes; 60 (47%) had abnormal esophagoscopy findings; 47 (37%) had a positive BAL result; and 38 (30%) had a positive esophageal biopsy result. There was no significant correlation between BAL and esophageal biopsy results (P =.11). The odds of having positive BAL or esophageal biopsy results were unaffected by the presence of vocal nodules; endoscopically visualized inflammation of the larynx, trachea, or esophagus; or symptoms or previous clinical history of gastroesophageal reflux disease. Conclusion: Positive esophageal biopsy and BAL results are prevalent among children with hoarseness, regardless of subjective upper aerodigestive tract endoscopic findings.

Management of dysphonia in children

“…Accordingly, we encounter a number of children in whom dysphonia coexists with airway problems or is a consequence of surgery. However, regardless of the study population, voice abuse is the commonest reason for children to have a hoarse voice, as seen in our series and those reported by others 6 , 8 …”

Comparison of Pediatric Voice Outcome Survey, Reflux Symptom Index, Reflux Finding Score, and Esophageal Biopsy Results

“…7 However, our group has previously failed to find any correlation between the endoscopic appearance of the pediatric larynx and the presence of esophagitis, thus highlighting the controversy regarding this topic. 8 In the present study, we found that in our pediatric population the RFS did not correlate with the PVOS scores, the RSI scores, or the esophageal biopsy results. In adults, the relationship between reflux symptoms and laryngeal findings also is unclear.…”

The Occurrence of Laryngeal Pathologies in a Treatment-Seeking Pediatric Population

“…23,56,58,59 Secondly, the proportion of vocal fold cysts in this study group was only 1.0%. Previous studies observed inconsistent results on the occurrence of pediatric vocal fold cysts, ranging from 0% 36,44,[48][49][50]53 to more than 25%. 23,51 Thirdly, no vocal fold polyps were identified in this study group.…”