Gastroesophageal reflux association with laryngomalacia: a prospective study.
Giannoni C. Sulek M. Friedman EM. Duncan NO 3rd.
Department of Otolaryngology, University of Florida, Gainsville 32610, USA.
OBJECTIVE: To identify the incidence and clinical role of gastroesophageal reflux (GER) in patients with laryngomalacia. DESIGN: Prospective evaluation of consecutive infants with a new diagnosis of laryngomalacia with an initial questionnaire, a barium esophagram or 24 h pH probe and record of their subsequent clinical course. SETTING: A large, tertiary pediatric referral center and its associated outpatient clinic. PATIENTS: New diagnosis of laryngomalacia in 33 consecutive infants were evaluated by questionnaire and 27 of these were evaluated for GER. RESULTS: GER was observed in 64% of patients and was significantly associated with severe symptoms and complicated clinical course (P = 0.0163). The presence of smokers in the infant's household negatively impacted his or her clinical course and symptomatology (P = 0.013) as did the presence of other major, concurrent medical problems (P = 0.065). CONCLUSIONS: In patients with laryngomalacia, GER was significantly associated with severe symptoms (a complicated clinical course), as was smoking in an infant's household and other significant medical problems.
Middle ear disease in cystic fibrosis.
Jorissen M. De Boeck K. Feenstra L.
E.N.T. Department, University Hospital Leuven, Belgium. Mark.Jorissen@uz.kuleuven.ac.be
A prospective cross-sectional study was done to investigate the involvement of middle ear disease in cystic fibrosis. Eighty-eight patients with cystic fibrosis, aged 1-28 years, were examined during the winter period 1995-1996 at regular follow-up visits to detect history and prevalence of inflammatory and infectious middle ear disease by questionnaire, otoscopy and tympanometry. One third of the patients had a history of otitis media, but only in 9% did this occur more than once. Hearing problems were recorded in 8%, but this was severe in only one case. Otoscopy showed 141 normal tympanic membranes, 17 times retraction, 15 times otitis media with effusion, once an acute otitis media in both ears. Only one patient had a grommet in one ear. More than 70% of the tympanograms were normal. A flat curve, type B according to Jerger's classification, was found in 11 ears. The youngest age group had a higher prevalence of abnormal findings on otoscopy and tympanometry, while patients who had undergone paranasal sinus surgery had less frequently abnormal findings. In conclusion, no evidence that cystic fibrosis is associated with increased prevalence of middle ear disease has been found in this prospective cross-sectional study.