Objective: To correlate direct laryngoscopic and bronchoscopic findings with the presence of positive test results for gastroesophageal reflux disease (GERD) in children.Design: Prospective collection of structured data.Setting: An academic pediatric otolaryngology department.Patients: Seventy-seven consecutive patients who underwent direct laryngoscopy and bronchoscopy between June and October 1999.Interventions: During direct laryngoscopy and bronchoscopy, descriptions of 7 laryngeal and 6 cricotracheal findings were recorded on a 3-point scale tie, absent, mild, or severe). Medical records were later reviewed to obtain results of the following tests, if they were part of the record: gastric scintiscan, 24-hour pH probe monitoring, upper gastrointestinal tract series, and esophageal biopsy.Main Outcome Measures: Correlation of mucosal abnormalities with the presence or absence of a positive test result for GERD.Results: Fifty (65%) of 77 patients had GERD diagnosed with at least 1 positive test result, 21 (27%) had no clinical symptoms and no positive GERD test results, and 5 (7%) had clinical symptoms but no positive test results. There were significant differences for total laryngeal and cricotracheal scores (P<.001) between the groups with positive and negative results. Significant differences were as follows: in the larynx-large lingual tonsil(P<.001), postglottic edema (P<.001), arytenoid edema (P<.001), ventricle obliteration (P=.03), and true vocal fold edema (P=.001), and in the cricotracheal region-general edema and erythema (P=.003) and blunting of the carina (P<.001). Severe arytenoid edema, postglottic edema, or enlargement of lingual tonsil were pathognomonic of GERD.Conclusion: Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.

Effective management of voice disorders in children requires an understanding of the anatomy and physiology of the pediatric vocal tract. The evaluation of children with disorders of phonation or resonance involves a unique interdisciplinary approach. This article reviews many of the common causes of dysphonia in infants and children. The role of underlying conditions, such as viz, extraesophageal reflux disease, allergy, and sinusitis, as predispositioning factors, is explored. The comprehensive evaluation and management of children with disorders of nasal resonance is outlined.

Background: Morbidity following tonsillectomy continues to be a major concern to parents, children, and physicians alike. Reduction in post-operative complications, optimal control of pain, and satisfactory return to a normal lifestyle are all important to both family and society. This study compares both the complication and recovery rates after microbipolar dissection (MBPD) technique of tonsillectomy to two well established tonsillectomy techniques: hot knife (HK) and cold knife/cautery (CK/C). Methods: A total of 200 consecutive patients presenting for tonsillectomy by the first author (MP) were randomized to either undergo MBPD or HK tonsillectomy. Concurrently, an additional two hundred patients were randomized to undergo MBPD or CK/C tonsillectomy by the second author (LB). Patients were prospectively followed for complications including bleeding and dehydration and multiple indicators of recovery rate. Results: Postoperative bleeding of any kind was significantly less in the MBPD group than in the CK/C and HK groups (5 vs 12.4 vs 12.5% (P < 0.001). The need for post-operative intervention for bleeding, i.e. local control or return to the operating room, was also significantly less in the MBPD group. Return to normal activity occurred 2 days earlier in the MBPD group versus either CK/C or HK (P < 0.001). Additionally, earlier recovery was reflected in fewer total doses of pain medication in the MBPD group. Operative time was 3-5 min longer for MBPD (24.2 min) than for CK/C or HK (21.1 and 16.5 min, respectively); blood loss was similar (within 15 cc) among all treatment groups. Conclusion: MBPD tonsillectomy compared most favorably to conventional techniques (CK/C and to HK tonsillectomy). Important clinical outcome differences included a lower bleed rate, earlier recovery and fewer days lost from work and school. The financial impact is estimated to be quite favorable. MBPD tonsillectomy is now our preferred method in children. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

This article outlines the perioperative and long-term management of children undergoing tonsillectomy, adenoidectomy, tympanostomy with tube insertion, and sinus surgery. Indications for complications of each of the procedures is reviewed in this article. The authors also cover the management of children with tracheostomies. Several questions frequently asked by parents of children with a tracheostomy are addressed.