Synchronous airway lesions and esophagitis in young patients undergoing adenoidectomy.

Objective: To determine the prevalence of synchronous airway lesions and esophagitis in children younger than 18 months undergoing adenoidectomy for adenoid hypertrophy and upper airway obstruction.

Design: Retrospective review spanning 4.5 years.

Setting: Tertiary care children's hospital.

Patients: All children younger than 18 months who underwent adenoidectomy for upper airway obstruction by 2 pediatric otolaryngologists.

Exclusion Criteria: craniofacial dysmorphism and congenital syndromes.

Interventions: Simultaneous interventions during adenoidectomy included flexible nasopharyngolaryngoscopy (n = 32), direct laryngoscopy (n = 31), rigid tracheobronchoscopy (n = 30), and esophagoscopy with biopsy (n = 32).

Main Outcome Measures: Prevalence of synchronous airway lesions and histologic esophagitis.

Results: Thirty-five children younger than 18 months underwent adenoidectomy for airway obstruction (2 also had simultaneous tonsillectomy). Synchronous airway lesions were found in 19 (59%) of 32 patients who underwent airway endoscopy, including laryngeal edema (n = 9), laryngomalacia (n = 8), tracheal vascular compression (n = 4), subglottic stenosis (n = 4), midmembranous vocal fold lesions (n = 3), bronchial stenosis (n = 1), and true vocal fold immobility (n = 1). Among 32 patients who underwent esophageal biopsy, histologic evidence of gastroesophageal reflux disease was found in 10 patients (31%), and eosinophilic esophagitis was found in 4 patients (13%). Overall prevalence of any synchronous finding (airway and/or esophagus) was 27 (77%) of 35.

Conclusions: Synchronous airway lesions and esophagitis (both gastroesophageal reflux disease and eosinophilic esophagitis) were prevalent among children younger than 18 months undergoing adenoidectomy for adenoid hypertrophy and upper airway obstruction. The presence of these findings argues for consideration of endoscopy during adenoidectomy for very young children.