P110

OtolaryngologyHead and Neck Surgery 145(2S)

Pediatric Otolaryngology
Laryngomalacia and Acid Reflux:
A Systematic Review
Trevor Hartl (presenter);
Neil K. Chadha, MBChB, MRCS, MSc

ORAL PRESENTATIONS

Objective: Laryngomalacia is widely described as having an

association with acid reflux. Many otolaryngologists therefore
employ empiric treatment with anti-reflux medication in this
setting. This study aims to identify and appraise the evidence
for this association, and to explore the potential role for treatment of reflux in the management of laryngomalacia.
Method: A predefined protocol was employed to search Medline, EMBASE, the Cochrane Library, and Google Scholar.
Included studies were those that explored the potential for an
association between laryngomalacia and gastro-esophageal
and/or laryngopharyngeal reflux. The Oxford Centre for Evidence Based Medicine (CEBM) guidelines were applied to
assess study quality of evidence.
Results: A total of 26 studies, representing 1295 neonates with
laryngomalacia, were included. Study quality varied from CEBM
2a (n = 3 to 4 (n = 20). No randomized controlled trials were
identified. While reflux definitions were diverse, overall reflux
prevalence in this group was 59%. Evidence supporting an association between reflux and laryngomalacia included: the near
ubiquity of acid reflux in dual-probe pH monitoring in children
with laryngomalacia (3 studies); case series and reports of laryngomalacia improvement with anti-reflux therapy (5 studies); histologic evidence of reflux-related laryngeal inflammation in children with laryngomalacia (2 studies); and implication of reflux as
a cofactor in laryngomalacia symptom severity (12 studies).
Conclusion: The literature shows a co-existence between acid
reflux and laryngomalacia, but the evidence for causal association is limited. In view of the widespread use of anti-reflux
treatment in laryngomalacia, an RCT of anti-reflux medication vs placebo appears well-justified. This review provides a
rational foundation for such an endeavor.

Pediatric Otolaryngology
Long-Term Quality of Life
Outcomes in Children Undergoing
Adenotonsillectomy for Obstructive
Sleep Apnea
Premjit Singh Randhawa (presenter); Geoffrey
Chilvers; Raul Cetto; Antony A. P. Narula, MA, FRCS
Objective: Assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years postsurgery
for continued and long-term improvement in quality of life
using the Child Health Questionnaire Physical Function version 28. We also sought to compare this group of children to a
healthy United Kingdom population.

Method: A telephone survey was carried out using the CHQPF28 questionnaire and administered to the primary care giver
of 37 patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years after initial surgery at our university
hospital tertiary referral center.
Results: A total of 33 patients (89.1%) from our initial cohort
were contacted. The mean age was 10.6 years (median, 11
years range, 5-16 years). The mean scores from our follow-up
study show improvements in 5 subscales and were statistically
significant in 2 subscales (role limitations P < .00001; bodily
pain P < .002) when compared to values obtained 3 months
postoperatively. The 4-year follow-up scores showed further
improvement in 5 subscales when compared with a healthy
population. All subscales of the CHQ-PF28 improved in the
long term when compared to scores preoperatively.
Conclusion: Quality of life data are an important measure when
deciding on a particular intervention. In the short term quality
of life measures have been shown to improve. Our study demonstrates that the benefits of surgery are still persistent, and
the children continue to improve in the long term.

Pediatric Otolaryngology
Management of Obstructive Sleep
Apnea in Children with Cerebral Palsy
Patrick D. Munson, MD (presenter); Andrew Dunham;
Charles M. Bower, MD; Gresham T. Richter, MD;
Larry D. Hartzell, MD; Ryan Guillory, MD
Objective: 1) Determine the efficacy of combined surgical techniques for improving obstructive sleep apnea (OSA) in pediatric patients with cerebral palsy (CP). 2) Evaluate the addition
of tongue base suspension for children with CP that have moderate to severe OSA.
Method: Seven-year retrospective chart review of 14 children
with CP undergoing surgical management of OSA, including
adenotonsillectomy (T&A) and uvulopalatopharyngoplasty
(UPPP), with or without tongue base suspension (TBS). Response
to treatment was determined by its impact on PSG parameters:
apnea/hypopnea index (AHI) and arousal index (AI).
Results: Children with CP who received TBS had a mean preoperative AHI of 27.2 compared with an AHI of 6.8 in the
group that underwent only T&A and UPPP (non-TBS). AHI
decreased by a mean of 16.5 (TBS) vs 5.0 (non-TBS); (P value
.03 vs 04). AI also improved in both groups (33.1 to 20.7 and
11.0 to 5.8); (P value .05 vs 10). Hospital length of stay was
slightly longer for the TBS groups than the non-TBS groups
(mean 9.3 days and 6.6 days) but was not statistically significant (P = .09). Average length of follow-up was 52 months
with no surgical complications.
Conclusion: Combined surgical therapy improves OSA in children with CP. Children with CP and moderate to severe OSA
(AHI>15) may safely benefit from the addition of tongue base
suspension to T&A and UPPP to maximize treatment.

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