TL;DR: It is suggested that GER plays a causative role in subglottic stenosis, recurrent croup, apnea, and chronic cough and is an important inflammatory cofactor in laryngoma-lacia and possibly in true vocal cord nodules and problematic recurrent choanal stenosis.
Abstract: Gastroesophageal reflux (GER) into the laryngopharynx causes or contributes significantly to a variety of upper respiratory problems in children. The pH probe, laryngeal examinations, and broncholveolar lavage results for children with subglottic stenosis, recurrent croup, apnea, chronic cough, laryngomalacia, recurrent choanal stenosis, vocal fold nodules, and chronic sinusitis/otitis/bronchitis were reviewed in an effort to quantify the role of GER in each of these disorders. This review suggests that GER plays a causative role in subglottic stenosis, recurrent croup, apnea, and chronic cough. It is an important inflammatory cofactor in laryngomalacia and possibly in true vocal cord nodules and problematic recurrent choanal stenosis. GER is also an important inflammatory cofactor in chronic sinusitis/otitis/bronchitis but may be the result of chronic illness in the older patients.
TL;DR: The group of children with a history of recurrent croup could be distinguished from the group with one or two episodes by male predominance, onset of the disease at a younger age, familial predisposition, a significantly greater association with allergy and airways hyper-reactivity, slightly lower expiratory flow rates in pulmonary function tests, and a tendency towards the subsequent development of asthma.
Abstract: One hundred and ten children were studied 9 years after each had been in hospital for croup. They were evaluated with a questionnaire, physical examination, allergy skin testing, pulmonary function tests, and a histamine inhalation challenge. Fifty-seven of them had recurrent episodes of croup, and 33 were defined as allergic. The association between allergy and recurrent croup was highly significant. Airways hyper-reactivity was found in 23 of them, and was associated with allergy and recurrent croup. The group of children with a history of recurrent croup could be distinguished from the group with one or two episodes by male predominance, onset of the disease at a younger age, familial predisposition, a significantly greater association with allergy and airways hyper-reactivity, slightly lower expiratory flow rates in pulmonary function tests, and a tendency towards the subsequent development of asthma.
TL;DR: The literature regarding the effects of gastroesophageal reflux disease (GERD) on otolaryngologic disorders in infants and children is reviewed and studies that suggest how GERD may be associated with sinusitis, cough, laryngitis, airway obstruction, apnea and recurrent croup in children are focused on.
TL;DR: Children with recurrent croup as well as those with asthma showed a significantly greater fall in maximal expiratory flow rates than that shown in healthy control subjects.
Abstract: Seventeen children with recurrent croup, who had their last episode within the previous 12 months, were evaluated clinically by allergy skin tests, pulmonary function tests, and a histamine inhalation challenge. Fourteen showed airway hyperreactivity. Flow-volume loops were obtained after a positive histamine response and compared with post histamine tracings of children with asthma and healthy control subjects. Children with recurrent croup as well as those with asthma showed a significantly greater fall in maximal expiratory flow rates than that shown in healthy control subjects. Those with recurrent croup also had a significantly greater fall in maximal inspiratory flow rates when compared to those with asthma and to the control subjects. A specific type of airway hyperreactivity suggestive of involvement of both upper and lower respiratory tract was seen in children with recurrent croup.
TL;DR: History suggestive of recurrent croup requires close monitoring and expedient direct laryngoscopy/bronchoscopy for diagnosis and long-term follow-up and antireflux treatment are necessary as well as endoscopic documentation of significant reflux resolution.