Incidence and Grading of Subglottic Stenosis and Associated GERD/LPR in Recurrent Croup

Abstract

Objectives:

(1) Determine incidence/grading of subglottic stenosis on endoscopic evaluation in recurrent croup. (2) Determine incidence of reflux on bronchoalveolar lavage (BAL) and esophageal biopsy (EBx) in pediatric population of recurrent croup.

Methods:

A retrospective chart review was conducted of pediatric patients (age ≤ 18 years) who underwent endoscopic evaluation with a diagnosis of recurrent croup over a 10-year period (2002-2012). A total of 1825 charts were reviewed, of which 269 were identified for inclusion, with preliminary results completed for the first 80 patients. Endoscopic findings, BAL cytology results, and EBx pathology were collected. Subglottic stenosis (SGS) was graded on Myer-Cotton scale. Lipid-laden macrophages (LLM) on BAL were noted as none/small/moderate/large with evidence of reflux noted as moderate or large. Bx specimens were evaluated for evidence of reflux esophagitis.

Results:

Mean age at endoscopy was 56 ± 5 months. SGS was noted in 19 of 80 patients (24%) and all were grade I. Moderate-large LLM were noted on 0 out of 14 BAL in SGS group. Moderate-large LLM were noted on 5 out of 48 BAL (10%) in non-SGS group. Evidence of reflux was noted on 6 out of 19 (32%) EBx in SGS group. Evidence of reflux was noted on 5 out of 57 (9%) EBx in non-SGS group. There was no difference between the groups on preliminary data analysis (LLM P = .58, EBx P = .07).

Conclusions:

Recurrent croup is a risk factor for subglottic stenosis. Evidence of reflux may be noted on BAL or esophageal biopsy but this may not correlate with SGS in recurrent croup patients.