Gastroesophageal Reflux Contributing to Chronic Sinus Disease in Children

Abstract

GASTROESOPHAGEAL reflux (GER) has been implicated as a contributing factor in the pathogenesis of many pulmonary and otolaryngological disorders. Gastroesophageal reflux has been associated with reactive airway disease, otalgia, stridor, pharyngitis, laryngitis, cricopharyngeal spasm, chronic cough, rhinitis, contact ulcerations, pneumonia, and others.1-6 Historically, most associations have focused on laryngeal and lower airway disease. More recently, however, attention has been directed toward relationships between GER and upper airway disease. Contencin and Narcy3 demonstrated a relationship between reflux into the nasopharynx and chronic rhinopharyngitis. Conley et al7 demonstrated the association of GER with certain upper airway obstructive disorders. Implication in these disorders has fostered speculation that GER plays a role in other upper airway maladies such as chronic sinus disease (CSD). If GER were shown to play a significant contributory role in CSD, it might change the way these children are evaluated and treated. Treatment of GER in children with medically refractory CSD might reduce disease burden, improve quality of life, avoid prolonged antibiotic therapy, and obviate the need for sinus surgery. Because of the potential risks associated with sinus surgery, which is rarely curative, and unknown effects on facial growth and development, the consensus is that all medical treatment options should be exhausted before considering elective sinus surgery in children.