Relação entre achados videonasolaringoscópicos e ph-metria esofágica de 24 horas em crianças com manifestações clínicas de refluxo extra-esofágico

Abstract

INTRODUCTION: gastroesophageal reflux is considered contributing factor on otolaryngology and respiratory diseases, mainly in children, that are not responsive to the usual therapies. The aim of this study was to compare the results of the flexible nasopharyngolaryngoscope with conventional 24hours esophageal pH probe monitoring of children with respiratory and otolaryngology manifestations of extraesophageal reflux.PATIENTS and METHODS: were studied 44 patients with ages between one and 12 years old, that had presented three or more otites media, laryngeal disorders, sinusitis, asthma in the last 12 months, without other diseases. The evaluation had followed individual protocol contend information about the main complaint, found to the fiber-optic nasopharyngolaryngoscopy and result of the pH-metries. The imagesconfigurations of the recorded video had been analyzed by the researcher and, later, for two other independent examiners, without correlation with clinical history and pHmetries results. To evaluate interobserver reliability assessment, the Kappa Statistics was determined. RESULTS: amongst 44 children, 15 (34,0%) had negative pH-monitoring and 29 (66,0%) positive pH-monitoring, being that 28 (64,0%) were male and 16 (36,0%)female. In relation to the sex, it was observed that amongst the 29 children with positive pH-monitoring, 19 (67,9%) were boys and 10 (62,5%) were girls. Sex distribution between groups was compared with Fishers exact probability test (p>0,05) and no statistically significant difference was found between group, although find a small predominance of occurrence in the male population. There was a highreproductibility interobserver in the nasopharyngolaryngoscope findings (KAPPA >0,70). Six children had purulent mucus in nasal cavity, probably associated with inflammatory sinusal process. In all children, the adenoids occupied less than 75,0% of the aerial column of nasopharynx. Amongst 44 children eight (18,0%) presented vocal cord nodules; five (11,0%) of them with positive pH-monitoring and three (7,0%) with negative pH-monitoring. The relation with the presence of posteriorlaryngitis (interarytenoideo edema/retrocricoídeo edema) and granulations in pharyngeal mucosa was not observed with the pH-metries. In the evaluated casuistry, the presence of signals of posterior laryngitis was found in 80,0% of the children with negative pH-monitoring and in 89,7% of the children with positive pHmonitoring.CONCLUSIONS: the result of the present study alert for the considerable prevalence of the gastroesophageal reflux disease in patients with recurrent respiratory e otolaryngology disorders. However, the gotten data had not demonstrated statistically significant difference (p> 0,05) about posterior laryngitis fiber optic findings associated or not with gastroesophageal reflux, proven for 24 hour esophageal pHmonitoring.Therefore, it was not possible to demonstrate, in the studied population,the relation between the pathological acid gastroesophageal reflux and alterations on the flexible nasopharyngolaryngoscopy. Key Words: children; recurrent respiratory and otolaryngology infections; gastroesophageal reflux disease; pH-monitoring; flexible nasopharyngolaryngoscope.