This is a guest article by pediatric ENT specialist Dr. Russell A. Faust, who blogs at Ask the Boogor Doctor.
We adults with reflux know it as heartburn. Other symptoms include burping and sour taste. That sour taste is regurgitation of stomach contents to the back of the throat (yuk!).
It’s called gastro-esophageal reflux (GER), and more than 135 Million, or about 44% of Americans, have reflux at least every month.
Babies, Infants, Children
We know reflux in babies and infants as “spitting up,” and we can all recognize the spitty baby from the white curds on their chin.
Most of these babies will outgrow their reflux without harm, and without intervention. Most will never have symptoms.
A small minority of infants and children with reflux will experience symptoms. Symptoms of reflux in children can be stealthy. They almost never complain of heartburn. The symptoms that they experience are usually indirect – they cough, wheeze, have chronic throat-clearing, recurrent bronchitis, or chronic sinusitis.
This is when simple GER becomes GER Disease, or GERD.
What I wanted to review here today is a connection that does not seem intuitive – that between reflux and sinusitis.
How in the World Can Reflux Cause Sinusitis?
Similar to the link between reflux and ear infections, there are two schools of thought on this connection:
- The first is based on a theory called the Unified Airway Model. This theory states that, because the upper aero-digestive tract is derived of the same lining, any inflammation occurring anywhere in that tract will stimulate the other areas also. Simply put, otitis can cause sinusitis, can cause asthma, etc. There is pretty good scientific support for this theory.
- The second thought it that if reflux reaches the back of the throat and lining of the nose, the resulting inflammation and swelling can cause sinusitis. There is pretty good scientific support for this theory too: studies have found gastric enzymes inside the middle ears (in cases of chronic otitis), or inside the sinuses (in cases of chronic sinusitis). This is pretty direct evidence that gastric contents has been regurgitated up to that level of the upper airway (not a pretty thought).
What is the Clinical Evidence for a Connection?
A study reported in 1999 (Bothwell) found that 89% of their pediatric candidates for sinus surgery were able to avoid surgery simply by treating for reflux. 89% avoided surgery!!
A study published one year later (Phipps) reported that 63% of children with chronic sinus disease had reflux, and that sinusitis improved in 79% of them when their reflux was treated.
That same year (2000), another group (Yellon) reported an even stronger correlation between reflux esophagitis and sinusitis: When they looked at the esophagus (food swallowing tube leading to the stomach) they found inflammation of the esophagus (esophagitis) in 100% of the children with sinusitis. That is, in their study every child with sinusitis had reflux esophagitis.
These correlations do not prove that reflux causes these symptoms, but there is strong implication.
What Can You Do With This Information?
Other symptoms to raise suspicion for GERD include:
- Cough, worse at night
- Wheezing, worse at night
- Choking at night
- Stomach ache, worse in the morning
- Chronic throat-clearing, worse in the morning
- Recurrent bronchitis
- Recurrent and chronic sinusitis
- Failure to thrive (difficulty gaining weight)
If your little monkey has chronic sinusitis, or any of these other symptoms, reflux should be considered as a contributing factor. Improving, or even eliminating, the symptoms might simply be a matter of treating the reflux. It still amazes me that I “cure” asthma or sinusitis in my clinic when I recognize reflux as the major causative actor and treat it.
Ask your pediatrician or pediatric boogor doctor about it.
Finally, Jan Gambino’s book, Reflux 101, is a great place to start if you have questions reflux in your infant or child, and what you can to do about it.
Next month I am reviewing how we test for reflux, and treatment options for reflux (conventional and alternative), and I invite y’all to come visit.
- Nelson, Chen, Syniar, Christoffel. Prevalence of symptoms of gastroesophageal reflux in infancy. Archives of Pediatric and Adolescent Medicine 151: 569-72; 1997.
- Stroh BC, Faust RA, Rimell FL: Results of Esophageal Biopsies Performed During Triple Endoscopy in the Pediatric Patient. Archives of Otolaryngology – Head and Neck Surgery, 124: 545-549; 1998.
- Bothwell M, Parsons D, Talbot R, Barbero G, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngology-Head and Neck Surgery. Vol. 121(3): 255-262; 1999.
- Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children. Archives of Otolaryngology-Head and Neck Surgery. Vol. 126: 831-836; 2000.
- Yellon RF, Coticchia J, Dixit S. Esophageal biopsy for the diagnosis of gastroesophgeal reflux-associated otolaryngologic problems in children. American Journal of Medicine. Vol. 108: 131s-138s; 2000.