title: Otolaryngologists may not be doing enough to diagnose pediatric eosinophilic esophagitis.
abstract: OBJECTIVE
  To systematically evaluate the diagnosis of eosinophilic esophagitis (EE).
  
  
  METHODS
  A retrospective review of 657 patients seen at the EE center of a tertiary care children's hospital between 1994 and 2007 was performed. Charts were reviewed for the 144 patients who were also seen by the otolaryngology service.
  
  
  RESULTS
  One hundred forty-four patients received 193 otolaryngology-related diagnoses. Eustachian tube dysfunction (27.5%) and sleep disordered breathing (24.9%) were the most common, followed by dysphagia (13.0%), rhinosinusitis/nasal congestion (9.3%) and airway stenosis (5.2%). Seventy-nine patients (54.9%) had a pre-existing diagnosis of EE at the time of their otolaryngology consultation. Twenty-one patients (14.6%) were referred to the gastroenterology service for evaluation for EE. Forty-four patients (30.5%) remained undiagnosed. Twenty-five of these patients presented with dysphagia, 16 of whom were not previously diagnosed with EE; only 4 of these 16 patients were referred for evaluation for EE. In one case, a child with moderate sized tonsils underwent adenotonsillectomy for dysphagia and failure to thrive; this patient was diagnosed with EE 1 month post-operatively.
  
  
  CONCLUSIONS
  Twenty percent of patients with EE may require care by an otolaryngologist for a myriad of complaints. Even experienced pediatric otolaryngologists may not recognize this condition. Otolaryngologists should consider EE in patients presenting with dysphagia. A careful gastroenterology review of symptoms may also allow otolaryngologists to identify EE in patients with allergy mediated nasal complaints, or laryngeal/airway disorders.
authors.affiliation: Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.
authors.forename: Lee P
authors.initials: LP
authors.lastname: Smith
authors.forename: Linda
authors.initials: L
authors.lastname: Chewaproug
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
authors.forename: Karen B
authors.initials: KB
authors.lastname: Zur
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004802:Eosinophilia / Q000276:immunology*; D004941:Esophagitis / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010036:Otolaryngology; D012189:Retrospective Studies