title: Objective endoscopic findings in patients with recurrent croup: 10-year retrospective analysis.
abstract: OBJECTIVE
  (1) To determine the incidence and severity of subglottic stenosis on endoscopic evaluation in a pediatric population of patients with recurrent croup. (2) To determine the incidence of abnormal findings on bronchoalveolar lavage and esophageal biopsy in a pediatric population with recurrent croup.
  
  
  METHODS
  Case series with historical chart review of clinical data for pediatric patients (age ≤18 years) at a tertiary care children's hospital who underwent endoscopic evaluation of the upper aerodigestive tract with a diagnosis of recurrent croup over a ten-year period (2002-2012). Subglottic stenosis was graded on Myer-Cotton scale. Lipid-laden macrophages on bronchoalveolar lavage were noted as none/small/moderate/large with evidence of reflux noted as moderate or large. Esophageal biopsy specimens were evaluated for evidence of esophagitis. Data is expressed as mean±SEM.
  
  
  RESULTS
  1825 charts were reviewed of which 197 met inclusion criteria. Mean age at endoscopy was 53±3 months. Subglottic stenosis was noted in 41 patients (20.8%) with 95.1% being mild or Grade I. Abnormal findings on bronchoalveolar lavage were noted on 9.5% of bronchoalveolar lavage specimens. Abnormal esophageal biopsies were noted on 19.9% of specimens. Esophagitis was noted on 8.8% of biopsy specimens.
  
  
  CONCLUSIONS
  Subglottic stenosis is a risk factor for recurrent croup. Evidence suggestive of reflux may be noted on bronchoalveolar lavage or esophageal biopsy, but these findings may not correlate with subglottic stenosis in recurrent croup patients.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street-5 Ravdin, Philadelphia, PA 19104, United States. Electronic address: benjamin.hodnett@uphs.upenn.edu.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Hodnett
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh-UPMC, Suite 7119, 4401 Penn Avenue, Faculty Pavilion, 7th Floor, Pittsburgh, PA 15224, United States. Electronic address: jeffrey.simons@chp.edu.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Simons
authors.affiliation: Department of General Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, TN 37232-2730, United States. Electronic address: katherine.m.riera@vanderbilt.edu.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Riera
authors.affiliation: Department of Surgery, Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 640, Houston, TX 77030, United States. Electronic address: dkmehta@texaschildrens.org.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Mehta
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh-UPMC, Suite 7121, 4401 Penn Avenue, Faculty Pavilion, 7th Floor, Pittsburgh, PA 15224, United States. Electronic address: maguirer2@upmc.edu.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Maguire
mesh_terms: D000293:Adolescent; D001706:Biopsy; D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000175:diagnosis* / Q000209:etiology; D004724:Endoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D015994:Incidence; D007223:Infant; D007829:Laryngostenosis / Q000150:complications / Q000175:diagnosis; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Bronchoscopy; Esophagoscopy; GERD; LPR; Recurrent croup; Subglottic stenosis