Pediatric Swallowing, Laryngopharyngeal and Gastroesophageal Reflux Disease, Eosinophilic Esophagitis, and Aspiration

The ubiquitous symptoms of cough, hoarseness, and dysphagia make the diagnosis and management of these patient complaints an almost circuitous challenge. Gastroesophageal reflux, oropharyngeal discoordination, and eosinophilic esophagitis (EoE) are sometimes but not always the cause of these symptoms. The otolaryngologist should understand the concepts that surround laryngeal disease as a manifestation of gastroesophageal reflux disease (GERD). Treatment of these complex patients requires evaluation and management coordinated across multiple disciplines that should focus on the most relevant of the numerous possible etiologies. To add to this challenge, current data are limited and can sometimes be conflicting. Thus the managing surgeon should have a broad base of understanding of the normal physiology of swallowing, an appreciation of the rationale and limitations of available tests, and finally an open mind to recognizing the limitations of current evidence. This chapter reviews the physiology and evaluation of swallowing, the laryngeal manifestations of GERD/EoE, the evaluation and testing of GERD/EoE, and the current management of dysphagia and esophageal disorders.