Abdullah Sindi
27/Mar/2025
Pediatric Otolaryngology
Introduction
• Recurrent croup (RC) is a common problem in the
pediatric population, with a reported incidence of
6.4% within the first 4 years of life
• Recurrent croup is not a diagnosis itself, but a
symptom of an underlying disease process.
• asthma or airway hypersensitivities
• Gastroesophageal reflux disease (GERD)
• subglottic stenosis
• laryngomalacia
• 45% of children may have no identifiable cause for
their RC
Hypothesis
• The inflammatory mucus from a post-nasal drip
(PND) may contribute to the edema and inflammation
of the airway and subglottis.
• by reducing the post-nasal drip, children will
have a significantly reduced number of RC events,
regardless of any underlying secondary airway
pathology
• anticholinergic agents inhibit the action of
acetylcholine, When applied to the nose, this
medication inhibits the secretions from serous
glands lining the nasal mucosa and decreases the
incidence of rhinorrhea and PND
methods
• Retrospective, patients <10 years of age, 2018 and 2020
• RC defined as having two or more episodes of a barking
cough, hoarseness, and stridor, either confirmed
medically or reported by a parent***
• The number of croup episodes, physician visits, and
steroids used were based on parental recall***
• Both groups were prescribed anti-reflux, allergy
medication or intranasal sprays ***
• average number of RC per year in the WoIB
group was 5.4 events, reduced to 3 after
treatment. 44.5% reduction in events.
• average number of RC per year in the WIB
group was 5.0, reduced to 1.3, correlating with
a 73.6% reduction in events
• Average number of events per year requiring
steroids in the WoIB group was 3.9 events,
and this was reduced to 1.9 events, correlating
with a 50% reduction in steroid use.
• The average number of events per year
requiring steroids in the WIB group was 4.5
events, reduced to 0.6 events, correlating with
an 85% reduction in steroid use
Discussion
• Previous studies have examined the role of endoscopy in
identifying the etiology of RC, with GERD as the most
common finding.
• A recent Meta-Analysis by Coughran et. al found the
incidence of GERD in patients with RC was 5%–87%.
•
A. Coughran, K. Balakrishnan, Y. Ma, et al., The Relationship between croup and gastroesophageal reflux: a systematic review
and meta-analysis, Laryngoscope 131
• treatment of GERD with anti-reflux medication improves
RC symptoms
• current study demonstrated an 85% reduction in steroid
use among patients with RC treated with IB
conclusion
• Intranasal IB is a novel therapeutic option
that may aid in reducing the incidence of RC,
improve patient symptoms and reduce steroid use