A recent study (R Rosen et al. J Pediatr 2017; 183: 127-31) adds additional data to the literature which has shown that ENT doctors are NOT able to tell if there is reflux by examining the airway.
Prior post on this topic: Accuracy of ENT diagnosis of Reflux Changes
This prospective, cross-sectional cohort study of 77 children correlated ENT examinations with “reflux finding score” (RFS) by three blinded otolaryngologists with objective measures of reflux: pH-metry and impedance. All children had chronic cough and underwent bronchoscopy and esophagogastroduodenoscopy.
- “There was no correlation between pH-MII variables and mean RFS”
- The concordance correlation for RFS between ENT doctors was low (intraclass correlation coefficient =0.32)
- Using pH-metry as a gold standard, the positive predictive value for the RFS was 29% whereas with MII as the gold standard, the positive predictive value for the RFS was 40%.
My take: ENT doctors are unable to tell if a patient has reflux. The finding of a red or swollen airway has poor predictive value in determining the presence of reflux –a coin toss is more reliable. Based on this study and others, starting a PPI because of an abnormal airway exam does not make sense.
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