Otorhinolaryngological manifestations of Eosinophilic Esophagitis in children: a case control study

Objectives: Otorhinolaryngological conditions seem to be more frequent in children with Eosinophilic Esophagitis (EoE), including allergic rhinitis, but, to our best knowledge, there are no studies showing if the frequency of these conditions is superior in children with EoE. The aim of this study is to determine whether otorhinolaryngological manifestations are more prevalent in these children. Design: Case control study Setting: Tertiary referral Paediatric Hospital of Lisbon, Portugal. Participants: Children with EoE (cases) and children diagnosed with allergic rhinitis but not diagnosed with EoE or other eosinophilic disorders (controls). Main outcome measures: Complete otorhinolaryngological evaluation of children under an observation protocol with questions about ear, nose and throat symptoms, and previous medical history; physical examination and the CARAT kids questionnaire to evaluate the level of control of children’s rhinitis. Results: This study included 45 children. The study group consisted of 15 children diagnosed with EoE and the control group consisted of 30 cases with allergic rhinitis. Both groups included 6 to 17 years old children. There were no differences concerning gender, age, total CARAT kids score or CARAT kids score for questions for upper and lower respiratory tract (p>0.05). When otorhinolaryngological symptoms were analysed separately there were no statistically significant differences between case and control groups (p>0.05), except for dysphagia (p=0,036) which was more prevalent in the case group. There were no significant differences related to the number of symptoms reported, frequency of asthma, otorhinolaryngological surgeries in the past, drug allergies, and documented hearing loss (p>0.05). There were no significant differences in laryngopharyngeal changes seen as markers for laryngopharyngeal reflux between both groups (p>0.05). Conclusions: Apparently, otorhinolaryngological conditions are not more prevalent in children diagnosed with EoE, but future larger studies are needed to confirm our findings. Yet, Otorhinolaryngologists must be aware of this condition since early referral of children with symptoms related to EoE such as dysphagia and atopy to a Gastroenterology appointment can speed up diagnosis and treatment, potentially reducing long-term sequelae.