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Video

Pediatric Otolaryngology

(A956) Unique Cases of Nasogastric Tube-Related Pressure Ulcers in Patients with a Postcricoid Cushion

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Felisha Amy Li, BA

    Medical Student
    Zucker School of Medicine At Hofstra/Northwell
    Fremont, California, United States

    • Co-Author(s)

  • Collin S. Hill, BS

    Medical Student
    Northwell
    West Hempstead, New York, United States

    • Senior Author(s)

  • Neha A. Patel, MD

    md
    Cohen Children's/Northwell Health
    New Hyde Park , New York, United States

    • Co-Author(s)

  • JS

    Joshua B. Silverman, MD, PhD

    Associate Professor, Department of Otolaryngology
    Northwell Heath
    Roslyn Estates, New York, United States

  • CH

    Catherine Han, MD

    Resident Physician
    New York Presbyterian Hospital (Columbia Cornell Campus)
    New York, New York, United States

  • Alison Maresh, MD

    Assistant Professor
    Weill Cornell Medical Center
    New York, New York, United States

Disclosure(s):
Felisha Amy Li, BA: No relevant relationships to disclose.
Neha A. Patel, MD: No relevant relationships to disclose.
Joshua B. Silverman, MD, PhD: No relevant relationships to disclose.
Catherine Han, MD: No relevant relationships to disclose.
Alison Maresh, MD: No relevant relationships to disclose.


Introduction: Nasogastric tubes (NGTs) are commonly used to provide nutrition to pediatric patients unable to take adequate calories orally or at risk for aspiration, but NGTs can also cause pressure injuries by compressing mucosal surfaces, impairing venous blood flow, and causing tissue ischemia or necrosis. While NGT-related pressure ulcers typically occur on the columella or nasal mucosa, we present a rare case series of ulceration at the postcricoid cushion, a normal anatomic variant with prominent venous plexuses in the posterior cricoid area.

Methods: Retrospective chart review of two patients with postcricoid cushion ulcers was conducted, including data from inpatient/outpatient records and operative reports from October 2024 to January 2025.

Results: Both patients, aged 2 and 3 months, had a history of Trisomy 21 and laryngomalacia and were admitted to the PICU for acute hypoxic respiratory failure due to viral bronchiolitis. Their hospital course was complicated by the inability to wean off CPAP and postcricoid cushion injury from NGT use indicated for poor oral intake. In both patients, supraglottoplasty was performed for worsening respiratory symptoms due to laryngomalacia––however, one patient had evidence of severe laryngeal reflux on exam that was likely contributing to their respiratory distress. Post-op management included CPAP, reflux precautions, and repeat airway evaluations to monitor inflammation and ulceration. One patient continued NGT feeds, while the other had the NGT removed to allow for healing before a smaller tube was placed and later transitioned to a gastrostomy tube.

Conclusions: Currently, there is a sparsity of literature on NGT-induced postcricoid cushion ulceration. Our recommended management includes NGT removal, replacement with a smaller tube, reflux precautions, and, if necessary, temporary feeding modifications (eg, gastrostomy or parenteral nutrition). For high-risk patients (eg, Trisomy 21, laryngeal reflux, URI), preemptively using the smallest NGT may help prevent such injuries.