Proton Pump Inhibitor Use for Otolaryngologic Conditions in the Pediatric Population: A Systematic Review

Introduction: Proton pump inhibitor (PPI) use is common in Otolaryngology specifically in the management of laryngomalacia, dysphonia, dysphagia, globus, subglottic stenosis, tracheal stenosis, airway reconstruction, vocal cord granulomas, and eosinophilic esophagitis (EoE). Significant, long-term side effects are associated with PPI use in children, including nutritional deficiencies, increased risk of fractures and infection, acute kidney injury, inflammatory bowel diseases, and allergy. Evidence supporting the use of PPIs in these conditions has not previously been evaluated in a systematic manner.

Methods: Using PRISMA guidelines, a systematic review examining PPI use for otolaryngologic concerns in children was conducted. Pubmed and Embase databases were queried January 2000 to September 2024.

Results: Of the 1390 records screened, 11 studies were included, assessing 1170 participants. 7 examined the role of PPIs in the management of EoE, 2 in laryngomalacia, 1 in esophageal atresia (EA), and 1 in chronic otitis media with effusion (OME). In EoE studies, PPI treatment was effective for achieving clinical response and histologic remission in a subset of patients. One laryngomalacia study found that acid suppression did not reduce the risk of aspiration or progression to supraglottoplasty (SGP), while the other concluded that medical management and close observation of infants with moderate to severe laryngomalacia are viable alternatives to SGP. The OME study had too small a sample size (n=16) to demonstrate the utility of PPI use in treating OME. Lastly, the EA study examined postsurgical patients and found that PPIs did not prevent formation of anastomotic strictures and were overutilized in children with tracheomalacia-associated airway symptoms without discernible clinical benefit.

Conclusions: There is a paucity of data to support or refute the use of PPIs in the management of otolaryngologic concerns in children. Given recent data on sequelae of PPI use, otolaryngologists should carefully consider the risks and benefits of PPI therapy prior to initiating treatment.