Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of "silent" GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.

In contrast to the relative frequency of granular cell tumors (GCT) in the larynx and bronchi, the occurrence of these tumors in the trachea is rare. A 50-year review of the English-language literature disclosed only 24 described cases of tracheal GCT. This report reviews the clinicopathologic data from those 24 cases, along with the data from 2 cases obtained via a personal communication and the data from 4 previously unpublished cases obtained from a 30-year review of the Armed Forces Institute of Pathology archives. Tracheal resection was the predominant mode of therapy and often was performed as a salvage procedure for failed endoscopic excisions. Recommendations for a more uniform approach to surgical management are provided.

Diagnostic imaging in the pediatric patient frequently requires sedation. The use of chloral hydrate, the standard agent for many years, has recently come under severe scrutiny. The American Academy of Pediatrics (AAP) published guidelines for the elective sedation of pediatric patients; however, compliance with the AAP guidelines is not compulsory. A review of the medical literature shows a wide range of medications used for pediatric sedation, along with a diversity in the protocols available for monitoring the cardiopulmonary status of the patient. When ordering computed tomography and magnetic resonance imaging scans, pediatric otolaryngologists indirectly are exposing their patients to the sedation practices and monitoring protocols of their referral imaging center. A questionnaire regarding the sedation protocol for routine, outpatient, computed tomography or magnetic resonance imaging scans in children aged 5 years or younger was sent to staff radiologists at 36 pediatric medical centers throughout the United States. A variety of sedation practices were elicited. The complete survey results are presented, including monitoring practices, complication, and success rates. Despite concerns about its safety, chloral hydrate remains a frequently used and safe method of pediatric outpatient sedation.

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