Clinical and microbiological differences between pyriform sinus fistulae in pediatric and non-pediatric patients

Abstract

Objective: To review our 15-year experience with pyriform sinus fistula (PSF) in a single institution for a better understanding of the disease, pertaining especially to symptom onset at different ages. Methods: Medical records were reviewed for all 21 PSF patients presenting between 1998 and 2012. Patients were then divided into pediatric ( 15 years old) and non-pediatric (>15 years old) groups according to the age at symptom onset. Clinical and microbiological features of both groups were compared. Results: There were 12 (57.1%) pediatric and 9 (42.9%) non-pediatric patients. It took an average of 13.1 months for the diagnosis of PSF to be confirmed in pediatric patients from the time of symptom onset, whereas the same interval was only 0.7 month in the non-pediatric group. The sensitivity of computed tomography was more than 90% in both age groups, whereas that of barium esophagography was higher in non-pediatric (50.0%) than in pediatric (28.6%) patients. Recurrence occurred after initial treatment in only three patients, all of whom were in the pediatric age group. Bacteriological studies showed that Streptococcus mitis was the most common species isolated from pediatric patients, while Klebsiella pneumoniae was the most common pathogen in the non-pediatric group. Conclusion: Non-pediatric PSF with late onset of symptoms is more common than expected or reported in the literature so far. This form of PSF present different clinical and microbiological characteristics compared to pediatric PSF. Therefore, diagnostic and therapeutic counseling for PSF should be tailored according to the age of symptom onset.