Association of reflux with otitis media in children

Abstract

Problem: Gastroesophageal reflux (GER) and otitis media (OM) are both common disorders in young children. Recent studies have found pepsin/pepsinogen in the middle ear fluid of children undergoing tympanostomy tube placement for glue ear, or pathologic GER by pH-probe studies in those with chronic or recurrent OM, suggesting that GER may cause OM. Our objective was to investigate the putative role of GER in OM. Methods: Middle ear fluid was collected from 34 children between the ages of 12 months and 7 years who had undergone tympanostomy tube placement for chronic or recurrent OM. This fluid was tested for the presence of pepsin/pepsinogen with 2 assays: a proteolytic enzyme assay and an ELISA specific for pepsinogen I. Parents completed validated questionnaires about symptoms of reflux in their children over the past 6 months. Results: Of the 34 children, 22 had fluid from the middle ear that was testable; 36 middle ear samples were tested with both assays for pepsin/pepsinogen. Of the 36 samples, 67% were positive using the proteolytic assay, and 69% were positive using ELISA; the agreement between assays was fair (kappa 0.33). Analyzing the data by child, 16/19 (84%) had a positive result in at least 1 ear with the proteolytic assay, while 17/20 (85%) had a positive result with ELISA. Questionnaire data did not suggest an increase of symptoms associated with GER in children. Conclusion: This pilot study replicates the finding of pepsin/pepsinogen in the middle ear fluid aspirates of many children with chronic or recurrent OM, although an increased incidence in symptoms associated with GER in children was not found. Further research is needed before a causative link between GER and OM can be established. Significance: If GER can be established as an etiologic factor in OM, new therapies to treat and prevent OM can be investigated. Support: None