Abstract
ObjectivesTo study the possible relationship between gastroesophageal reflux and chronic middle ear effusion by (i) evaluating the presence of pepsin/pepsinogen in middle ear fluid of children with chronic otitis media with effusion (OME) and to (ii) differentiate between pepsin from gastric juice and pepsin derived from plasma pepsinogen.Patients and methodsThis was a prospective study carried out in the Departments of Otorhinolaryngology and Clinical Pathology, Alexandria University. Middle ear effusions and blood samples were collected from 25 patients undergoing bilateral myringotomy with tube placement for chronic OME. These samples were prepared for pepsin assay. The total pepsin/pepsinogen concentrations of effusions and serum samples were measured with an enzyme-linked immunosorbent assay using human pepsin-specific antibody.ResultsPepsin was detected in 22 of 25 (88%) patients and in 42 of 50 (84%) of the ears, and it was detected in all serum samples. A total of seven of 25 (28%) patients and nine of 50 (18%) ears were found to have higher pepsin levels in their middle ear effusion samples than the cut-off value of serum. The average pepsin level in all effusion samples was 109.99 ng/ml, whereas it was 55.72 ng/ml in serum samples.ConclusionThe gastroesophageal reflux is one of the contributing factors in the etiopathogenesis of middle ear effusion as gastric pepsin reaches the middle ear through the nasopharynx and Eustachian tube to cause OME.
Highlights
Otitis media with effusion (OME) is characterized by the collection of serous or mucous fluid behind an intact tympanic membrane during an inflammatory process and the lack of acute signs and symptoms of infection
Using enzyme-linked immunosorbent assay (ELISA), the presence of pepsin was tested in all effusion and serum samples (Fig. 1)
Pepsin was detected in 22 of 25 (88%) patients and in 42 of 50 (84%) of the ears and it was detected in all serum samples
Summary
Otitis media with effusion (OME) is characterized by the collection of serous or mucous fluid behind an intact tympanic membrane during an inflammatory process and the lack of acute signs and symptoms of infection. It leads to a reduction in the tympanic membrane mobility and conductive hearing loss. The role of gastroesophageal reflux (GER) or extraesophageal reflux in this disease has only been recognized recently [2]. Once these reflux events produce pathological changes in the esophagus or upper aerodigestive tract, they are termed GER disease or extraesophageal reflux disease [3,4]
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