Abstract

ROLE OF REFLUX IN THE ETIOLOGY OF OTITIS MEDIA WITH EFFUSION IN CHILDREN

*Mahmoud Elbahrawy, MD and Ali Sobhi Mohamed

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Abstract

Background: Chronic secretory otitis media is a common disease in children, especially in developing countries. In these countries secretory otitis media may pass unnoticed for a long time and then develop slowly into a chronic condition. In spite of the common occurrence of secretory otitis media, its etiology and pathobiology are still largely unknown. Causes of this disorder are believed to be multifactorial, including viruses, allergy, bacteria and their products, and dysfunction of the Eustachian tube. Gastro-esophageal reflux (GER) could also be a cause of this disease. Reflux of gastric contents from the nasopharynx to the middle ear is possible. Objective: To study the possible relationship between gastro-esophageal reflux and chronic middle ear effusion by evaluating the presence of pepsin in middle ear fluid of patients with chronic otitis media with effusion (OME). Results: All effusions collected from 40 children with OME contained pepsin protein in a concentration range of (523.25 – 1214.0 ng/ml) effusion. The average pepsin level in all effusion samples was 841.98 ng/ml(SD 179.82).The difference between the levels of pepsin and degrees of hearing loss was statistically significant [probability of overlap (P) value = 0.0001 (P value < 0.05)], and there is a significant positive correlation. [correlation-confident (r) = 0.691]. Conclusion: The presence of pepsin in MEE supports the relationship between gastro-esophageal reflux disease (GERD) and OME. Measurement of pepsin can be considered a reliable marker for assessment of reflux in children with OME. However, further research is needed to establish a definite association between GERD and OME by measuring pepsin/pepsinogen concentration in serum, gastric juice and MEE.

Keywords: Otitis media with effusion, secretory otitis media, Gastro-esophageal reflux disease, Myringotomy, Ventilation tube.