Treatment of gastro-esophageal reflux disease may improve surgical outcomes for chronic otitis media

ABSTRACT

This study has been designed to investigate the clinical association between gastro esophageal reflux disease [GERD] and chronic otitis media [COM] in adults and also the role of GERD treatment on the outcome of COM surgery. In a randomized clinical trial, 58 patients with COM who were candidates for surgery were evaluated for GERD and divided in two groups; GERD positive [case] and GERD negative [control] patients. The GERD positive patients were randomized to either receiving medical treatment for GERD or not prior to surgery. The surgical outcomes were assessed at 3 and 6 months after COM surgery in the three groups. Fifty-eight [26 males] patients were enrolled. Forty-two [72.4%] of these had GERD according to a validated questionnaire. Three months after surgery auditory recovery in GERD negative patients was significantly higher [16[100%]] than those suffering from GERD [28 out of 42 [66.7%]], p=0.008. The figures remained similar at six months follow up as well [100% vs. 72.5% in GERD negative and positive patients respectively, p=0.002]. In the GERD-positive group, 8 of 18 [44.4%] patients who did not receive GERD treatment before tympanomastoidectomy recovered after three months whereas, while 20 of 24 [83.3%] patients who received GERD treatment recovered during this time [p<0.001]. At six months 44.4% of non-treated GERD patients had auditory recovery as compared to 95.5% of those treated for GERD [p<0.01]. Our data show that the effect of GERD on the outcome of COM surgery may be considerable. On the other hand, treating COM patients for GERD medically for two months before tympanoplasty improves the surgical outcomes. Therefore, we suggest that COM patients be evaluated for GERD before undergoing tympanoplasty and if GERD is present, they be treated medically for a couple of months before undergoing surgery.