Role of Gastroesophageal reflux in the pathogenesis of otitis media with effusion

ABSTRACT

This prospective comparative study was designed to define the presence of Helicobacter pylori [H. pylori] in middle ear effusion [MEE] and to compare pepsin levels both in serum and MEE as a trial to define a possible role for them in the pathogenesis of otitis media with effusion [OME]. The study included 40 children with chronic OME, 30 patients had bilateral OME, whereas 10 patients had unilateral OME. Blood samples were taken before induction of anesthesia and MEEs were collected at the time of myringotomy and was divided into two parts; the first was used for determination of the presence of H. pylori and the second part for determination of pepsin-like activity. H. pylori could be detected in 48 effusion samples [71.6%] obtained from 21 patients with bilateral OME [21/30; 70%] and 6 patients with unilateral OME [6/10; 60%]. Twenty-seven [56.3%] samples were obtained from right ear and 21 samples [43.7%] were obtained from the left ear. There was a negative significant correlation, [r=-0.662, P<0.05] between age and the presence of H. pylori. Pepsin-like activity was detected in 35 samples [52.2%], at pH 2.2 in 26 samples [74.3%] and at pH 8 in 9 samples [25.7%]. There was a significant increase [P<0.05] of total pepsin-like activity in effusion compared to levels detected in serum. Furthermore, mean pepsin-like activity detected at pH 2.2 showed a significant increase compared to activity level detected both in serum and to that detected in effusion at pH 8, moreover, mean pepsin-like activity detected at pH 8 showed a significant increase compared to activity level detected in serum. There was a positive significant correlation between the presence of H. pylori and the activity level of pepsin, [r=0.81, P<0.05]. We could conclude that gastric reflux with its acidity and contents of H. pylori and pepsin plays a role in pathogenesis of otitis media with effusion