Role of laryngo-pharyngeal reflux in otitis media with effusion in young children [new technique]

Background: Otitis media [OM] has the highest incidence among all medical conditions in children younger than age five, Otitis media with effusion [OME] is the most common cause of childhood deafness. Gastroesophageal reflux disease [GERD] refers to the symptoms and complications of abnormal passage of gastric contents into the esophagus. Laryngopharyngeal reflux [LPR] is the movement of gastric contents beyond the esophagus up to the laryngeal and pharyngeal area. As well as pepsin and acid of gastric contents can include bile acids and pancreatic enzymes, all of which can injure tissues not adapted to them. Although Gasteroesophogeal Reflux [GER] may be normal, LPR [Laryngopharyngeal Reflux] should never be considered physiologic. LPR has been implicated in the OME pathogenesis: therefore, it is necessary to identify the presence or absence of gastric juice in the middle ear

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Hypothesis: The objective was to investigate the potential use of pepsin and pepsinogen as diagnostic marker for Laryngopharyngeal reflux disease in otitis media with effusion

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Study design: We studied 100 children with symptoms suggestive of either gasroeosophgeal reflux [GER] or OM clinically; all patients were subjected to pharyngeal PH test, Tympanometry, middle ear fluid samples [obtained by myringotomy from patients with Otitis media with effusion] were examined for the presence of pepsin and pepsinogen by using a proteolytic enzyme assay

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Result [s]: There was a statistical significant difference as regarding the effect of LPR proved by pharyngeal PH <4.0,in cases of otitis media with effusion. Of 34 patients with OME subjected to myringotomy 61.76% were positive for pepsin and pepsinogen

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Conclusion: A strong significant relation was found between LPR and OME [evidenced by pharyngeal PH <4.0 and Middle ear fluid pepsin and pepsinogen] We suggest a causative link between LPR and OME in young children