OTITIS MEDIA WITH EFFUSION AND GASTROESOPHAGEAL REFLUX DISEASE

Abstract

There is increasing evidence from observational studies that both pediatric and adult patients with upper respiratory tract infection frequently have associated gastroesophageal reflux disease (GERD) and extraesophageal reflux (EOR) and that these patients may benefit from medical antireflux therapy. GERD and EOR may contribute to the pathogenesis of chronic sinusitis by causing sinonasal congestion, compromised sinus drainage, and inflammation. Otitis media Otitis media with effusion (OME) is a prevalent condition and the most common cause of hearing loss in childhood. Recently, Tasker et al reported high concentrations (up to a 1000-fold greater than serum levels) of pepsin/pepsinogen in 59 of 65 middle ear effusion samples from children with OME. The authors concluded that reflux of gastric juice into the middle ear may be the primary factor in the initiation of OME in children. Using upper gastrointestinal endoscopy and 24 hour pH monitoring, we prospectively assessed the coexistence of GERD in consecutive adult patients with chronic secretory otitis media (CSOM) or with a chronic refractory feeling of pressure in the ear(s) (CRFP). All patients with CSOM and most patients with CRFP had evidence of GERD (oesophagitis and/or abnormal pH metry). Medical antireflux therapy with open label PPI led to cessation of middle ear drainage and CRFP after, on average, 11 weeks and four weeks, respectively.