Comparison of Three Methods Used in the Diagnosis of Extraesophageal Reflux in Children with Chronic Otitis Media with Effusion

Abstract

Objectives. Detection of extraesophageal reflux (EER) in children with chronic otitis media with effusion (OME) using three different diagnostic methods. Methods. Children between 1 and 7 years with OME who underwent adenoidectomy and myringotomy with insertion of a ventilation tube were included in this prospective study. EER was detected using three methods: oropharyngeal pH was monitored for 24 hours using the Restech system; detection of pepsin in middle ear fluid obtained during myringotomy was done using Peptest, and detection of pepsin in an adenoid specimen was done immunohistochemically. Results. Altogether 21 children were included in the study. Pathological oropharyngeal pH was confirmed in 13/21 (61.9%) children. Pepsin in the middle ear fluid was present in 5/21 (23.8%) children; these 5 patients were diagnosed with the most severe EER established through monitoring of oropharyngeal pH. No specimen of adenoids tested was positive for pepsin upon immunohistochemical examination. Conclusions. Diagnosis of EER in patients with OME using Restech is sensitive but less specific when compared to the detection of pepsin in middle ear fluid using Peptest. Pepsin in the middle ear was consistently present in patients with RYAN score above 200, and these patients in particular could potentially profit from antireflux therapy.

Laryngopharyngeal reflux and herpes simplex virus type 2 are possible risk factors for adult‐onset recurrent respiratory papillomatosis (prospective case–control study)

“…Laryngopharyngeal reflux can cause or facilitate many pathologies, such as acute or chronic otitis media, rhinosinusitis and chronic laryngitis . The presence of pepsin in gastric refluxate is considered a main pathogenetic factor that causes proteolysis and cell damage.…”

Laryngopharyngeal Reflux Is a Potential Risk Factor for Juvenile-Onset Recurrent Respiratory Papillomatosis

“…Therefore, it is very important to choose the proper diagnostic method for evaluating whether LPR is a relevant factor. Measuring pepsin in fluids or tissues appears to be the most suitable method for evaluating a possible relationship between a pathology and LPR [24, 29]. The advantage of pepsin detection over esophageal impedance is that pepsin can be detected in tissues and fluids, even in the absence of a reflux event within the past several days [24].…”

Combined multichannel intraluminal impedance‐pH monitoring should be used to diagnose reflux‐related otitis media with effusion in children

“…Although standardised method to diagnose GER‐related OME is still a matter of debate, according to Formánek et al. , extraoesophageal reflux is probably one of the aetiological factors in as many as one‐third of the children with OME. That statement is absolutely in line with the results of our study and the results of a previously cited study from Poland .…”

“…It has been proposed that the presence of gastric content triggers an inflammatory reaction, leading to swelling of the mucosa, mucus hypersecretion and ciliary dyskinesia . The increasing interest in the association between OME and GER has led to several publications in this field .…”