Detection of gastric pepsin in middle ear fluid of children with chronic otitis media with effusion

Shewel, Yasser; Bassiouny, Mokhtar; Rizk, Mohamed M.

doi:10.4103/1012-5574.133176

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Several studies correlate LPR with OME by identifying pepsin in middle ear effusions 12 35–39. Correlation between LPR and OME may be caused by excessive vagal reactivity and direct noxious exposure of the middle ear mucosa to gastric acid contents, causing swelling, ciliary dyskinesia, mucus hypersecretion and stimulation of inflammatory mediator secretion that leads to ET dysfunction 40.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study

et al. 2022

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ObjectiveIdentify the risk factors for otitis media with effusion (OME), especially laryngopharyngeal reflux (LPR), adenoid hypertrophy and allergic rhinitis, that could be used to develop prevention strategies in children.DesignA comparative cross-sectional study was conducted to make sure the adequacy of proportions of OME and non-OME cases in finding the related factors.SettingHistory taking, ear/nose/throat (ENT) examination, and tympanometry were performed in preschool and elementary schools. Flexible fibreoptic nasopharyngolaryngoscopy was performed in a bronchoesophagology outpatient clinic in a tertiary referral hospital in Jakarta, Indonesia.ParticipantsPreschool and elementary children in East Jakarta, Indonesia were recruited for this study. A total of 2016 participants underwent history taking, ENT examination and tympanometry. The case group was 46 children with OME, and the control group was 46 children without OME. The number of subjects fulfilled the minimum sample size for two proportions comparison.Main outcome measuresA type B tympanogram indicated OME. A Reflux Finding Score of more than 7 indicated LPR. Adenoid hypertrophy was diagnosed using flexible fibreoptic nasopharyngolaryngoscopy. Allergic rhinitis was diagnosed using a questionnaire based on the International Study of Asthma and Allergies in Childhood phase III that has been validated for Indonesians.ResultsThe proportion of LPR in the OME group was significantly higher than in the non-OME group, at 78.3% and 52.2%. The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR (OR 3.3; 95% CI 1.33 to 8.189; p=0.01). There was no significant relationship between adenoid hypertrophy and OME (p=0.211; 95% CI 0.71 to 3.97), and also between allergic rhinitis and OME (p=0.463; 95% CI 0.61 to 4.28).ConclusionThe probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR. LPR should be considered in patients with OME and vice versa.

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Section: Discussionmentioning

confidence: 99%

Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study

et al. 2022

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“…Results herein corroborate prior estimates of the incidence of EER in pediatric OM and MEF pepsin concentration. Pepsin has been immunologically detected in ~85% pediatric OM cases 10 at concentrations up to 3,600 ng/ml 41–43 ; 68% incidence was reported via MII‐pH 19 . The pathological cutoff of pepsin in adult saliva is ~200 ng/ml 44,45 .…”

Section: Discussionmentioning

confidence: 99%

Association of Pepsin With Inflammatory Signaling and Effusion Viscosity in Pediatric Otitis Media

et al. 2021

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Objective: Otitis media (OM) is a common inflammatory disease spectrum. Cytokine signaling, neutrophil activity, and mucin hypersecretion during recurrent and chronic OM contribute to persistent, viscous middle ear (ME) effusions, hearing loss, and potential for developmental delay. Extraesophageal reflux (EER), specifically pepsin, triggers inflammatory signaling in respiratory mucosa and is associated with OM. The objective of this study was to investigate the association of pepsin with ME inflammatory signaling and the outcomes and examine causality in vitro.Study Design: Cross-sectional study. Methods: ME fluid (MEF) and preoperative audiometric data were collected from 30 pediatric subjects undergoing tympanostomy tube placement for recurrent OM or OM with effusion. MEF viscosity was characterized by the surgeon. Pepsin, inflammatory molecules, and mucin were assayed by enzyme-linked immunosorbent assay (ELISA). ME epithelial primary culture was exposed to 0.1 to 1 mg/ml pepsin at pH 5, 6, and 7 for 30 minutes, and cytokine expression was assayed via qPCR.Results: Pepsin was observed in the MEF of 77% of patients (range 71-2,734 ng/ml). Pepsin correlated with effusion viscosity, interleukins À6 and À8, neutrophil elastase, and mucin 5B (P < .05). Pepsin-negative MEF was more frequently absent of interleukin 8 or mucin 5B (P < .05). Weak acid was generally insufficient to elicit cytokine expression in ME cells in vitro, however, pepsin induced IL6, IL8, and TNF at pH 7 (P < .05) and weak acid (pH 6) facilitated a response at lower pepsin concentration.Conclusions: Pepsin may contribute to inflammatory signaling, persistent viscous effusion, and poorer OM outcomes.

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Detection of gastric pepsin in middle ear fluid of children with chronic otitis media with effusion

Cited by 2 publications

References 14 publications

Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study

Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study

Association of Pepsin With Inflammatory Signaling and Effusion Viscosity in Pediatric Otitis Media

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