The GERD-caused middle ear mucous membrane transformation features in chronic otitis media with effusion

Abstract

Introduction. Chronic otitis media with effusion (COME) is a middle ear disease, characterized by mucous effusion accumulation in its structures. One of the important COME formation mechanism is gastric reflux. Gastric contents reflux into the tympanic cavity which contributes to the irreversible transformation of its mucous membrane.Aim. To substantiate the significance of the gastric reflux in the middle ear mucosa fibrous remodeling.Materials and methods. The study included 96 people diagnosed with COME and concomitant gastroesophageal reflux disease (GERD), 54 women and 42 men, in the age range from 18 to 65 years (mean age 51.4 years). All patients underwent tympanostomy tube installation and supervised by an otolaryngologist during 12 months. Patients were divided into 2 groups depending on their consent to GERD therapy. The conservative treatment of COME and GERD was carried out in accordance with established and current medical care standards and clinical guidelines for the relevant nosology.Results and discussion. 14 days after the tympanostomy, the otorrhea decrease was noted in 31 (75.6%) of the main group and 31 (56.6%) participants in the comparison group (n = 96).By the end of 12 months observation a positive disease outcome such as exudation reduction and complete tympanic membrane repair was recorded in 35 (83.3%) and 25 (62.5%) patients of both groups respectively (n = 82).Patients with a mixed 34 (35.4%) and non-acid 11 (11.5%) types of reflux showed worse disease outcome rates, just like in patients with COME who delayed GERD treatment 8 (8.3%).Conclusions. The combination of infectious agent exposure causes an active mucous membrane exudation in the disease early stages with mixed and non-acid gastric reflux leads to mucous membrane middle ear fibrous remodeling. It has also been established that an unsuccessful COME treatment duration aggravates the outcome of the disease in the absence of GERD therapy.