Esophageal reflux tied to pediatric middle ear inflammation

Last Updated: 2015-02-06

By David Douglas

NEW YORK (Reuters Health) - Extraesophageal reflux appears to be closely involved in inflammatory processes in the middle ear in children, but evidence of a cause and effect relationship is lacking.

In a January 29th online paper in JAMA Otolaryngology Head and Neck Surgery, Drs. Zhaoping He and Robert C. O'Reilly of Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware and colleagues note that extraesophageal reflux is one of the mechanisms that may drive middle ear disease in children.

In previous work the team detected gastric pepsin A in middle ear samples from 15% of children with otitis media.

In the new study, they followed 129 children undergoing myringotomy with tube placement for otitis media.

Out of 199 ear samples, 82 samples (41%) from 64 patients (50%) were positive for pepsin A.

Examination of inflammatory status and logistic regression analysis showed that only interleukin 8 (odds ratio, 3.96) and younger age (odds ratio, 3.83) were significant independent variables associated with positivity for pepsin A.

The presence of pepsin A in the middle ear was not associated with increased bacterial infection but IL-8 was independently and significantly associated with both pepsin A levels and bacterial infection.

Multiple linear regressions demonstrated that levels of pepsin A were correlated with IL-8 levels and with need for a second or third tube, six to 12 months after the first.

"This correlation between the presence of pepsin A and clinical outcome," say the investigators, "may suggest that extraesophageal reflux disease plays a role in the persistence of otitis media and further supports the concept that gastric reflux in younger children may be pathophysiologic."

Most of the children involved in the study were not confirmed to have gastroesophageal reflux disease (GERD). In fact, the researchers point out that clinical symptoms of GERD "have repeatedly been demonstrated to lack strong and consistent correlation with extraesophageal manifestations in the upper airway of children."

However, they say, "even a few reflux episodes, failing to attain the level of florid GERD, might still reach and aggravate the existing condition in the middle ear."

In a joint email to Reuters Health, Drs. He and O'Reilly wrote, "Our study supports the concept that extraesophageal reflux, and its associated inflammatory response, are a component in the pathophysiology of recurrent acute and chronic serous otitis media."

"The development of reliable clinical tests to detect the presence of refluxate in the middle ear cleft will assist in directed pharmacotherapy," they conclude.

SOURCE: http://bit.ly/1zpJlIR

JAMA Otolaryngol Head Neck Surg 2015.