Diagnostics of Extraesophageal Reflux in Children with Chronic Otitis Media with Effusion


Authors: J. Syrovátka 1;  P. Komínek 1,2;  P. Matoušek 1,2;  R. Tomanová 3;  K. Zeleník 1,2;  M. Formánek 1,2
Authors‘ workplace: Otorinolaryngologická klinika FN Ostrava ;  přednosta doc. MUDr. P. Komínek, Ph. D., MBA Katedra kraniofaciálních oborů Lékařská fakulta, Ostravská univerzita v Ostravě 1;  vedoucí katedry doc. MUDr. P. Komínek, Ph. D., MBA Ústav patologie FN Ostrava přednosta MUDr. J. Dvořáčková, Ph. D. 2
Published in: Otorinolaryng. a Foniat. /Prague/, 63, 2014, No. 2, pp. 68-74.
Category: Original Papers

Overview

Objective:
The study investigated the frequency of extraesophageal refflux (EER) in children with chronic otitis media with effusion (OME).

Methods:
The prospective study included child pa-tients at the age of one to five years of age, who were indicated myringotomy with or without pressure equalizing tube because they suffered from OME. When the adenoid vegetation was present, adenoidectomy was indicated as well. The parents filled outa questionnaire containing demographic and anamnesis data concerning the signs of reflux and middle ear inflammation in their children. EER was diagnosed by several methods. The presence of pepsin in the middle ear (an indirect EER sign) was estimated by means of the Peptest. Children indicated myringotomy as well as adenoidectomy the authors measured oropharyngeal pH by the Restech system and pepsin in the pharyngeal tonsil was determined by immunohistochemical methods.

Results:
Thirty eight children were included in the study from June 2012 till June 2013. Pepsin in the middleear was determined by means of the Peptest in 12 children (32%). The simultaneous myringotomy and adenoidectomy was performed in 15 children. In this group the authors measured pH in oropharynx by the Restech system and the presence of pepsin in a sample from the pharyngeal tonsil by immunohistochemical examination. EER was determinedin 10 out of 15 children (67%) by measuring oropharyngeal pH (Restech). In three children with demonstrated EER during examination of oropharyngeal pH the authors also demonstrated the present of pepsin in middle ear by means of the Peptest. A marked EER was demonstrated in three of these patients by the Restech. In other children with a negative Peptest, a milder form of EER was determined by Restech. Immunohistochemical examination of pharyngeal tonsil did not show pepsin in any of the children examined. The severity if the problem reported by the parents did not correlate with the results of oropharyngeal pH metry and Peptest.

Conclusion:
The presence of pepsin in middle ear (an indirect sign of pathological EER) was established in 12 out of 37 (32%) patients with OME. The examination of oropharyngeal pH was demonstrated by EER in two thirds of patients with OME. The EER diagnostics by means of these two methods is simple and well tolerated by the children, both methods can be combined and the EER diagnostics in OME patients is therefore more precise. Immunohistochemical examination of pepsin from the nasopharyngeal tonsil does not seem suitable for the establishment of EER. Based on our results we suppose that one third of patients with OME could benefit from antireflux therapy (diet, regiment measures, proton pumps).

Keywords:
extraesophageal reflux, chronic otitis media with effusion, pepsin, Peptest, oropharyngeal pH metry


Sources

1. Ayazi, S., Lipham, J. C., Hagen, J. A., Tang, A. L.: A new technique for measurement of pharyngeal pH: normal values and discriminating pH treshold. J. Gastrointest Surg., 13, 2009, s. 1422-1429.

2. Chheda, N. N., Seybt, M., W., Schade, P. R., Postma, G. N.: Normal values for pharyngeal pH monitoring. Ann. Otol. Rhinol. Laryngol., 118, 2009, s. 166-171.

3. Crapko, M., Kerschner, J. E., Syring, M., Johnston, N.: Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope, 117, 2007, s. 1419-1423.

4. Deal, L., Gold, B. J., Gremse, D. A., Winter, H. S.: Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. JPGN, 41, 2005, s. 178-185.

5. DelGaudio, J. M.: Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis. Laryngoscope, 115, 2005, s. 946-957.

6. Harris, P. K., Hussey, D. J., Watson, D. I., Mayne, G. C, Bradshaw, A., Joniau, S., Tan, L. W., Wormald, P. J., Car-ney, A. S.: Reflux changes in adenoidal hyperplasia: a controlled prospective study to investigate its aetiology. Clin. Otolaryngol., 34, 2009, s. 120-126.

7. He, Z., O‘Reilly, R. C., Mehta, D.: Gastric pepsin in middle ear fluid of children with otitis media: clinical implications. Curr Allergy Asthma Rep., 2008, 8, s. 513-518.

8. Jiang, A., Liang, M., Su, Z., Chai, L., Lei, W.: Immuno-histochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux. The Laryngoscope, 121, 2011, s. 1426-1430.

9. Keles, B., Ozturk, K., Gunel, E., Arbag, H., Ozer, B.: Pharyngeal reflux in children with chronic otitis media with effusion. Acta Otolaryngol., 124, 2004, s. 1178-1181.

10. Kleinman, L., Nelson, S., Kothari-Talwar, S.: Development and psychometric evaluation of 2 age stratified versions of the pediatric GERD symptom and quality of life questionnaire. JPGN, 52, 2011, s. 514-522.

11. Lieu, J. E., Muthappan, G., Uppaluri, R.: Association of reflux with otitis media in children. Otolaryngol. Head Neck Surg., 133, 2005, s. 357-361.

12. McCoul, E. D., Goldstein, N. A, Koliskor, B., Weedon, J., Jackson, A., Goldsmith, A. J.: A prospective study of the effect of gastroesophageal reflux disease treatment on children with otitis media. Arch. Otorhinolaryngol. Head Neck Surg., 137, 2011, s. 317-319.

13. O‘Reilly R. C., He, Z., Bloedon, E., Papsin, B., Lundy, L., Bolling, L., Soundar, S., Cook, S., Reilly, J. S., Schmidt, R., Deutsch, E. S., Barth, P., Mehta, D. I.: The role of extraesophageal reflux in otitis media in infants and children. Laryngoscope, 118, 2008, s. 1-9.

14. Rožmanic, V., Velepic, M., Ahel, V. et al.: Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux in children with chronic tubotympanal disorders. Journal of Pediatric Gastroenterology and Nutrition, 34, 2002, s. 278-280.

15. Strugala, V., Faruqi, S., Dettmar, P., W., Morice, A. H.: Detection of pepsin in sputum and exhaled breath condensate: could it be a useful marker for reflux - related respiratory disease? Eur. Resp. J., 34, 2009, s. 704.

16. Vandenplas, Y., Rudolph, C. D.: Pediatric Gastroesophageal Reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Jurnal of Pediatric Gastroenterology and Nutrition, 49, 2009, s. 498-547.

17. Werner, G. J., Tsukashima, R., Kelly, C.: Oropharyngeal pH monitoring for the detection of liquid and aerosolised supra-esophageal gastric reflux. J. Voice, 23, 2009, s. 498-504.

18. Zeleník, K., Schwarz, P., Urban, O., Vydrová, J., Komínek, P.: Extraezofageální reflux up-to-date. Čes. a Slov. Gastroent. a Hepatol., 64, 2010, 6, s. 10-14.

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Audiology Paediatric ENT ENT (Otorhinolaryngology)
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