Association between Otitis Media and Gastroesophageal Reflux: A Systematic Review

作者：Miura Mauricio Schreiner^*; Mascaro Miguel; Rosenfeld Richard M

来源：Otolaryngology - Head and Neck Surgery, 2012, 146(3): 345-352.

DOI：10.1177/0194599811430809

• otitis media
• otitis media with effusion
• chronic otitis media with effusion
• recurrent acute otitis media
• gastroesophageal reflux
• laryngopharyngeal reflux
• reflux
• pepsin
• pepsinogen

Objective. To systematically review the association between otitis media and gastroesophageal/laryngopharyngeal reflux in children. %26lt;br%26gt;Data Sources. Cochrane library, MEDLINE (1966-September 2011), EMBASE (1974-September 2011), proceedings of International Symposia on Recent Advances in Otitis Media, and reference lists of relevant selected articles. %26lt;br%26gt;Review Methods. Studies with planned data collection, in children with chronic otitis media with effusion/recurrent acute otitis media, assessing gastroesophageal/laryngopharyngeal reflux, pepsin/pepsinogen in middle ear, or antireflux therapy, were included. %26lt;br%26gt;Results. Of 242 initial studies, 15 met inclusion criteria. The authors found a mean prevalence of gastroesophageal reflux disease in children with chronic otitis media with effusion of 48.4% (range, 17.6%-64%) and in children with recurrent acute otitis media of 62.9% (range, 61.5%-64.3%). A mean prevalence of laryngopharyngeal reflux of 48.6% (range, 27.3%-70.6%) was found in children with otitis media. Mean pepsin/pepsinogen presence in otitis media was 85.3% (range, 60%-100%) and of enzymatic activity was 34.2% (range, 14.5%-73%). Two randomized trials could not find benefit after antireflux treatment for 3 months, with an absolute rate difference (95% confidence interval) of 0.23 (0.023-0.42) and 0.13 (-0.086 to 0.34), respectively. Reporting of adverse events was limited, or absent, in most studies. %26lt;br%26gt;Conclusion. The prevalence of gastroesophageal reflux disease in children with chronic otitis media with effusion/recurrent acute otitis media may be higher than the overall prevalence for children. Presence of pepsin/pepsinogen in the middle ear could be related to physiologic reflux. A cause-effect relationship between pepsin/pepsinogen in the middle ear and otitis media is unclear. Antireflux therapy for otitis media cannot be endorsed based on existing research.

• 出版日期2012-3