Advertisement

Current Allergy and Asthma Reports

, Volume 8, Issue 6, pp 513–518 | Cite as

Gastric pepsin in middle ear fluid of children with otitis media: Clinical implications

  • Zhaoping He
  • Robert C. O’ReillyEmail author
  • Devendra Mehta
Article

Abstract

Gastroesophageal reflux and extraesophageal reflux have been postulated to be involved in the pathogenesis of otitis media. This is supported by recent studies revealing the presence of gastric pepsin in the middle ear space of children with otitis media but not in control patients without otitis media. Reflux’s role in otitis media appears to be most pronounced in younger children and those with purulent effusions.

Keywords

Otitis Medium Eustachian Tube Chronic Otitis Medium Eustachian Tube Dysfunction Eustachian Tube Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Lubianca Neto JF, Hemb L, Silva DB: Systematic review of modifiable risk factors for recurrent acute otitis media in childhood. J Pediatr (Rio J) 2006, 82:87–96.CrossRefGoogle Scholar
  2. 2.
    Hing E, Middleton K: National hospital ambulatory medical care survey: 2001 outpatient department survey. Adv Data 2003, 338:1–26.PubMedGoogle Scholar
  3. 3.
    Berman S, Byrns PJ, Bondy J, et al.: Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric Medicaid population. Pediatrics 1997, 100:585–592.PubMedCrossRefGoogle Scholar
  4. 4.
    Bluestone CD: Studies in otitis media: Children’s Hospital of Pittsburgh-University of Pittsburgh Progress Report-2004. Laryngoscope 2004, 114(Suppl 105):1–26.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenfeld RM, Culpepper L, Doyle KJ, et al.: Clinical practice guideline: otitis media with effusion. Otolaryngol Head Neck Surg 2004, 130(Suppl 5):S95–S118.PubMedCrossRefGoogle Scholar
  6. 6.
    Nelson SP, Chen EH, Syniar GM, Christoffel KK: Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 1997, 151:569–572.PubMedGoogle Scholar
  7. 7.
    Gibson WS, Cochran W: Otalgia in infants and children: a manifestation of gastroesophageal reflux. Int J Pediatr Otorhinolaryngol 1994, 28:213–218.PubMedCrossRefGoogle Scholar
  8. 8.
    Poelmans J, Tack J, Feenstra L: Prospective study on the incidence of chronic ear complaints related to gastroesophageal reflux and on the outcome of antireflux therapy. Ann Otol Rhinol Laryngol 2002, 111:933–938.PubMedGoogle Scholar
  9. 9.
    McGuirt WF: Gastroesophageal reflux and the upper airway. Pediatr Clin North Am 2003, 50:487–502.PubMedCrossRefGoogle Scholar
  10. 10.
    Burton DM, Pransky SM, Katz RM, et al.: Pediatric airway manifestations of gastroesophageal reflux disease. Ann Otol Rhinol Laryngol 1992, 101:742–749.PubMedGoogle Scholar
  11. 11.
    O’Reilly RC, He Z, Bloedon E, et al.: The role of extraesophageal reflux in otitis media in infants and children. Laryngoscope 2008, 118(Suppl 116):1–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Cusimano F, Cocita VC, D’Amico A: Sensorineural hearing loss in chronic otitis media. J Laryngol Otol 1989, 103:158–163.PubMedCrossRefGoogle Scholar
  13. 13.
    Bluestone CD, Klein JO: Otitis media and eustachian tube dysfunction. In Pediatric Otolaryngology. Edited by Bluestone CD, Stool SE, Alper SM, et al. Philadelphia: Saunders; 2003:474–685.Google Scholar
  14. 14.
    Heavner SB, Hardy SM, White DR, et al.: Transient inflammation and dysfunction of the eustachian tube secondary to multiple exposures of simulated gastroesophageal refluxant. Ann Otol Rhinol Laryngol 2001, 110:928–934.PubMedGoogle Scholar
  15. 15.
    Heavner SB, Hardy SM, White DR, et al.: Function of the eustachian tube after weekly exposure to pepsin/hydrochloric acid. Otolaryngol Head Neck Surg 2001, 125:123–129.PubMedCrossRefGoogle Scholar
  16. 16.
    Johnston N, Dettmar PW, Lively MO, et al.: Effect of pepsin on laryngeal stress protein (Sep70, Sep53, and Hsp 70) response: role in laryngopharyngeal reflux disease. Ann Otol Rhinol Laryngol 2006, 115:47–58.PubMedGoogle Scholar
  17. 17.
    Roberts NB. Review article: human pepsins-their multiplicity, function and role in reflux. Aliment Pharmacol Ther 2006, 24(Suppl 2):2–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Wittenborg MH, Neuhauser EB: Simple roentgenographic demonstration of eustachian tubes and abnormalities. Am J Roentgenol Radium Ther Nucl Med 1963, 89:1194–1200.PubMedGoogle Scholar
  19. 19.
    Holma B, Lindegren M, Andersen JM: pH effects on ciliomotility and morphology of respiratory mucosa. Arch Environ Health 1977, 32:216–226.PubMedGoogle Scholar
  20. 20.
    Ohashi Y, Nakai Y, Koshimo H, Esaki Y: Ciliary activity in the in vitro tubotympanum. Arch Otorhinolaryngol 1986, 243:317–319.PubMedCrossRefGoogle Scholar
  21. 21.
    Park K, Bakaletz LO, Coticchia JM, Lim DJ: Effect of influenza A virus on ciliary activity and dye transport function in the chinchilla eustachian tube. Ann Otol Rhinol Laryngol 1993, 102:551–558.PubMedGoogle Scholar
  22. 22.
    Butehorn HF, Downs BW, Prazma J, Pillsbury HC: Acute gastroesophageal reflux and eustachian tube function [abstract]. ARO Abstracts of the Twenty-Second Midwinter Research Meeting. Mount Royal, NJ: Association for Research in Otolaryngology; 1999:199.Google Scholar
  23. 23.
    Moody SA, Alper CM, Doyle WJ: Daily tympanometry in children during the cold season: association of otitis media with upper respiratory tract infections. Int J Pediatr Otorhinolaryngol 1998, 45:143–150.PubMedCrossRefGoogle Scholar
  24. 24.
    Sudhoff H, Bucker R, Groll C, et al.: Tracing of gastric reflux into the middle ear in a Mongolian gerbil model. Otol Neurotol 2006, 28:124–128.CrossRefGoogle Scholar
  25. 25.
    Rozmancic V, Velepic M, Ahel V, et al.: Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux in children with chronic tubotympanal disorders. J Pediatr Gastroentrol Nutr 2002, 34:78–80.Google Scholar
  26. 26.
    Keles B, Ozturk K, Gunel E, et al.: Pharyngeal reflux in children with chronic otitis media with effusion. Acta Otolaryngol 2004, 124:1178–1181.PubMedCrossRefGoogle Scholar
  27. 27.
    Martinsen TC, Bergh K, Waldum HL: Gastric juice: a barrier against infectious disease. Basic Clin Pharmacol Toxicol 2005, 96:94–102.PubMedCrossRefGoogle Scholar
  28. 28.
    Jones AT, Roberts NB: Peptide maps of five human pepsin isoenzymes and other aspartic proteinases. J Chromatogr 1993, 646:207–212.PubMedCrossRefGoogle Scholar
  29. 29.
    Tasker A, Dettmar PW, Panetti M, et al.: Reflux of gastric juice and glue ear in children. Lancet 2002, 359:493.PubMedCrossRefGoogle Scholar
  30. 30.
    Tasker A, Dettmar PW, Panetti M, et al.: Is gastric reflux a cause of otitis media with effusion in children? Laryngoscope 2002, 112:1930–1934.PubMedCrossRefGoogle Scholar
  31. 31.
    He Z, O’Reilly RC, Bolling L, et al.: Detection of gastric pepsin in the middle ear fluid of children with otitis media. Otolaryngol Head Neck Surg 2007, 137:59–64.PubMedCrossRefGoogle Scholar
  32. 32.
    Krishnan U, Mitchell JD, Messina I, et al.: Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr 2002, 35:303–308.PubMedCrossRefGoogle Scholar
  33. 33.
    Crapko M, Kerschner JE, Syring M, Johnston N: Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope 2007, 117:1419–1423.PubMedCrossRefGoogle Scholar
  34. 34.
    Lieu JE, Muthappan G, Uppaluri R: Association of reflux with otitis media in children. Otolaryngol Head Neck Surg 2005, 133:357–361.PubMedCrossRefGoogle Scholar
  35. 35.
    Sone M, Yamamuro Y, Hayashi H, et al.: Otitis media in adults as a symptom of gastroesophageal reflux. Otolaryngol Head Neck Surg 2007, 136:19–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Sone M, Yamamuro Y, Hayashi H, et al.: Prediction of gastroesophageal reflux in otitis media with effusion in adults. Acta Otolaryngol 2007, 127:470–473.PubMedCrossRefGoogle Scholar
  37. 37.
    Antonelli PJ, Lloyd KM, Lee JC: Gastric reflux is uncommon in acute post-tympanostomy otorrhea. Otolaryngol Head Neck Surg 2005, 132:523–526.PubMedCrossRefGoogle Scholar
  38. 38.
    Bates DD, Lively M, Koufman J, et al.: Pepsin not detected in middle ear effusions in children [abstract]. Otolaryngol Head Neck Surg 2006, 135(2 Suppl):99.CrossRefGoogle Scholar
  39. 39.
    El-Fattah A, Maksoud G, Ramadan A, et al.: Pepsin assay: a marker for reflux in pediatric glue ear. Otolaryngol Head Neck Surg 2007, 136:464–470.CrossRefGoogle Scholar
  40. 40.
    Foster C, Aktar A, Kopf D, et al.: Pepsinogen C: a type 2 cell-specific protease. Am J Physiol Lung Cell Mol Physiol 2004, 286:L382–L387.PubMedCrossRefGoogle Scholar
  41. 41.
    Taggart RT, Cass LG, Mohandas TK, et al.: Human pepsinogen C (progastricsin): isolation of cDNA clones, localization to chromosome 6, and sequence homology with pepsinogen A. J Biol Chem 1989, 264:375–379.PubMedGoogle Scholar
  42. 42.
    Gupta SK, Hassall E, Chiu YL, et al.: Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci 2006, 51:858–863.PubMedCrossRefGoogle Scholar
  43. 43.
    Bauman NM, Bishop WP, Sandler AD, Smith RJ: Value of pH probe testing in pediatric patients with extraesophageal manifestations of gastroesophageal reflux disease: a retrospective review. Ann Otol Rhinol Laryngol Suppl 2000, 184:18–24.PubMedGoogle Scholar
  44. 44.
    Nassif PS, Simpson SQ, Izzo AA, Nicklaus PJ: Interleukin-8 concentration predicts the neutrophil count in middle ear effusion. Laryngoscope 1997, 107:1223–1227.PubMedCrossRefGoogle Scholar
  45. 45.
    Chung MH, Choi JY, Lee WS, Yoon JH: Compositional difference in middle ear effusion: mucous versus serous. Laryngoscope 2002, 112:152–155.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Zhaoping He
  • Robert C. O’Reilly
    • 1
    Email author
  • Devendra Mehta
  1. 1.Division of Pediatric OtolaryngologyAlfred I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations